COPD, asthma, EILO and VCD

COPD (chronic obstructive pulmonary disease) is a term covering a group of chronic respiratory illnesses that cause reduced airflow through the airways. It includes emphysema and chronic bronchitis. People with COPD usually have a mix of these, with an emphasis on one or the other. Chronic bronchitis is a long-term inflammation of the bronchi (-itis means inflammation). The cilia that normally catch mucus don’t effectively work together. This means more mucus is released, which can cause inflammation of the lungs. By breathing through our nose, we can make sure fewer contaminating particles from the air around us get into the bronchi and lungs, resulting in less irritation and inflammation.

People with COPD often have a shallow and fast breathing pattern; they don’t get the necessary movement of their diaphragm and easily develop muscular tension in their chest, upper back and ribs. Someone with COPD will find exhaling especially challenging.

Most people who develop COPD are or have been smokers, but the disease can also be caused by hereditary factors or exposure to toxic gases, tobacco smoke, industrial smoke or other air pollutants.

COPD is the disease whose prevalence increases fastest in the world. It’s estimated that roughly 6% of the Norwegian population over 40 has COPD.

According to WHO, COPD is today the world’s third most common cause of death.

The symptoms of COPD are lasting breathlessness, which gradually worsens, chesty coughs and increased phlegm production. The symptoms usually develop slowly and over years. With time, you may start hearing wheezing sounds or gargling from the chest, and lung capacity will decrease due to increased obstructions in the airways. Your ribs and diaphragm will often stiffen and you may experience chest pain.

Living with COPD can have a huge impact on everyday life, and many also develop musculoskeletal diseases, anxiety and/or depression

COPD causes the residual volume of the lungs to decrease. This means we expel less and less of the air from our lungs, and there is a lot of air left that’s never exchanged. Additionally, both the lungs and the diaphragm stiffen when they’re not used optimally, which in turn causes the ribcage to stiffen. By practising breathing techniques that prolong exhalation and encourage relaxed inhalation, you will increase the mobility of the diaphragm and ribs. It’s also important to do physical exercises that increase the flexibility of the ribs. Someone with COPD will, understandably, feel the need to inhale as much air as possible, as they always – or often – feel like they’re not getting enough air. This may cause them to suck in large amounts of air, which in turn can cause stress and the activation of their “fight-or-flight” mode.

When your breathing pattern is superficial, only moving the chest and collarbone, you only use a small amount of the air in your lungs. At the same time, the lower part of your lungs will stiffen more and more from not being in use. If you use an inhaler, the medicine will not help sufficiently as it won’t be able to reach the lower part of the lungs, where you have the most alveoli. By practising deep and diaphragmatic breathing, you will also see much better effects from the medicine, as well as increased flexibility of the diaphragm, lungs and ribs.

When we practise breathing exercises, we focus on letting the abdomen be free, as many people constantly tighten their abdominal musculature by holding in their belly. By releasing your belly, you’ll achieve a deeper and slower inhalation, and you will also be able to use this musculature more efficiently to increase your exhalation volume. A slower breathing pattern will also make your body less acidic as oxygen is released to the muscles and brain, which in turn will decrease levels of anxiety and depression.

Try, as much as you can, to reduce breathing through your mouth and transfer to nose breathing. When we suck in large amounts of air through our mouth, our inner feeling of unease will increase and our feeling of needing air will increase. By keeping your mouth closed, you can more easily remain calm and reduce physical discomfort during movement.

– I’ve had clients with COPS who haven’t dared walk up a staircase for years because of breathlessness, who have now managed to walk up the stairs at the office three times in a row, without opening their mouth.

Asthma is a chronic condition where the airways are irritated over time. The symptoms are coughing, breathlessness and trouble exhaling, and wheezing or gargling sounds in the chest. The symptoms are often worst at night (while lying down) or in the morning. Between “asthma attacks”, your breathing might be more or less normal.

Asthma can be a reaction to particles in the air, like dust, dust mite allergens, pollen or animal allergens. Other things that can trigger an asthma attack include air pollution, the cold, tobacco smoke, strong smells, perfume, stress, some medications, fog, certain gases, viral infections, colds and exercise.

Most people with asthma get it as children, but some can also develop the condition later in life.

Three different things happen during an asthma attack:

1. The musculature around the airways contracts.
2. The lining of the airways becomes inflamed and swells up. The air passages become narrower and it becomes harder to breathe.
3. There is an increase in mucus that you can’t cough up, which collects in the airways.

Asthma can have environmental or genetic causes. Hereditary asthma often has additional symptoms like allergies and eczema. More boys have asthma as children than girls, and being overweight may also be a factor.

Environmental factors that can cause asthma are pollution particles in the air, tobacco smoke, after-effects of illnesses in the airways, diet and various dangerous substances. Many children with asthma also have allergies. It is therefore important to avoid allergens like cigarette smoke, animals and mould in families with increased risk of asthma.

In industrial countries, the prevalence of asthma is ever increasing. England is on top with more than 24% of children between 13 and 14 suffering from asthma. The prevalence increases with higher living standards, and there are very few occurrences among people who live more simply. Lifestyle and environment are therefore thought to play a huge part in developing the disease.

