By David Deppeler, PT, DSc

Orienting to our health is a great gift that we give ourselves and others. Self-care through the breath is especially relevant in these times of COVID-19. As individuals, we have a unique opportunity engage breath-related practices that help prevent illness and improve recovery.

How the Virus Works

 

Inflammation and Organ Failure

COVID 19 PictureCOVID-19 is caused by SARS CoV-2 virus droplets that infect cells. The virus takes hold by interacting with a cell wall protein called Angiotensin Converting Enzyme 2 (ACE2). This protein is largely found in cells of the upper respiratory tract and lungs, and to a lesser extent in the lining of the blood vessels, heart, kidneys, and intestines. The virus primarily reproduces in the lungs, causes systemic inflammation, and eventually involves all major organ systems. The effects of the virus become much more problematic if the virus reaches the lower lobes of the lungs, where our immune fighting capability is less, and the cells are rich with the protein ACE2 (SHI, 2020).

Compromised Gas Exchange and Breathing Pattern Dysfunction

As the virus infects the lungs, the alveoli collapse, and gas exchange is significantly impaired. This creates a transient elevation of CO2, which triggers an increased respiratory response (IWASAWA, 2020). This generally results in faster upper-chest breathing and increases the relative dead-space in the minute ventilation (ventilation volume per minute), creating less-efficient breathing. Chest-breathing also increases the sympathetic nervous system stress response and elevates upper back and neck muscle tension tone. The stress response elevates cortisol levels, which will eventually magnify the inflammatory response from the virus infection. Acute respiratory distress syndrome follows and can be physically damaging and emotionally traumatic. This faulty breathing pattern may last even after the virus has receded – especially if the seeds of the pattern were present before the virus struck – as is the case with many people.

Excessive Blood Clotting

To make matters worse, the virus also appears to destroy cells that regulate blood clotting (IBA, 2020). Blood clots are a common secondary threat of COVID-19. Clotting is also likely further facilitated by immobility, dehydration, and the inflammation that is part of this condition.

While all of this sounds like doom and gloom, it is worth noting that a recent British study found that 70% of those positive are asymptomatic (DAY, 2020). That probably means that for most, the immune response of the upper respiratory system does a good job knocking it back.

Two Natural Questions

  • What can be done to improve the immune response and prevent the infection from reaching the lower lobes of the lungs?
  • If the infection has landed in the lower lobes, what can be done to improve recovery?

Before we answer these questions, let’s dig around a little more.

 

 

Can We Make Things Worse? Yep.

 

Mouth Breathing

Mouth breathing bypasses the filtering, warming, humidifying process of nose breathing. It is easier to bring toxins deep into the lungs with mouth breathing. Additionally, it robs our body of access to the extremely valuable compound nitric oxide (NO). NO is produced primarily in the nasal passages and is not carried into the lungs with mouth breathing (LUNDBERG, 1995). NO helps hemoglobin bind oxygen (making breathing more efficient) by being a vasodilator. NO is also an antibacterial, antiviral, anti-fungal, and antioxidant agent (BIAN, 2003). Again, mouth breathing gives us less access to the powerful health benefits of nitric oxide.

Big Breathing

Excessive, big, deep breaths (hyperventilation) can carry the virus to the unprotected lower lobes of the lungs. A recent study out of Germany in April of this year showed that mouth breathing, rigorous exercise, and hyperventilation caused the condition to progress to widespread systemic problems (MATRICARDI, 2020). Practices like the Taoist practice of Heart Mirror or the Tibetan Tummo breathing (which both use hyperventilation to change metabolic, autonomic, endocrine, and nervous system activity) may drive the virus into the lower lobes of the lungs.

Note: There is likely a place for these breath practices. Ancient wisdom teachings held these practices in a sacred place. They were not generally practiced by the masses. While benefits have been noted by many, the practices may also come with risk. As practitioners of breath work, it is prudent to develop a system that helps to identify the indications, caution points, and contraindications to these more aggressive practices.  

