Dynamic Breathing

Dinah Bradley is a New Zealand trained respiratory physiotherapist with over thirty years’ experience working in Britain, Australia and New Zealand. Her book Hyperventilation Syndrome/Breathing Pattern Disorders was first published in New Zealand in 1991 (3rd edn Random House NZ, 2003); in Britain in 1992 (Kyle Cathie), and the USA in 2001. She also co- wrote Multidisciplinary Approaches to Breathing Pattern Disorders (Churchill Livingstone, 2002) for clinicians.

Tania Clifton-Smith is a physiotherapist with a post-graduate diploma in manipulative therapy. She sits on the Medical Board for Allergy New Zealand, is a recognised practitioner for the NZ Academy of Sport and a preferred provider for the Pinnacle Group, a sports organization which helps aspiring world champions. She is the author of Breathe to Succeed, published by Penguin Books NZ, and co-author of Breathing Matters, published by Random Books NZ in 2006.

Together the authors operate Breathing Works Ltd, the first breathing pattern disorders clinic in Australasia. They developed the BradCliff Method®, their unique physiotherapy-based programme for the treatment of functional breathing pattern disorders/hyperventilation syndromes. They also co-wrote Breathe, Stretch & Move (Random House NZ, 2005). Overcoming Common Problems Series

Selected titles A full list of titles is available from Sheldon Press, 36 Causton Street, London SW1P 4ST and on our website at www.sheldonpress.co.uk

The Assertiveness Handbook Coping When Your Child Has Cerebral Palsy Mary Hartley Jill Eckersley

Assertiveness: Step by step Coping with Age-related Memory Loss Dr Windy Dryden and Daniel Constantinou Dr Tom Smith

Backache: What you need to know Coping with Birth Trauma and Postnatal Dr David Delvin Depression Lucy Jolin Body Language: What you need to know David Cohen Coping with Bowel Cancer Dr Tom Smith The Cancer Survivor’s Handbook Dr Terry Priestman Coping with Candida Shirley Trickett The Candida Diet Book Karen Brody Coping with Chemotherapy Dr Terry Priestman The Chronic Fatigue Healing Diet Christine Craggs-Hinton Coping with Chronic Fatigue Trudie Chalder The Chronic Pain Diet Book Neville Shone Coping with Coeliac Disease Karen Brody Cider Vinegar Margaret Hills Coping with Compulsive Eating Ruth Searle The Complete Carer’s Guide Bridget McCall Coping with Diabetes in Childhood and Adolescence The Confidence Book Dr Philippa Kaye Gordon Lamont Coping with Diverticulitis Confidence Works Peter Cartwright Gladeana McMahon Coping with Down’s Syndrome Coping Successfully with Pain Fiona Marshall Neville Shone Coping with Dyspraxia Coping Successfully with Panic Attacks Jill Eckersley Shirley Trickett Coping with Eating Disorders and Body Image Coping Successfully with Period Problems Christine Craggs-Hinton Mary-Claire Mason Coping with Epilepsy in Children and Young Coping Successfully with Psoriasis People Christine Craggs-Hinton Susan Elliot-Wright

Coping Successfully with Ulcerative Colitis Coping with Family Stress Peter Cartwright Dr Peter Cheevers

Coping Successfully with Varicose Veins Coping with Gout Christine Craggs-Hinton Christine Craggs-Hinton

Coping Successfully with Your Hiatus Hernia Coping with Hay Fever Dr Tom Smith Christine Craggs-Hinton

Coping Successfully with Your Irritable Bowel Coping with Headaches and Migraine Rosemary Nicol Alison Frith Overcoming Common Problems Series

Coping with Hearing Loss A Guide to Anger Management Christine Craggs-Hinton Mary Hartley

Coping with Heartburn and Reflux Heal the Hurt: How to forgive and move on Dr Tom Smith Dr Ann Macaskill

Coping with Kidney Disease Helping Children Cope with Anxiety Dr Tom Smith Jill Eckersley

Coping with Life after Stroke Helping Children Cope with Grief Dr Mareeni Raymond Rosemary Wells

Coping with Macular Degeneration How to Approach Death Dr Patricia Gilbert Julia Tugendhat

Coping with a Mid-life Crisis How to be a Healthy Weight Derek Milne Philippa Pigache

