Buteyko therapy: For your escape from Asthma

By Peter Kolb

Introduction

Over the past few years a novel new drug-free treatment for asthma has swept through Australia and has already made an impression in the United Kingdom. Buteyko therapy is, in fact, a very well developed treatment for Chronic Hyperventilation Syndrome (CHVS). That it is so universally successful in the treatment of all "forms" of asthma suggests that western medicine has underestimated the significance of CHVS as serious disorder in our community.

The treatment was developed in the 1950's in Russia by medical doctor and scientist Professor Konstantin Buteyko. A double blind controlled clinical trial held in Brisbane in 1995 demonstrated a reduction in the use of bronchodilators by 96% and a reduction in steroids by 49% after 12 weeks of Buteyko therapy [1]. The figures are particularly remarkable considering that the treatment relies 100% on patient compliance. These findings support the substantial body of anecdotal evidence available from thousands of former asthmatics who have attended Buteyko clinics in the west, that Buteyko therapy is very effective at removing the cause of asthma. The treatment has not yet been taken up by the medical profession although former patients are forming pressure groups to change this much as they did in Russia where the treatment now has official approval.

The theory goes back over a century to 1871 when Da Costa discovered a strange symptom complex suffered by American soldiers during the civil war [2]. The condition was called "soldier's heart" and later "Da Costa's syndrome". These symptoms were later shown to form part of a very large and bizarre group of symptoms collectively known as Chronic Hyperventilation Syndrome [5]. Many of these appear to be unrelated with each other. They include: Loss of blood supply to the brain, migraines, spasm of the coronary blood vessels to the heart, angina pains, heart attacks, muscular stiffness and aching, irritable bowel syndrome, hiatus hernia, high blood pressure, extreme fatigue and intolerance of any exertion such as is found in chronic fatigue syndrome, excessive sweating, asthma, seizures, visual and auditory disturbances, sleep disturbances, phobias, panic attacks, flue like symptoms...and the list goes on [3,4,5]. CHVS is a condition in which the patient has habituated to breathing too much. The symptoms developed depend entirely on an individual's genetic predisposition.

While CHVS is well described in the medical literature, it is not well understood by most doctors and rarely diagnosed correctly [3,5]. Although the prevalence has been given as between 6 and 11% [5] the Buteyko experience would suggest that it is considerably higher than this.While hyperventilation is always seen in asthmatics [6,7] it has generally been assumed that this is the result rather than the cause of asthma.

The way Buteyko therapy works is by reversing the process by which normal episodes of acute hyperventilation become chronic. It is a treatment that aims at curing the hyperventilation disorder. When successfully applied the symptoms of asthma disappear along with the myriad of other symptoms often accompanying asthma. Patients sleep better, require less sleep, feel better, have more energy and have an improved quality of life [1].

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Physiological basis of Buteyko's theory

Normal healthy people have an arterial carbon dioxide content (PaCO2) of 40mmHg. Respiration is regulated to maintain this level by the respiratory center in the brain stem. For normal healthy individuals under normal conditions there is more than enough oxygen available to keep the blood pretty much saturated, so lack of oxygen is not normally the driving force for breathing.

Now consider a young child breathing normally. His mother is a little over concerned about him getting cold and tends to over dress him when he is put to bed at night. The normal basal metabolic activity produces heat that has to be dissipated. If he can't get it out through his skin (he might even have been dressed with a bonnet), the child has to breathe more to get rid of the heat. This lowers his CO2 level which tends to make his blood more alkaline, a condition know as respiratory alkalosis. To restore the acidity (pH) back to normal, the kidneys excrete bicarbonate ions through the urine. This is a very slow process. If this over breathing is sustained all night, the gradual compensation by the kidneys leads to a restoration of pH but a loss of both carbon dioxide and Bicarb. This is part of the reason the respiratory center adapts to CO2 levels that are too low (3,4,5). The other part has to do with the slow diffusion of bicarbonate ions across the blood/brain barrier.

The lost Bicarbonate is accompanied by valuable minerals such as magnesium, sodium and calcium [2,4]. The loss of Bicarbonate is also very significant in terms of a loss to the pH buffering capacity of the blood. This means small changes in respiration will cause relatively larger pH swings when the buffer has been depleted.

On top of this, the oxygenation of the tissues is directly affected by low CO2. The release of oxygen from hemoglobin for the oxygenation of metabolically active tissues depends on the CO2 environment. This is known as the Bohr effect and is well understood by physiologists [4,5]. If there is insufficient CO2, less of the oxygen is released and simply returns to the lungs. What it means is that all the organs and tissues including the brain get less oxygen than they would if CO2 levels were normal. Breathing more doesn't help; in fact it only makes oxygenation worse because you further depress the Bohr effect with the loss of even more CO2.

