I LOVE Breathing!!!

You may have noticed a lot of talk of Ayurvedic medicine in my last couple of posts. There's a simple reason for that: it focuses a LOT on breathing. Pranayama is often a term heard in Yoga and Ayurveda and it is simply the practice of breath, or the breath of life. As asthmatics we really understand that "breath of life" bit! There are a TON of breathing exercises out there and I am a firm believer that any breathing exercises that you can do as an asthmatic are going to be beneficial. This post is not about Ayurveda... it's about breathing!

In fact there have been various studies done that have shown promise for breathing exercises as a clinical tool in helping asthmatics reduce their dependence on corticosteroids. A 2006 article on WebMD discusses an Austrailian study that found a whopping 86% reduction in use of rescue inhalers and a 50% reduction in use of corticosteroids among its 57 participants. It does not specify which breathing method they used although my guess would be the popular Buteyko Method. In most of the studies, the focuses are on nasal breathing and expiration. 

Why are nasal breathing and expiration the main focuses with asthma? 

Let's start with nose breathing: First of all, the nose was made for breathing. Breathing through the nose allows for maximum preparation of air for the lungs. The nose carries the air to the sinuses and through various hairs, cilia, and mucous which filter and help to expel any potential pollutants. It also produces Nitric Oxide which helps to kill germs and is a natural bronchiodialator (think natural albuterol) so it helps your lungs take in oxygen. The sinuses also warm and humidify the air to help reduce irritation. The act of nasal breathing slows breathing down which allows the lungs to maximize the exchange between oxygen and carbon dioxide. All of that comes down to: nose breathing is good.

Expiration: One of the common things that you may have noticed whenever you have had an asthma attack is that it's not only harder to take air in but it takes you longer and is also difficult to get air out.  Studies have also found that those with severe or uncontrolled asthma have a tendency towards "air trapping" or not expelling all of the air in their lungs properly. Since old, stale air is sticking around in your lungs, you aren't allowing for proper oxygen/carbon dioxide exchange. 

There are a lot of different methods of practicing nose breathing and expiration: 

• Using your PEAK flow meter to practice forced expiration.
• Diaphramatic Breathing to help expel trapped air. 
• Pursed Lip Breathing focuses on expiration of trapped air and requires nasal inhalation.
• The Buteyko Method mentioned above is one very popular one and there are plenty of YouTube videos to help you practice. It focuses on nasal breathing, expiration and avoiding over breathing (with the belief that many asthmatics have a tendency to hyperventilate).
• The Papworth Method focuses on relaxation and diaphragmatic breathing.
• Pranayama/Yoga breathing including
• Deep breathing (deep inspiration and deep expiration) through both nostrils.
• alternate nostril breathing
• 3 & 4 part breaths
• Ocean breath

Pick your favorite breathing exercise and hop to it! I personally love yoga and practice my yoga breaths often. Another way that I have found to practice and get some feedback is through an app I found on my iPhone called MyBreath Lite. You use wired headphones that have a microphone, put the mic under your nose and practice breathing. It's a simple but effective li'l app.

Another thing that I'd like to mention is that when I exercise I ONLY breath through my nose. If I feel like I can't breath through my nose I slow down or stop because I know that then I'm working towards an exasperation. There are other articles such as this one that I have found on a blog that make the argument that nasal breathing is good for athletes for the same reason. 

What if you can't breath through your nose? Talk to your doctor, especially if the reasons are within some control, like allergy treatment and congestion. Breathing is too important to neglect.

Oh Hello Pollen!

It's that time of year again! Spring is in the air... literally! I am among those that are allergic to the tree pollens that arrive in early spring; so allergic, in fact, that I historically have had bad episodes in March. This allergy season is kicking my butt! I think springtime hates me as much as I hate it. It's like a nymph singing to me "Come outside! Feel the warm sun on your skin! Dance with the breeze!" just to tempt me to crash and burn. I was trying to take walks: I'd pull my hair into a hat, take some meds before leaving, take a shower and neti when I got home and then I would sit down to take off my shoes and... pass out. Then as the pollen count grew higher and higher, every time I would go outside I'd start coughing... and then miss an hour of work trying to stop. I've come to embrace my boyfriend's raincoat though! It's great for zipping all the way up to protect my hair, most of my clothes and most of my face from the pollen. My coworkers tease me about it saying things like "Uh, Sara, it's not raining" and I respond with "Sure it is! It's raining pollen!" I've been having the last laugh though as others in my office sniffle and wipe residual pollen into their already itchy eyes. But then I feel bad and offer them an antihistamine and eye drops.My reactions to my allergens have become much better over the last couple of years thanks to a combination of habits & treatments, including that silly raincoat.