Stress

Excessive physical and mental stress elevates cortisol levels and weakens the immune system. It is valuable to recognize that too much exercise and activity can be as problematic as no activity. The cortisol-stress response can also be elevated by prolonged exposure to low-grade stress, not eating and sleeping well, alcohol, drugs, and environmental toxins.

 

 

Get Tougher Through the Breath

 

Let’s first acknowledge that the breath is among the top three things a person can do to improve the immune system and general health. The other two are eating and sleeping well. These two things are not addressed here, but they are important.

Let’s get on to the breath…

Breathing Less

The first and most important breath-related practice is to right size the breath during sitting, baseline breathing. Most people with breathing pattern problems are over breathing, even though these same people report not breathing enough (FRIED, 1990). Correcting the breath for many is all about breathing less, in comfortable ways. Breathing less elevates carbon dioxide (CO2) and makes it easier for hemoglobin to liberate oxygen. While it’s true that many people would be better off with more cellular oxygen, breathing more air is not the way to get it. Breathing more decreases CO2, which suppresses oxygen availability and delivery. Breathing less improves CO2 levels and oxygen availability. Oxygen saturation, or the amount of oxygen in the body, is rarely the problem. Getting access to oxygen is a function of CO2 levels. CO2 levels are frequently too low and problematic. Monitoring CO2 levels with capnography, or the use of a CapnoTrainer®, is one way to be precise in finding the best breathing practice.

Breathing Low

 

Breathing low, or using the diaphragm correctly, helps to efficiently bring air into the lungs without muscle tension in the upper back and neck. It helps to regulate autonomic nervous system activity. Slowing the exhale increases parasympathetic tone, which is the opposite of a stress response. In this, we feel better, digest food better, and we rest and repair better. Using the diaphragm correctly improves spine and postural stability by properly regulating trunk (intrathoracic and intra-abdominal) pressure. Lastly, using the diaphragm improves venous blood return to the heart and decreases gastric reflux.

Nose Breathe

Nose breathing is where it’s at, even during heavy activity. Martel has shown that taping the mouth closed during sleep reduces the chance of getting the common cold. (MARTEL, 2020) Nose breathing triggers the body’s first immune response by filtering, warming, and humidifying the air. Do not miss this benefit. Nose breathing also adds resistance and decreases the chance of over breathing – the most common form of breathing dysfunction. Resistance also helps strengthen the diaphragm and opens airways over time. Nose breathing creates more alpha brain waves. This helps our body relax, allowing more resources to be used by digestion, repair, and regeneration. Conversely, mouth breathing increases brain beta waves associated with the stress response. And remember, nose breathing improves nitric oxide production. (LEE, 2020)

Hum!

Yes, hum. Humming increases nasal nitric oxide 15 times more than gentle breathing, thus reducing the chance for upper respiratory infections (WEITZBERG, 2004). Inhaled NO was used effectively to treat SARS (sever acute respiratory syndrome) and is likely very valuable in improving immunity against COVID-19 symptoms (MARTEL, 2020). We generally recommend ten minutes of humming a day.

Be Active

Mindfulness-based activities may play an especially significant role, as they coordinate the breath with activity. This may include but is not limited to practices like Qi Gong and Yoga.

 

 

Specifically, What Can Breathe Your Truth Do to Help?

 

Technology

Habitual over breathing weakens the immune system and having COVID-19 may leave behind maladaptive breathing patterns. The first and possibly most important breath-related practice that Breathe Your Truth offers is the technology to help people find their best baseline sitting breathing practice. We use the CapnoTrainer® to speed learning and take the guess work out of what helps and what does not. These practices are often a surprise to the learner, and not intuitive.

Systematic Process

We provide a graded framework to guide activity progress through three phases of work. We start by helping people find breath practices that improve baseline sitting CO2 levels, then we take those practices into daily activity. Ultimately, we lean into advanced breath work to improve physical performance and deepen meditation practices.

