DW: We all breathe automatically, but do we automatically do everything properly?

Pfeiffer-Kascha: Basically yes. As long as healthy people don't constantly consciously intervene in the breathing process, it happens on its own. The highly sensitive respiratory center in the medulla oblongata in the brain processes signals from all sorts of places in the body and thus controls the autonomic, or involuntary, function of breathing while we remain completely unconscious of it. Inhaling and exhaling should take place through the nose, which prepares the air for the exchange of gases in the lungs, by warming, filtering and moistening it. It's not beneficial to breathe in through the nose and out through the mouth, or in and out through the mouth. It's different if nasal breathing is impaired, for instance when the nose is swollen, the adenoids are enlarged, or there's a deviated septum. Then breathing through the mouth is easier. Of course, the source of the problem in the nose has to be remedied, so that once again physiological nasal breathing is reinstated.

DW: What are the most frequent forms of inadequate breathing?

Pfeiffer-Kascha: One of the major forms is breathing through the mouth and not the nose. When you inhale and exhale through your open mouth, your mouth and pharynx dry out. In addition the mucous membranes in the lower respiratory tract lose their function, so that a dry cough or higher susceptibility to infection results, and occasionally asthmatic attacks may be more intense. Another is not using the diaphragm adequately to help you breathe. Fear and stress promote unconscious tensing of the abdominal muscles and the surrounding fascia, so that the diaphragm can no longer be lowered sufficiently, because the tension in the abdominal muscles and surrounding fascia prevent the diaphragm from protruding. Those are the two most frequent ways in which breathing becomes restricted in people with healthy lungs.

DW: Does improper breathing affect our health?

Pfeiffer-Kascha: Stress and fear can lead to deep and frequent breathing, to hyperventilation. In the long term, that leads to changes in the body's control mechanisms. The results of this disrupted breathing pattern with frequent gasping can be that breathing takes place primarily in the upper thorax, that as a consequence the entire upper musculature tenses, and that headaches, discomfort and physical weakness can ensue.The lungs are healthy, but this way of breathing is a strain on the body.

DW: What do patients learn in respiratory therapy?

Pfeiffer-Kascha: In physiotherapeutic respiratory treatment, which is also called respiratory physiotherapy, the aim is to restore and maintain optimal respiratory function. Depending on the medical findings and their history, patients learn to be aware of their disorder and their breathing in the first place and to influence it. That means learning to use breathing techniques that improve the aeration of the lungs or techniques to improve exhalation during respiratoy distress, especially in disorders such as chronic obstructive pulmonary disease or asthma. Or they learn techniques to improve the dissolution of secretions - for example, in chronic bronchitis or cystic fibrosis. Or they learn techniques for more effective expectoration, which many disorders make more difficult. They also learn relaxation techniques and breath control in stress-related hyperventilation. Great emphasis is placed on self-help techniques that are suitable for promoting self-management in chronically ill patients.

DW: Can we influence diseases with proper breathing?

Pfeiffer-Kascha: Dealing with chronic conditions such as asthma, cystic fibrosis and COPD can be positively influenced with the support of acquired techniques. When sufferers recognize that they can use their own techniques in addition to medication to make their breathing easier, it has a great influence on their acceptance of their chronic conditions and their quality of life.

Dorothea Pfeiffer-Kascha works in Wuppertal as a physiotherapist, focussing on respiratory physiotherapy. She heads the working group on respiratory therapy in the German Association of Physiotherapy (ZVK).
ag-atemtherapie@physio-deutschland.de

Interview: Marita Brinkmann