breathing

A breath of fresh air

Your Health DR GITA MATHAI

Work your lungs Stand straight with feet shoulder width apart. Take a deep breath for a count of 20, allow air to fill your chest, and then push out your abdomen. Hold it for a count of 20. Breathe out, pushing in your stomach and forcing your diaphragm upwards. Do this for a count of 40. Repeat 20 times Life starts with a baby’s first breath and ends with the last one. We breathe without being conscious of it. It is an autonomous reflex that is so deeply embedded in the brain that it is not possible to commit suicide by holding your breath. Shortness of breath occurs when we become conscious of our breathing and it is no longer automatic. We feel it is insufficient, or that the “air” is not enough. It can occur for many reasons. It may be just a subjective perception; anxiety may make you take short, sharp, ineffective breaths or attention-seeking individuals may have conscious intermittent sighing respiration, which induces anxiety in care givers and bystanders. The respiratory rate can be measured by counting the number of breaths for a full minute. It is 30-60 per minute in babies. It then gradually falls to 12-20 per minute in adults. The rate increases with illness, in anxiety, fear or with exercise. It decreases (8-18/min) and becomes imperceptible and shallow while sleeping. During breathing, air enters through the nose and reaches the lungs through a system of pipes and airways. The lungs have multiple alveoli or sacs where oxygen from the air enters the body and carbon dioxide (a waste product) leaves the body. The lungs expand when air is breathed in. This occurs because the rib cage moves out, the diaphragm (a muscle that separates the chest from the abdomen) moves down and the stomach moves out. With age, the rib cage becomes fixed and the muscles that move it weak. Breathing becomes laboured, inefficient and difficult. Obesity causes mechanical problems. The rib cage and stomach do not move efficiently so the lung capacity is reduced. Fat deposits around the neck can cause obstruction and snoring while sleeping. Difficulty in breathing may be due to problems in the nose itself. It may be blocked with an allergy or a viral infection, there may be obstructive polyps, the septum may be deviated to one side or the sinuses that drain through the nose may be infected. Allergies can be due to dust, paint, cement, cockroaches, house mites, incense sticks, aerosol sprays or vapourising mosquito repellents. Avoiding the allergen may cure the nose block. If this is not possible, tackle it with nasal drops and sprays. Medicated sprays tend to be habit forming and cause rebound congestion. This means they become less effective and have to be used more frequently. It is better to use saline drops or a locally acting steroid like fluticasone. Steam inhalations also help. Antihistamines dry nasal secretions. A deviated septum may require surgical correction. Enlarged tonsils and adenoids can cause mechanical block and snoring in children. Hyperactive airways can constrict and collapse when there is infection, an allergy or exposure to more or less the same allergens that cause nose blocks. This results in a wheezing sound. Breathing becomes laboured and a fear of “asthma” sets in. This constriction can be effectively tackled by direct delivery of medication to the lungs. Nebulizers, spacers, inhalers and rotahalors do this efficiently and effectively. Since these deliver the medication directly to the target organ (lung), the side effects are minimal. Before these systems were developed, only tablets and syrups were available. They had to get absorbed from the intestines and then be carried by the blood to the lungs. This took a long time and the medication also produced side effects. Heart, liver and kidney disease or failure causes fluid build up in the body. The feet and abdomen become swollen and fluid accumulates in the lungs, making breathing difficult. This fluid has to be medically removed for breathlessness to improve. Even though breathing is a reflex, we need to make sure the apparatus functions efficiently. Aerobic exercises such as running, jogging, swimming, cycling and brisk walking increase the oxygen requirements of the body. Breathing becomes rapid and all the muscles need to function to their maximum capacity. Exercising for an hour most days a week keeps our breathing apparatus working in tip-top condition. There are breathing exercises in yoga, Tai Chi and in the martial arts. If performed regularly, they increase lung capacity. These are worth practising every day so that age-induced changes do not reduce respiratory capacity. These exercises complement aerobic activity. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in