There are a lot of manifestations of allergies from itchy hives, eczema, runny nose, cough, asthma episodes, anaphylaxis, etc. and we are not always sure where they come from. The Mayo Clinic defines an allergy as an immune response including inflammation and the manufacture of antibodies to a substance that is not actually harmful. My biggest recommendation is to talk to your doctor and consider getting an allergist so that at the very least you can be tested so that you know what substances are your allergic triggers. Allergies can be life threatening so avoidance is ALWAYS your best option and knowing exactly what to avoid can make that a lot easier. Some allergens are relatively impossible to avoid (like dust and pollen) so you do your best and you create other good habits.

Now I am not going to claim to be a perfect patient. In fact, my doctors and I joke that I am not an ideal patient because I am not organized at all and due to my severe dust allergy I have an aversion to cleaning. Seriously, I'm a brat. Here is what I DO do:

Check the pollen count: I use Pollen.com's app. Generally, pollen counts are highest on sunny, windy days, in the morning and at dusk. They are usually lowest on rainy days. Knowing that helps me to plan my day around severe problems.

Keep windows closed: Pollen particles are eensy weensie and have no problem coming through my screens. If I must open my windows I try to do it on rainy days or at night.

Choose appropriate bedding: All of my covers can be and are washed in hot water and I wrap my pillows in dust mite barrier covers. You should also get one for your mattress. Sheets should be washed, again in hot water, weekly and comforters every 2-3 weeks.

Use a Neti Pot: This is another one of those Ayurvedic practices that I mentioned in my last post, except this one has a LOT of research behind it. If you have never seen or heard of a neti pot before, it is a teapot shaped device designed to rinse your sinus cavity by pouring water through one nostril and allowing it to flow out the other side. It is tremendously effective in rinsing the pollen out of your nose and whenever I have spent any time outdoors I use my neti.

Use Eyedrops: This is a trick that I learned from my optometrist- Keep single-use, preservative free artificial tears on you at all times and use them to moisturize your eyes throughout the day, especially if they're itchy. The trick is to use the whole single uses package, even if you're tearing up and half of it is dripping down your face. It's helping your eyes expel any debris (pollen and dust included) and basically disinfecting your eye. These are great to keep on hand anyway as they are exactly what your doctor is going to recommend if you ever scratch your eye or get any kind of infection.

Take a shower at night: You do not want to sleep with your allergies and pollen gets caught up in your hair and on your skin so it's important to rinse it off, just like you want to rinse it out of your nose. Now, I don't like to wash my hair every day, so I will sometimes just rinse it out or skip this step completely. Make sure to pay attention to washing your face though, especially your eyes because they do work so hard to keep pollen out.

Wear a hat: Keep as much of that pollen out of your hair as possible, especially if you're like me and don't like to wash your hair every day

Wear sunglasses: Give your eyelashes, eyebrows and eyelids a little help by putting a barrier between your eyes and the outside world to keep pollen away from your precious eyes.

Exercise safely: During high pollen counts try to move your workout indoors. When you do work out outside, remember to wear sunglasses, take some medicine, try to always breathe through your nose, neti and shower when you get back.

Wear a mask and gloves when cleaning, or just get someone else to do it. If I had the money for it, I'd get a cleaning lady to do the dusting & sweeping. In the meantime I medicate, barrier up, shower and leave while the dust "settles" but mostly I con my boyfriend into doing it when I'm not home.

Medicine: If all else fails, take allergy medicine, get allergy eye drops or nasal spray! They're there for a reason, kids!

Immunotherapy: I have a super awesome allergist that I see at least once per month for my allergy shots. I am about half way through my 5 year course of injections which contain a combination of serums containing the substances that I am allergic to (pollens, dust, etc). I have felt a profound impact on my allergies and after about 6 months I started to feel better and I have not had a severe allergic asthma episode since I started treatment. I still avoid my allergens when I can and I still take medication; I take Singulair every night and I take Zyrtek as I need it and prior to my shots. But man oh man have those shots been life-changing! My reactions are FAR less severe, if I react at all anymore. The best part? Just about every insurance plan covers them.


