Author Archives: Jackie Aim

Breathing control exercises and plan

All of the breathing control exercises are different depending on which type of altered breathing pattern is identified.

Each child needs an individualised assessment and breathing control treatment plan.

This is just an example of a personal breathing control plan. Each person is different. You can ask your respiratory team if a breathing control plan would help your child. Specialist respiratory nurses and respiratory physiotherapists are usually the ones to work out your child’s individual plan.

Example of a breathing control plan
You need to do these breathing control exercises regularly. Aim for 5 minutes every hour during the day.
For the first 2 weeks, lie down.

  1. Put one hand on your chest.
  2. Put one hand on your tummy.
  3. Keep your breathing rate as low as possible for age (you need respiratory physiotherapy guidance for your individual rate).
  4. Keep your tidal volume (the amount of airflow in and out of your lungs) low.
  5. Minimise your sighs as much as possible.
Next once you are familiar with the breathing exercises, remain sitting up

  • Carry out steps 1 – 5 as above
Next, do your breathing control exercises as needed throughout the day. Aim to integrate them into your normal activities.
If you get worse or relapse … this is usually due to:

  • Stress.
  • Infection.
  • Exercise.

Go back to the beginning, lying down and carry out steps 1 – 5.

Recognising breathlessness

Person listening to child's chest

© Crown Copyright

The challenge is for the condition to be recognised. Your child should be referred for expert assessment and management.

This is usually done by a paediatric respiratory physiotherapist.

They will carefully explain the terms used and work out a plan with you and your child based on individualised breathing control exercises.

What are Altered Breathing Patterns?

Child with hand over mouth

© Crown Copyright 2012

When anxiety becomes severe it can cause your child to become very breathless and feel that they cannot breathe. This is acute hyperventilation and can be very frightening. These are commonly described as panic attacks.

If the individual child or young person’s breathing pattern is altered for some time it can become their normal way of breathing (chronic). This can be shown in 3 ways:

  1. Increased (fast) number of breaths per minute with shallower breaths.
  2. Deep breaths. This indicates a large tidal volume (the air moving in and out of the lungs) with slow number of breaths per minute.
  3. Frequent sighs or yawns.

Breathlessness and anxiety

Nurse listening to teenager's chest with a stethoscope

© Crown copyright 2009

However, anxiety can become chronic:

  • In some people, this anxiety cycle can evolve into an altered breathing pattern.
  • This is even more common in people who already have a respiratory condition for example asthma.
  • It is less common (but can happen) in children.
  • It is more common in teenagers (and adults).

Physiological effects of anxiety

Your child’s anxiety may make them feel:

  • Fear.
  • Breathlessness.
  • Choking sensation.
  • Palpitations of the heart.
  • Restlessness.
  • Increased muscular tension.

If your child makes themselves breathless deliberately by exercising regularly, their brain will get used to the feeling of being breathless and stop over reacting to it.

Anxiety cycle and breathlessness

Cycle of anxiety

Cycle of anxiety

  • When your child’s brain is not used to them being breathless, it can over analyse their symptoms.
  • Your child’s brain interprets a normal (breathlessness) reaction as a threat.
  • Anxiety and breathlessness can be linked.

The anxiety cycle:
Threat → Alarm → They feel breathless → They feel their heart is pounding → You and / or your child thinks something is wrong → They feel worse → You and / or your child thinks they are having an asthma attack → You and / or your child think sitting down prevents them from having an asthma attack → Safety

Cycle of inactivity

Cycle of inactivity

Cycle of inactivity

If your child tries to avoid activity and exercise, they become deconditioned (unfit).

Your child can then fall into the cycle of inactivity:

  • They feel breathless → They avoid activities that makes them breathless → They do less → Their muscles become weaker and less efficient → They get more breathless → They avoid activities that makes them breathless

Difficult to control asthma – allergies

Dustmite

pollen

pet

Allergies
Allergens can be found in a variety of sources such as house dust mite, pollen and pet dander.

If you are allergic to something, ongoing exposure can aggravate the inflammation in your airways and increase the severity of your asthma.

Therefore, avoiding or reducing exposure to risk factors, when possible, can help improve asthma control.

Other aggravating disorders
Other underlying health conditions may not necessarily be related to asthma but can make it worse:

  • Rhinitis (inflammation of the nasal passages).
  • Sinusitis (inflammation of the sinuses).
  • Acid reflux (indigestion, heartburn).
  • Sleep apnoea (pauses in breathing during sleep which reduce the oxygen level in your blood).
  • Psychological problems (like anxiety, low mood or depression).
  • Abnormal breathing patterns (sometimes called dysfunctional breathing).
  • Obesity (Being overweight adds to all kinds of health problems including asthma).

It is known that of those people with difficult to control asthma 90% will also have an allergic reaction to at least one substance when skin prick testing is done.

Sometimes despite working with your GP and practice team, difficult to control asthma continues and you may require the expert attention of respiratory specialist team in hospital.

Symptoms of an allergic reaction
Any medication may have side effects but most of the time they are mild and easily tolerated. A few people may have an allergic reaction to their medicine such as:

  • Rash, difficulty breathing, swelling or feeling faint.
  • Joint pain with or without swelling or stiffness, rash, fever, swollen lymph nodes, muscle pain.
  • Swelling, pain or rash around blood or lymph vessels, high level of a specific type of white blood cells.
  • Worsening problems with breathing, nasal congestion, heart problems, pain, numbness, tingling in the arm and legs.

Important

If you notice any of these symptoms you may be having a reaction to your medicine. You should seek medical advice as soon as possible.