Coping with PMS How to Beat Pain Dr Farah Ahmed and Dr Emma Cordle Christine Craggs-Hinton

Coping with Polycystic Ovary Syndrome How to Cope with Difficult People Christine Craggs-Hinton Alan Houel and Christian Godefroy Coping with Postnatal Depression How to Fight Chronic Fatigue Sandra L. Wheatley Christine Craggs-Hinton Coping with Radiotherapy Dr Terry Priestman How to Get the Best from Your Doctor Dr Tom Smith Coping with a Stressed Nervous System Dr Kenneth Hambly and Alice Muir How to Stop Worrying Dr Frank Tallis Coping with Suicide Maggie Helen How to Talk to Your Child Penny Oates Coping with Tinnitus Christine Craggs-Hinton Hysterectomy: Is it right for you? Janet Wright Coping with Type 2 Diabetes Susan Elliot-Wright The IBS Healing Plan Theresa Cheung Coping with Your Partner’s Death: Your bereavement guide Letting Go of Anxiety and Depression Geoff Billings Dr Windy Dryden

The Depression Diet Book Living with Angina Theresa Cheung Dr Tom Smith

Depression: Healing emotional distress Living with Asperger Syndrome Linda Hurcombe Dr Joan Gomez

Depressive Illness Living with Autism Dr Tim Cantopher Fiona Marshall

Eating for a Healthy Heart Living with Bipolar Disorder Robert Povey, Jacqui Morrell and Rachel Povey Dr Neel Burton

Every Woman’s Guide to Digestive Health Living with Birthmarks and Blemishes Jill Eckersley Gordon Lamont

The Fertility Handbook Living with Crohn’s Disease Dr Philippa Kaye Dr Joan Gomez

The Fibromyalgia Healing Diet Living with Eczema Christine Craggs-Hinton Jill Eckersley

Free Your Life from Fear Living with Fibromyalgia Jenny Hare Christine Craggs-Hinton

Free Yourself from Depression Living with Food Intolerance Colin and Margaret Sutherland Alex Gazzola Overcoming Common Problems Series

Living with Gluten Intolerance Overcoming Panic and Related Anxiety Jane Feinmann Disorders Margaret Hawkins Living with Grief Dr Tony Lake Overcoming Procrastination Dr Windy Dryden Living with Loss and Grief Julia Tugendhat Overcoming Shyness and Social Anxiety Ruth Searle Living with Osteoarthritis Dr Patricia Gilbert Overcoming Tiredness and Exhaustion Fiona Marshall Living with Osteoporosis Dr Joan Gomez Reducing Your Risk of Cancer Dr Terry Priestman Living with Physical Disability and Amputation Dr Keren Fisher Safe Dieting for Teens Linda Ojeda Living with Rheumatoid Arthritis Philippa Pigache Self-discipline: How to get it and how to keep it Living with Schizophrenia Dr Windy Dryden Dr Neel Burton and Dr Phil Davison The Self-Esteem Journal Living with a Seriously Ill Child Alison Waines Dr Jan Aldridge Simplify Your Life Living with Sjögren’s Syndrome Naomi Saunders Sue Dyson Sinusitis: Steps to healing Living with Type 1 Diabetes Dr Paul Carson Dr Tom Smith Stammering: Advice for all ages Losing a Child Renée Byrne and Louise Wright Linda Hurcombe

The Multiple Sclerosis Diet Book Stress-related Illness Tessa Buckley Dr Tim Cantopher

Osteoporosis: Prevent and treat Ten Steps to Positive Living Dr Tom Smith Dr Windy Dryden

Overcome Your Fear of Flying Think Your Way to Happiness Professor Robert Bor, Dr Carina Eriksen and Dr Windy Dryden and Jack Gordon Margaret Oakes The Thinking Person’s Guide to Happiness Overcoming Agoraphobia Ruth Searle Melissa Murphy Tranquillizers and Antidepressants: When to Overcoming Anorexia take them, how to stop Professor J. Hubert Lacey, Christine Craggs-Hinton Professor Malcolm Lader and Kate Robinson The Traveller’s Good Health Guide Overcoming Anxiety Dr Ted Lankester Dr Windy Dryden Treating Arthritis Diet Book Overcoming Back Pain Margaret Hills Dr Tom Smith Treating Arthritis: The drug-free way Overcoming Depression Margaret Hills and Christine Horner Dr Windy Dryden and Sarah Opie Treating Arthritis: More ways to a drug-free Overcoming Emotional Abuse life Susan Elliot-Wright Margaret Hills