A word about food allergies and Oral Allergy Syndrome: Food allergies can be VERY serious, but there is something called Oral Allergy Syndrome where your mouth and throat can get itchy but you do not have any other reaction to the food. This may actually be a symptom of a pollen allergy and not a food allergy, which is great news because immunotherapy can eliminate those OAS symptoms so that you can eat those delicious and nutritious foods! If you have any type of reaction to a food please visit an allergist to find out if you are actually allergic to the food or if it is OAS. I used to react to apples and kiwi; now I don't! Now this graphic that I pulled from Dr. Oz suggests that these foods could be making your seasonal allergies worse, but that is the only time I have ever seen or heard that from any source, so I'm not sure how accurate that is. In fact, if any of these foods are giving you OAS symptoms you should be able to tolerated them just fine if they're cooked. The food list is pretty accurate though and would be a great starting point for a chat with your doctor.

We had a ROUGH winter this year, which sadly predicts a rough spring pollen season since everything is just blooming all at once. I'm going to keep my water up, keep cleaning my mouth and do everything I can to keep that pollen away! What are your favorite ways to combat your Spring allergies?

Start with a good clean morning mouth

All that water talk reminded me of another common asthmatic issue... dry mouth and all the other nastiness that comes with it. So my second step of getting on track is stepping up my oral health.

The water increase has definitely been helping, but I still end up with dry mouth from the corticosteroids. On top of that, your doctor may have warned you of the threat of thrush if you don't rinse your mouth out well after taking your meds. I don't know if you have ever seen or experienced thrush before, but take my word for it: it's NASTY. Don't be that guy. More importantly though, residual medicine hanging out in your mouth can get into your blood stream increasing the risks of side effects (Think a cocaine user putting excess powder on their gums or someone that needs their Xanax to work faster dissolving it under their tongue).

Some of the known effects of asthma on oral health: Dry Mouth & decreased salivatory flow (which could be brought on by the medication or just mouth breathing), tooth damage from acid reflux, some asthmatics have a tendency to anxiously grind their teeth, the medications often contain sugar which gets stuck to teeth and gums, and bone loss as a side effect from some meds.

All of this just makes me want to take better care of my mouth. I feel like if my mouth is clean and healthy then it can do a better job of keeping germs out. The good news is that most of us already have some pretty good habits here & can just step up our game a little. Just make sure to be diligent on brushing and flossing your teeth, twice a day after using your inhalers, preferably with a spacer to help the medicine bypass your mouth and get more to your lungs. Don't forget to gargle. And if you need a night guard, wear it.

Now there's one other thing that I like to add to my routine: Oil Pulling. I know it's trendy and controversial, but hear me out for a minute. I am not saying I oil pull to cure my asthma. I'm not even saying that there is any evidence that it is helping my asthma. I'm just saying that I do it.

The practice of oil pulling comes from the Ayurvedic dinacharya, or daily routine. The practice is oddly similar to what most people do to get ready for their day and includes many things that could benefit anyone, including waking up, meditating, washing your face, drinking water, pooping, tongue scraping, cleaning between the teeth (flossing), oil pulling, chewing, brushing the teeth,  exercising, practicing breathing, cleaning the nose, ears & body and moisturizing. It just happens to have a particular emphasis on mouth cleaning because in Ayurvedic medicine the mouth and tongue are very important to diagnosis, treatment and disease prevention.

What I do: In the morning after I take whatever inhaler I need to take, I drink some water and swoosh it around but I still feel like there is all kinds of crap left in my mouth and on my teeth. I haven't had my one cup of coffee yet or eaten my breakfast so I am not quite ready to brush my teeth, I've flossed the night before and my mouth is dry anyway. So I put a teaspoon of coconut oil in my mouth and swoosh it around for 20 minutes. The first thing that I notice is that I have to focus on breathing through my nose and take nice deep breaths. Then I notice that I'm salivating more and that my mouth feels less dry. So I'm moisturizing my mouth. As the saliva mixes with the oil it creates kind of a soap-like feeling (which makes sense since soap is essentially an oil and an alkaline and saliva fits that bill) that feels like it is cleaning all of those little gross particles off my teeth. Afterwards I just feel like I did a a little breathing exercise and like I have a little coating that will prevent my coffee from staining my teeth.