 

 

Summary

 

When using the breath as a tool to improve immune system resiliency, or recovery from COVID-19 symptoms, consider the following:

  1. NOSE BREATHE – moisture, filter, resistance, nitric oxide
  2. Breathe light – over breathing is a problem for many people
  3. Breathe low – keep the diaphragm in the game
  4. Hum for 10 minutes a day – 15 times more nitric oxide
  5. Keep moving – exercise appropriately and keep the spine and ribs flexible
  6. Take care of the emotional system – it matters
  7. If you are concerned that you may have COVID-19, do not take big breaths deep into the lungs as instructed in many current breath practices. This could drive the virus deep into the unprotected parts of the lungs.
  8. Consider individual coaching and the use of a CapnoTrainer® – find the best breath practices.

 

BIAN, K.; MURAD, F. Nitric oxide (NO)–biogeneration, regulation, and relevance to human diseases. Front Biosci, 8, p. d264-278, Jan 2003.

DAY, M. Covid-19: four fifths of cases are asymptomatic, China figures indicate. BMJ, 369, p. m1375, Apr 2020.

FRIED, R.; FOX, M. C.; CARLTON, R. M. Effect of diaphragmatic respiration with end-tidal CO2 biofeedback on respiration, EEG, and seizure frequency in idiopathic epilepsy. Ann N Y Acad Sci, 602, p. 67-96, 1990.

IBA, T.; LEVY, J. H.; CONNORS, J. M.; WARKENTIN, T. E. et al. The unique characteristics of COVID-19 coagulopathy. Crit Care, 24, n. 1, p. 360, 06 2020.

IWASAWA, T.; SATO, M.; YAMAYA, T.; SATO, Y. et al. Ultra-high-resolution computed tomography can demonstrate alveolar collapse in novel coronavirus (COVID-19) pneumonia. Jpn J Radiol, 38, n. 5, p. 394-398, May 2020.

LEE, K. J.; PARK, C. A.; LEE, Y. B.; KIM, H. K. et al. EEG signals during mouth breathing in a working memory task. Int J Neurosci, 130, n. 5, p. 425-434, May 2020.

LUNDBERG, J. O. N.; FARKAS-SZALLASI, T.; WEITZBERG, E.; RINDER, J. et al. High nitric oxide production in human paranasal sinuses. Nature Medicine, 1, n. 4, p. 370-373, 1995/04/01 1995.

MANISCALCO, M.; SOFIA, M.; WEITZBERG, E.; CARRATU, L. et al. Nasal nitric oxide measurements before and after repeated humming maneuvers. Eur J Clin Invest, 33, n. 12, p. 1090-1094, Dec 2003.

MANISCALCO, M.; SOFIA, M.; WEITZBERG, E.; DE LAURENTIIS, G. et al. Humming-induced release of nasal nitric oxide for assessment of sinus obstruction in allergic rhinitis: pilot study. Eur J Clin Invest, 34, n. 8, p. 555-560, Aug 2004.

MARTEL, J.; KO, Y. F.; YOUNG, J. D.; OJCIUS, D. M. Could nasal nitric oxide help to mitigate the severity of COVID-19? Microbes Infect, 22, n. 4-5, p. 168-171, 2020 May – Jun 2020.

MATRICARDI, P. M.; DAL NEGRO, R. W.; NISINI, R. The first, holistic immunological model of COVID-19: Implications for prevention, diagnosis, and public health measures. Pediatr Allergy Immunol, May 2020.

SHI, Y.; WANG, Y.; SHAO, C.; HUANG, J. et al. COVID-19 infection: the perspectives on immune responses. Cell Death Differ, 27, n. 5, p. 1451-1454, 05 2020.

WEITZBERG, E.; LUNDBERG, J. O. Humming greatly increases nasal nitric oxide. Am J Respir Crit Care Med, 166, n. 2, p. 144-145, Jul 2002.