Overcoming Hurt Understanding Obsessions and Compulsions Dr Windy Dryden Dr Frank Tallis

Overcoming Insomnia When Someone You Love Has Dementia Susan Elliot-Wright Susan Elliot-Wright

Overcoming Jealousy When Someone You Love Has Depression Dr Windy Dryden Barbara Baker Overcoming Common Problems Dynamic Breathing How to manage your asthma

DINAH BRADLEY AND TANIA CLIFTON-SMITH First published in New Zealand in 2002 by Random House New Zealand

First published in Great Britain in 2010

Sheldon Press 36 Causton Street London SW1P 4ST

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

The author and publisher have made every effort to ensure that the external website and email addresses included in this book are correct and up to date at the time of going to press. The author and publisher are not responsible for the content, quality or continuing accessibility of the sites.

British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library

ISBN 978–1–84709–078–2

1 3 5 7 9 10 8 6 4 2

Typeset by Fakenham Photosetting Ltd, Fakenham, Norfolk Printed in Great Britain by Ashford Colour Press

Produced on paper from sustainable forests Contents

Acknowledgements ix Foreword by Dr Mike Thomas xi Foreword by Dr Allen Liang xv Introduction 1 1 Breathe well to be well 3 2 When good breathing goes bad 9 3 It’s right under your nose 15 4 The vital pump 24 5 Body works 30 6 Coughing 36 7 A recipe for good breathing patterns 42 8 Posture and body mechanics 53 9 Breathing and exercise 62 10 Stretches and movement 69 11 Allergies 82 Appendix I Medication for asthma 87 Appendix 2 Inhalers 90 Appendix 3 Other co-existing breathing disorders 98 Useful addresses 101 Index 105 This page has intentionally been left blank Acknowledgements

Thanks to: Dr Mike Thomas (in the UK) and Dr Allen Liang (in New Zealand) for their generous contribution to and support of this project; the New Zealand Asthma and Respiratory Foundation of New Zealand (Inc.) for use of asthma education material; the Auckland Asthma Society; and last but not least, the people who live with asthma, for their kind contribution of illuminating comments. Many thanks everyone.

ix Note: This is not a medical book and is not intended to replace advice from your doctor. Do consult your doctor if you are experiencing symptoms with which you feel you need help.

x Foreword

It is with great pleasure that I write the foreword to the UK edition of this useful and comprehensive book on healthy breathing techniques in asthma, written by Dinah Bradley and Tania Clifton-Smith. The authors are both practising respiratory physiotherapists with great hands-on and theoretical experience in the diagnosis and treatment of breathing disorders in asthma. They are well known in professional and public circles for their work and for their writing, and have done much to further interest in breathing exercises for the management of asthma in the general public and amongst fellow professionals. This book is the fruit of their background knowledge and practical experience, and is a very useful introduction to breathing exercises to the interested lay reader as well as being a valuable source of general scientific information on asthma. The authors have managed to combine pragmatic and easy-to-understand practical advice with a well-presented and readable summary of the important physiological principles underlying asthma and the breathing disorders that may be associated with it. They show how it is possible to improve symptoms and quality of life for people with asthma by practising simple exercises and they explain how these exercises may work. The frequent quotes from patients they have treated and helped to gain control of their asthma symptoms corres- pond very much with my own experience of diagnosing, treating and researching this area over the last 10 years. Asthma has been described as the epidemic of our time, and the prevalence of asthma in the general public has trebled within a single lifetime, particularly amongst children. For reasons that we do not fully understand, we are becoming more allergic and wheezier. This is a pattern that is seen all around the developed world in association with Westernised lifestyles, and has been described as a disease of afflu- ence. Scientists are slowly unravelling the complex reasons behind the notable phenomenon, and we all live in the hope that prevention will become possible within our times. In the meantime, however, asthma remains a reality for many millions of people. Although we have many treatments for asthma, we do not have a cure, and many people need to take regular medication to control their asthma on a long-term basis. In spite of very effective treatment to prevent asthma attacks and symptoms and to treat them when they do occur, surveys reveal that many people still have very significant symptoms from asthma, and