Don't worry, my boyfriend thinks it's stupid too, but at least he doesn't have to listen to me for 20 minutes.

The truth of the matter is that while the oil pulling isn't necessary, taking care of your mouth is. Brush your teeth at least twice a day, floss at least once and it will just add to the overall health goodness that you need to keep your asthma on track.

Getting back on track... starting with water

Before this latest episode I was feeling like my asthma life was mostly controlled. However, I am willing to admit that I was not on track. What exactly is on-track? Well, for one, not having another episode any time soon would be pretty awesome. But I think I need to go bigger; like overall wellness.

There are 12 systems in the body (Respiratory, Skeletal, Circulatory, Digestive, Immune, Endocrine, Lymphatic, Nervous, Muscular, Reproductive, Urinary, Integumentary), and I already know that I have at least one defective one, so it seems to me that I should be making sure that the others are functioning as optimally as possible in order to best protect my 5 most essential organs (lungs, brain, heart, kidneys & liver).

The fact of the matter is that the body is interconnected and that things we do to one part of the body have effects on others. If I take care of my whole body, besides just focusing on my lungs, I feel like my lungs will benefit the most. Transversely, if I take better care of my lungs the rest of my body will also benefit.

I'm starting out simple. I'm trying to drink 2 liters of water per day. According to the Mayo Clinic, I will be positively impacting just about every part of my body.

More importantly, there are some real, direct implications of making sure you have enough water as an asthmatic. As I was doing research on this, I found a number of blogs and articles that are convinced that asthma can be cured by just increasing water intake. That's not what I'm saying. Science doesn't say that either. However, what I am saying is that water is good for you, and it may have particular benefits for those who do have asthma and is a very simple habit that could have significant positive effects. 

First of all, let's take a look at what actually makes someone asthmatic:

 As this picture shows, one of the primary trademarks of asthma is increased mucous production and inflammation. Since our asthmatic bodies seem to LOVE to keep mucous production high, it would make sense that we would want it to be as thin or viscous as possible so that a) when we flare up it doesn't become so thick that it is impossible to cough out and b) if we can keep it working properly when we do come in contact with one of our triggers our bodies can expel it as quickly as possible and thereby reduce the amount of time we spend in a more severe state. Dehydration can also trigger histamine production and in itself trigger an inflammatory response.

Water is also what our muscles need to stay moist and our lungs are really no different. In fact we lose about a pint of water per day just by exhaling. When we have an acute exacerbation we lose even more and we add more stress to our water needs by needing to repair irritated sinus passages and throats from all that hacking and wheezing. Adding more water just allows our bodies to do what it needs to do most efficiently and effectively.

What else does water do? It helps all of the nutrients and medications that we take to be delivered to the right places and then It helps us rinse ourselves from the inside out. All of those germs, depleted medicines and viruses that we take in have to get filtered out. Right now I'm on a pretty typical course for a severe exasperation: I'm taking prednisone, singular, dulera, xopenex... all of which have to be filtered through the body. And when you don't rinse your body of these medicines there are additional side effects, like yeast infections, thrush, constipation, etc. The water also helps to ensure that those same medications are able to travel to the places they are needed most and then leave the body as soon as they are no longer helping.

When we get sick for any reason, whether it be a cold, flu, tummy ache or just generally run down, it is always recommended that we drink water if even just to help our bodies work as efficiently as possible. Why would it be any different for asthma? And if water can help us improve our immune systems by flushing out the bad stuff before it has a chance to get more inflamed and react, then we can get one step ahead of the control game.

What I'm doing to keep track of my water intake: I have a 1 liter bottle that I really like and I fill it up in the morning and then fill it up again when it's empty. I used to set a timer to remind me to drink every hour, but I found it annoying and not helpful, so I stopped that. If it works for you though, by all means! I log my intake in my current health tracker of choice MyFitnessPal, which is joined to my FitBit Flex. (Perhaps I'll discuss those trackers another day).

BTW, prednisone does have the side effect for some people causing them to urinate more often... I feel like I've been peeing like every 30-40 minutes... don't get discouraged! Water is good!