Every biosynthetic process in the body relies on carbon dioxide [9]. There is a minimum level of CO2 below which an individual cannot survive. Between this minimum level and the normal level required for good health, there must be a gray area in which normal metabolic functions are impaired. As a result, if CO2 levels are too low, the body does not function properly affecting the production of all hormones [9]. According to Buteyko, asthmatics with hypereactive airways run Cortisol deficits. One of the functions of Cortisol is to dampen the immune response and prevent it from overreacting following a meal or the inhalation of minor non-pathogenic foreign particles. In the case of asthmatics such disturbances to the immune process cause hyper allergenic responses.

According to Buteyko, arthritis too is caused by such immune process disturbances.

Finally, the small bronchioles leading to the alveolar air sacs in the lungs are surrounded by smooth muscle. The function of this muscle tissue is to prevent local over ventilation of the lungs by reducing the diameter of these little tubes. By this action the lungs become ventilated more evenly. Lack of CO2 is well known to cause spasming of this smooth muscle [3,4,5]. Since hyperventilators are low in CO2, each part of the lungs is independently trying to prevent over ventilation in its area. Asthmatics have smooth muscle in the bronchioles which is up to 2.5 times thicker than normal [10]. The Buteyko theory has it that their bronchioles are genetically predisposed to constrict very much more effectively in response to over ventilation than for non-asthmatics.

The same effect can be seen in people who suffer from migraines, except in their case the problem lies with low CO2 causing a reduction in the arterioles to the brain. [5]. The same can be said of some people suffering with angina pains [3] with their coronary arteries being affected by hyperventilation.

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Factors that lead you to breathe too much

Stress is a well-known stimulant for hyperventilation. When our ancestors were startled by the proverbial lion, their respiration would increase. This got rid of CO2, which made room for the rapid build up during the subsequent effort at escaping the lion. But this stress was short-lived. If you weren't eaten by the lion you would escape to your cave and the stress would disappear. But twentieth century living has seen an increase in chronic stress... a boss that's harassing you, concerns about the mortgage, concerns about whether your kid would make the finals etc. These lingering stresses span the sort of time period required for your hyperventilation to become chronic.

Professor Buteyko discovered that both lack of exercise and over eating are factors leading to over-breathing. It's so easy to get food that we no longer eat because we're hungry, but because we enjoy eating and because food is so accessible. We sit in front of TV after sitting at a computer all day and ring up for a pizza instead of going outside to catch a rabbit.
Sleeping in stuffy rooms, breathing through the mouth (something many of us do when asleep,) all encourage over breathing. Even physical stresses such as infected tonsils, bad teeth and other infections produce hyperventilation according to professor Buteyko.
How Buteyko therapy works.

In the same way that lingering stresses sustain hyperventilation for long enough for the respiratory center to adapt to lower levels of CO2, so too Buteyko therapy works by sustained under breathing over a long time. The basis of the treatment is a program in which you spend about 90 minutes a day deliberately reducing your breathing by relaxing all your respiratory muscles, and developing and sustaining a slight hunger for air. It sounds simple but it can be hard to do at first. The idea is that this should become a habit so that you unconsciously reduce your breathing in the train, in the car and at boring meetings. The formal part of the exercises is no longer required once the habit has been instilled and the hyperventilation has disappeared. The basic technique can take anything from a few minutes to a few days for people to learn to do effectively. Assistive techniques are taught to help you ensure that you always breathe through your nose, even in your sleep and when playing sport.

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Side Effects

As the CO2 levels rise and the body's biochemistry changes, the individual will see physical changes taking place. Bronchospasm reduces immediately to the point where often on the first day of the therapy the patient is free of bronchodilators. Inflammation of the lungs as well as hay fever symptoms take longer to disappear, since the changes in the biochemistry such as increased production of Cortisol can take a while to pick up. Occasionally chronic inflammations that have been dormant can flare up because of heightened biochemical activity. There is always an improvement in sleep with the disappearance of snoring and sleep apnea. Over weight individuals will feel their appetite suppressed, resulting in weight loss. Patients report that they "feel better", more energetic, more active and healthier. In time they become tolerant to their allergens.

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Buteyko therapy and conventional treatment for asthma

People on conventional asthma management plans do not have to make any changes to their drug regimes. Bronchodilators are taken as rescue medication as and when needed, while steroid medication is taken as prescribed. The only change they have to make is to try the breathing therapy when they feel an asthma attack coming on. With this and the routine breathing exercises they will find that there is a reduced need for bronchodilators and usually the need disappears altogether within days. Once asthma symptoms have disappeared, they can consult with their doctor on reducing steroids gradually.

Occasionally an individual will have a relapse following severe exposure to a mass allergen assault. Cortisol production has not fully recovered and the immune system reacts vigorously. At this time the individual won't be able to control his breathing and his pulse will race. This will require a visit to the ER. If he is given just sufficient steroids to overcome the deficit then within an hour his breathing will return to being controllable and his pulse will return to normal. People who suffer from such outbreaks will typically require 30% less steroids at each successive event. Within a year to 18 months there should be no more such emergencies for the few who experience them.