xi xii Foreword for many people asthma impairs their quality of life and limits their horizons1,2. It is also clear that in spite of evidence of effectiveness and safety, many people do not like having to use medication on a regular basis to control their asthma. They resent being tied to their inhalers, worry that the effects will wear off over time and are concerned about the side effects of long-term treatment. There is great public and increasing professional interest in non-drug treatments for asthma, with evidence in the UK that one third of people with asthma use Complementary and Alternative Medicine (CAM) to treat their asthma, usually in addition to, but sometimes instead of, standard medical treatment3. Breathing exercises and yoga have been widely used to treat asthma in Eastern and Western societies for many years, and generally centre on manipulating the respiratory pattern to reduce respiratory frequency and hyperventilation. As explained in this book, breathing is a complex action, involving many muscle groups and controlled by different parts of the brain. Although uncon- scious reflexes control basic breathing patterns, we can modify natural patterns if we consciously decide to, and sometimes natural patterns of breathing may become altered through a variety of physical and psychological mechanisms, and dysfunctional ‘bad’ breathing patterns may occur. Can these patterns be corrected by breathing retraining? Unfortunately, in contrast to the wealth of high-quality evidence from scientific studies on drug-based treatment in asthma, often driven by the pharmaceutical industry, there is a paucity of information on non- pharmacological treatments, such as breathing retraining. A review of the scientific studies on breathing exercises for asthma in the ‘evidence based’ Cochrane Library concluded that while there were suggestions that such treatment was effective, too few rigorous studies have been made to make firm conclusions4, and calls for more research. As part of a collaborative research group that includes the University of Aberdeen, University of Leicester and the NHS Gloucestershire Research and Development Support Unit, I have investigated this area and our recent work has shown that there may indeed be a major overlap between asthma and abnormal, dysfunctional breathing. We have recently published papers showing that up to one in three people with asthma have evidence of abnormal breathing5, and that a physiotherapy-based breathing retraining programme can improve their symptoms and quality of life6. Further studies to confirm these findings and investigate the way in which breathing retraining works are currently underway. The accusation is sometimes levelled against doctors that they are too focused on pharmacological ‘drug-based’ treatments for illnesses, and it may be that there is some truth in this in the asthma field. Foreword xiii

Doctors are encouraged to be sceptical of claims of effective treatment, drug based or otherwise, until that treatment has been proven to be effective in properly conducted trials. The shortage of such evidence has meant that breathing therapy has often not been part of main- stream practice, and so has not been available to many people. We are, however, starting to see more interest and more trials done in CAM and in breathing retraining in asthma. Doctors and scientists are perhaps slowly catching up with what therapists like Dinah and Tania, and their patients, have known for some time – that many people with asthma breathe badly and that with a little time and effort, something can be done to correct this. I would fully concur with their advice that this is time and effort well spent! I have seen patients many times who have been found to have abnormal ‘dysfunctional’ breathing as a factor in their asthma, and who have come back after breathing treatment similar to that described in this book feeling so much better, feeling ‘in control’ and understanding themselves and their bodies better. I hope that you, like me, will find this book useful, stimulating, educational and enjoyable. Dr Mike Thomas GPIAG Research Fellow Department of General Practice University of Aberdeen

Dr Mike Thomas is the GPIAG Clinical Research Fellow with the Department of General Practice and Primary Care, University of Aberdeen and works principally in the field of respiratory research and education. He continues to work part-time in general practice, and is also Primary Care Advisor to Gloucestershire NHS Research and Development Support Unit, a specialist advisor to the UK National Asthma Campaign. He has published original asthma research, including recent papers in the British Medical Journal and Thorax on the overlap between asthma and abnormal breathing patterns, and leads an ongoing multi-disciplinary research team investigating the effectiveness of breathing exercises in asthma.