It’s important to see a doctor if you suspect you may have asthma, as it is often necessary to be treated with various medication. Practising breathing techniques will, however, be helpful alongside the medicine, primarily in increasing the mobility of the diaphragm, lungs and ribs, but also in allowing you to get the full effects of the inhaler medicine. If you have a shallow breathing pattern, the medicine won’t be able to work effectively, as it won’t reach the lower part of the lungs where the most alveoli are.

It is important to keep correct posture to achieve optimal breathing. Unfortunately, many hunch over when they exhale, even when using PEP flutes or other breathing exercise apparatus. This makes it much harder, if not impossible, for the diaphragm to work optimally. We have to stand – or sit – steadily, with our back as straight as possible, keep a relaxed and open chest, a long neck and a straight head. With this posture, we facilitate an optimal breathing pattern where our abdominal muscles, diaphragm, iliopsoas and pelvic floor can collaborate in a good way. If we hunch over while exhaling, however, we do the opposite. We close our chest and tighten our abdominal muscles so they can’t aid in optimal breathing.

Do you feel like you can’t breathe at all in the middle of a workout? Then it might be EILO, not asthma, that you suffer from.

Many people – especially young people – who actively exercise and practise sports, and who struggle with breathing during training, have unfortunately been misdiagnosed with exercise-induced asthma. Instead, they may be suffering from EILO – exercise-induced laryngeal obstruction – or VCD – vocal cord dysfunction.

EILO and VCD make the vocal cords tighten when the voice is not in use. Normally, the vocal cords are tightened when we vocalise but relaxed when we just breathe. This way, air can pass freely between them. EILO and VCD may make the vocal cords tighten so much during inhalation – and sometimes exhalation – that it becomes hard to breathe. There’s only a narrow passage left between the vocal cords for air to pass through. You may experience symptoms like tightness in the throat, a feeling of being suffocated, high peeping sounds from the larynx, voice changes and difficulties inhaling.

Many are misdiagnosed with asthma, as the symptoms can be very similar. However, with asthma, exhaling is the difficult part, but with EILO and VCD, it’s primarily inhaling that’s challenging. If the inhaler you get for your asthma doesn’t work, it may be because it’s not asthma that you’re suffering from. Around 10% of those who seek assessment for asthma and don’t see the necessary effect from asthma medication actually suffer from EILO or VCD. Most of those diagnosed are between 9 and 18 years old, and it’s far more common in girls than boys. It is also more common in those who participate in organised sports and experience high stress levels. Some also suffer from heartburn. It is not uncommon to have both asthma and VCD or EILO.

EILO and VCD are often mentioned in the same breath, but there is a difference. EILO almost exclusively happens during physical exertion, while VCD can also occur while at rest. It is important to know that this is not dangerous, although the experience can be very uncomfortable. With EILO, as soon as you stop exercising, your breathing will normalise without the need for medical help.

I’ve seen that practising breathing techniques has helped several athletes diagnosed with EILO or VCD.

In my experience, it’s crucial to work on diaphragmatic breathing techniques, which help avoid a superficial breathing pattern. The techniques help you avoid tightening the muscles of the chest, shoulders and neck, which will help the vocal cords relax as much as possible. By working on breathing and voice exercises, you have good chances of bettering the symptoms of EILO and VCD. In some cases, learning that it isn’t dangerous may be enough to see improvement, but in most cases, it is useful to learn relaxation techniques in the form of calming breathing exercises, as well as exercises that make the vocal cords relax. This helps you take control of your breathing and condition. At the same time, it may be useful to use Sleep Tape both while sleeping and while exercising to help you use nose breathing instead of mouth breathing.

Regardless of which of these conditions you suffer from – COPD, asthma, EILO or VCD – practising breathing techniques will give you positive results. Although you can’t “breathe yourself well” from COPD or asthma, you can make better use of your lung volume. This will give you increased inner calm, better sleep and a better breathing pattern. You will see far greater effects from inhalers as the medicine will reach the lower part of the lung, where there are more alveoli. I would go so far as to say that if you suffer from EILO or VCD, breathing techniques can completely remove your symptoms.

https://pubmed.ncbi.nlm.nih.gov/30612266/ (Shows that singing may positively affect COPD)

http://www.themusicalbreath.com/wp-content/uploads/2019/02/The-Musical-Breath-Research-References_13Feb2019.pdf (A list of research done on singing and breathing exercises and respiratory illnesses)

https://pubmed.ncbi.nlm.nih.gov/29050661/ (Research on breathing exercises for EILO in athletes)

https://www.sciencedaily.com/releases/2017/10/171016081956.htm (2/3 of participants said breathing exercises helped against EILO)

https://www.uptodate.com/contents/exercise-induced-laryngeal-obstruction (Research on voice training and EILO)

https://www.healthline.com/health-news/exercises-that-help-athletes-with-breathing-disorders (Article on breathing exercises for EILO in athletes)

https://training-conditioning.com/article/breath-of-fresh-air/ (Article that shows that 80% of the athletes suffering from EILO were helped by breathing exercises)