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Why have doctors not accepted this treatment?

Buteyko therapy has its detractors. Doctors have relied for decades on lung function tests to assess asthma objectively. These tests have become a kind of "gold standard". Doctors point out that Buteyko patients, although they don't have worse lung function without their medication, they also show no improvement in these measurements.

From a purely scientific point of view, the new understanding that the hyperventilation theory brings to asthma makes it clear that those tests are fundamentally flawed. In science it is important to understand what you're measuring. But with the lung function tests we have been measuring a disorder that has never been understood. The hyperventilation theory explains that in the case of asthmatics the airways constrict particularly well in response to hyperventilation maneuvers. And since the lung function tests rely on such maneuvers, they test what is, in part, a healthy response to an abnormal breathing process. Opposition to Buteyko based on lung function tests is clearly driven by sentiment rather than science.

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How do I learn the Buteyko technique?

It's best to turn to a Buteyko practitioner for help. Buteyko therapy is the only health treatment program that I know of that gives a full money-back guarantee. If it doesn't work you get your money back, so you have nothing to lose but your asthma!

However, some practitioners are more experienced than others and some have better basic training than others. It is wise to inquire about this (and the money back guarantee) especially when seeking help for non-asthmatic disorders such as chronic fatigue syndrome (CFS). While asthma is quite easy to treat with Buteyko therapy and results are readily achieved and observed, CFS treatments, which rely entirely on the restoration of the body's biochemical processes, take longer and require a great deal of support.

Buteyko therapy is usually provided on the basis of a one time up-front fee of around US$ 350, although prices can vary quite widely. For this you get group tuition over a week to ten days with individualized programs and support for as long as it takes to get rid of your disorder. Private consultations are usually provided on the basis of cost per consultation.

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Conclusion

On the medical side, instead of dismissing the claims of Buteyko patients as being "anecdotal", there is an urgent need for these reports to be thoroughly investigated. Doctors should be more vigilant in detecting CHVS and consider Buteyko therapy for those patients who are suspected of having the disorder.

As far as the general public is concerned, we need to understand the importance of correct breathing. Parents should be vigilant about over dressing children and ensure that they always keep their mouths closed. Teachers should immediately stop the practice of encouraging deep breathing during exercise classes. There is no physiological basis for the practice and according to Professor Buteyko it is one of the chief culprits in the high incidence of CHVS related disorders in the western world.

We have already discovered the importance of healthy diet and exercise for healthy living. Buteyko has provided the evidence that we also need to keep our breathing healthy.

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Further Information

Over the past few years a great deal of information has become available through books, Videos, DIY/self help kits and, of course, the internet.

Buteyko Practitioners are listed in Holistic-online.com directory of providers. The author's website:
http://www.wt.com.au/~pkolb/buteyko.htm
also has additional information including a directory of practitioners and links to other sites

Peter Kolb BSc (Eng), MSc (Med), CPEng (Biomed)
Biomedical Engineer
pkolb@wt.com.au

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References

1. 
   Bowler S, Green A, Mitchell C, "Buteyko breathing and asthma: a controlled trial", Medical J. of Australia, VOL 169, December 1998, 575-578

2. DaCosta JM, "On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences," Am J Med Sci, VOL 61, 1871, 17-53

3. Nixon PGF, "Hyperventilation and cardiac symptoms", Internal Medicine, VOL 10:12, December 1989, 67-84

4. Demeter SL, Cordasco EM, "Hyperventilation syndrome and asthma", The American Journal of Medicine, VOL 81, December 1986, 989-994

5. Sher TH, "Recurrent chest tightness in a 28-year-old woman", Annals of allergy, VOL 67, September 1991, 310-314

6. Donnelly PM, "Exercise induced asthma: The protective role of CO2 during swimming", The Lancet, VOL 337, 19 January 1991, 179-180

7. McFadden WR, Lyons HA, "Arterial-Blood Gas Tension in Asthma", The New England Journal of Medicine, VOL 278:19, 9 May 1968, 1027-1032

8. Guyton AC, Hall JE, "Textbook of medical physiology", Chemical control of respiration, PUBLISHER: WB Saunders; ISBN:0-7216-5944-6; 1996; EDITION: 9; PAGES: 527-528.

9. Kazarinov VA, "Buteyko Method: The experience of implementation in medical practice", The biochemical basis of KP Buteyko's theory of the diseases of deep respiration, EDITOR: Buteyko KP; PUBLISHER: Patriot Press Moscow; 1990; PAGES: 198-218. English translation available at:
   http://www.wt.com.au/~pkolb/biochem.htm

10. Dail DH, "Pulmonary pathology", Eosinophilic Infiltrates, EDITOR: Dail DH, Hammar SP; 1988; PAGES: 359-362.

Information on Buteyko's cure for asthma provided by grateful ex-asthmatics