References 1. Price, D., Ryan, D., Pearce, L., Bride, F., ‘The AIR study: asthma in real life’. Asthma J 1999; 4:74–8. 2. Rabe, K.F., Vermeire, P.A., Soriano, J.B., Maler, W.C., ‘Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study’. Eur Respir J 2000; 16:802–7. xiv Foreword

3. Ernst, E. ‘Complementary therapies for asthma: what patients use’. J Asthma 1998; 35:667–71. 4. Holloway, E. and Ram, F.S.F. ‘Breathing exercises for asthma’ (Cochrane review). The Cochrane Library Issue 3. 2000; Oxford, Update Software. 5. Thomas, M., McKinley, R.K., Freeman, E., Foy, C. ‘Prevalence of dysfunctional breathing in patients treated for asthma in Primary Care: a cross-sectional survey’. BMJ 2001; 322:1098–100. 6. Thomas, M., McKinley, R.K., Freeman, E., Foy, C., Prodger, P., Price, D. ‘Breathing retraining for dysfunctional breathing in asthma – a ran- domised controlled trial’. Thorax 2003; 58:110–5. Foreword

‘As easy as breathing in and out’ is a phrase often used to describe the ease of things that come naturally. The first obvious sign of a new life is the cry that comes after taking those first big breaths and opening the airless lungs. The switch from obtaining oxygen and disposing of carbon dioxide via the placenta to breathing air is dramatic and sudden, and the switch only takes minutes to complete. From then on, breathing is on autopilot. For the best part of our lives, we are not aware of our breathing. But breathing can be modified according to need: both the pattern and depth of breathing can be modified semi-consciously or consciously. For example, a singer trains her diaphragm for vibrato and other vocal dynamics, or a birthday child draws in a huge breath to blow out all the candles in one go. Apart from the intentional use of breath, we are generally not aware of our breathing. George Bernard Shaw was correct to say that awareness of breathing already indicates problems. The patterns of breathing respond automatically to need, such as exercise. At the same time, all the respiratory muscles can be consciously modified. We can deliber- ately take in a big breath of fresh sea air at the beach, or hold our breath when walking through thick smoke. The respiratory muscles consist of two main groups: those related to the movement of the ribcage and those related to the diaphragm. When we need to take a deep breath in, it is often the ribcage muscles (intercostal muscles) that are activated. When we want to hold a breath, both groups of muscles temporarily stop their actions at what- ever phase of respiration. The diaphragm is a very powerful respiratory muscle and often needs to be trained to achieve the degree of respir atory control demanded by those who need ‘big lungs’. The relevance and importance of abnormal breathing patterns in the diagnosis and treatment of disease is well known through all civilizations. Western medicine has had a clear run of medical discoveries, in both scientific unveilings of disease mechanisms and the ‘silver bullet’ of pharmaceuticals to cure them. Only recently have we begun to ‘re-dis- cover’ the wisdom of our forefathers with regard to the use of breathing in the promotion of good health, and as an adjunct to recovery from poor health.

xv xvi Foreword

The emphasis on breathing for health is particularly strong in the East. Chinese emphasize ‘chi’, which can be roughly translated as ‘air’ and features prominently in the practice of chi-oong (qi-gong). The practice of chi-oong concentrates on the mind and its ability to utilize the breathing muscles fully (especially the diaphragm) to achieve internal tranquillity and metabolic balance. The practice of tai-chi (incidentally, this ‘chi’ is not the same as in chi-oong, and actually means ‘extreme’ or ‘ultimate’) involves not just the flow of movements; the pattern of breathing is important for those who want to reach tai-chi’s higher levels. Similarly, yoga, the ancient Hindu discipline, is not just about tying oneself in knots – a big part of its practice has to do with breathing control to ‘effect union of the soul with a universal spirit’. In particular, pranayama (one of the eight steps of yoga training) deals explicitly with the control of breathing. Pranayama deals with a gradual reduction in breathing frequency (attainment of a 1:2 ratio in inspiration:expiration) and with mental concentration on breathing effecting an exclusion of worldly inter ference as a means to inner tranquillity. Scientific studies examining the effectiveness of yoga on breathing pattern disorders, asthma and chronic obstructive airway diseases have reported a variable degree of success. Its effectiveness in some people is unquestionable, but among those who do not achieve control of their disease, the criticism is of the difficulty of mind–body training when a person is fully distracted by the symptoms of the disease. Yoga aficionados already well-versed in its practice claim much better effects when employing yoga in the event of respiratory distress. Other yoga practices, such as Hatha yoga, have been shown to improve the vital capacity of normal healthy subjects as well as people with lung diseases. As a young university student during a summer voluntary project in Lantau plateau, Hong Kong, I observed a young lady being brought into a monastery who was in obvious respiratory distress. She was breathing heavily, her hands were shaking and her neck was somewhat contorted. I remember her being put into a side room with a number of monks who began chanting quickly in accordance with the patient’s breathing. As a bystander, I witnessed the progressive slowing of the chanting, and the woman was finally ushered into participating. The progressive slowing of her breathing finally calmed her so much that she actually recovered and was later left to sleep. This was my first encounter with passive modification of breathing patterns to achieve an end. I was in my early days as a medical student and foolish enough not to enquire Foreword xvii further. Obviously it was a known method, used without herbs or needles. Many modernized breathing-modification techniques exist in different parts of the world. The better-known ones are the Alexander Technique and the much-advertised Buteyko Method. These techniques suffer from a lack of robust research to back up claims of benefits. The Cochrane Database Research Group has so far concluded that more robust, well-controlled trials are required to test such claims of effects on asthma control. The sensation of dyspnoea (difficulty of breathing) varies from person to person. Some people perceive dyspnoea earlier and in greater discomfort than others. Such high perceivers tend to consume relatively high doses of reliever medication (bronchodilators). Specific inspiratory muscle training and breathing exercises reduce both the perception of dyspnoea and bronchodilator consumption. This may explain the few success stories of breathing techniques. Franchise breathing technique holders unfortunately modify well-meaning methods through com- mercial hype that may eventually hurt the patient while transferring money from the patient’s pocket to their franchise accounts. A common practice is to:

1 discuss the harmful effects of any medication as a sales pitch; 2 charge hefty fees; and 3 disseminate the techniques without medically qualified persons to supervise on the suitability of the technique and the speed of medication reduction. Equally successful and often cheaper ways to achieve the same end can be obtained through trained professions, at both reduced risk and lower cost. In Dynamic Breathing, it is great to see the wisdom of our forebears being distilled together with scientific know-how into book form – and being made available for the interested public. This information incorporates practical experiences in the special area of breathing, both in health and in disease, but it is presented in a way that allows easy understanding. This openness illustrates well the ideal of scientific transparency, and allows public scrutiny so that further progress can be made by future discoveries. This book by Dinah and Tania is truly state-of-the-art in this field. They deserve our applause and congratulations for a job well done.

Dr Allen Liang ONZM, ME, BS, FRACP, FACA, FCCP President, Asthma New Zealand, President, Auckland Asthma Society Senior Paediatric Consultant, Auckland Children’s Hospital Vice President, Auckland Chinese Medical Association American College of Chest Physicians Regent for New Zealand This page has intentionally been left blank Introduction

Asthma is a fascinating subject. Millions of people worldwide suffer from its symptoms – with mild to life-threatening episodes. A recent World Health Organization report states that 150 million people have this disorder; it affects people of all ages, all races ‘humble or poor, rich or renowned’. It has even been observed in animals. Yet ask five different medical specialists what the causes are and you’ll get five different answers. Similarly, asking five alternative health practitioners the same question will reveal the same diversity of opinion. There have been hundreds upon thousands of books written on this mysterious, breathing-related disease, from orthodox sources through to alternative ‘cures’. Research articles and latest findings are all freely available from numerous websites. Often patients know more about what’s new than their overworked doctors. At Breathing Works, we see many people, referred for help with their asthma education and management. We are registered practising physiotherapists and we have both published books and presented papers on breathing pattern disorders nationally and internationally. Why do we think we have anything extra to add? There are two reasons: the first is that people with asthma often develop truly dreadful breathing patterns. They use their chest muscles the wrong way, they breathe through their mouths, and they breathe too fast. We see this all the time in our clinic. There are many reasons why this happens and we will cover them in this book. Our concern is that these ‘bad breathing’ patterns can make asthma worse, even trig- gering attacks or – to use the more politically correct term – episodes. Curiously, since the advent of user-friendly inhalers 30-odd years ago and newer asthma ‘wonder drugs’, less attention has been paid by the medical profession to the business of breathing itself. Asthma awareness and education programmes highlight information about what goes on inside the chest – what happens to the airways, how to use the various devices for delivering asthma medications, how to reduce environmental triggers. But we want to add to this information. We want to show those with asthma the value of physical coping skills – i.e. learning what’s happening on the outside of the chest wall and including this as a vital part of asthma self-management. Knowing how to breathe properly and efficiently by employing physical coping skills enhances drug therapies, and in many instances

1 Note: This is not a medical book and is not intended to replace advice from your doctor. Do consult your doctor if you are experiencing symptoms with which you feel you need help.