COVID-19 and the Breath – What You Can Do

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 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.

Take a deeper dive with the paper Thrive & Survive by David A. Hanscom, MD, orthopedic spine surgeon, Oakland, CA

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 breathwork practices) can carry the virus to the unprotected lower lobes of the lungs. A recent study out of Germany showed that mouth breathing, rigorous exercise, and hyperventilation caused the condition to progress to widespread systemic problems (MATRICARDI, 2020). Open mouth, hyperventilation breath practices like the Wim Hof Method and Sudarshan Kriya Yoga (SKY) may pose some risk in the infection phase.

Note: Don’t get us wrong, we appreciate these breath practices. Ancient wisdom teachings held these practices in a sacred place. While the benefits have been noted by many, it’s wise to appreciate the potential pitfalls. Unskilled hyperventilation practices can drive the virus deeper into the lungs. It can also train low CO2 blood plasma levels and decreased CO2 tolerance. As practitioners of breath work, we employ a system that identifies the indications, caution points, and contraindications to these more aggressive practices. Let us know if we can help you determine which practices are best for you.   


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.

Poor Diet

Given the inflammatory nature of primary and secondary Covid-19 systems, a diet that increases the systemic inflammatory response could be even more problematic. That includes diets high in saturated fat, processed foods, and those that include alcohol and excessive sugar. Diets with a wide diversity of plants seem to bolster the gut-biome and our immune system.


Boost the Immune System Through the Breath

Breathing Less

The first and most important breath-related practice is to right size the breath during sitting, baseline breathing. Most people in modern times over breath or breathe too fast. Ironically this results in a feeling a mild chronic shortness of breath (FRIED, 1990). A chronic reduction in blood plasma levels of carbon dioxide (CO2) from over breathing resets the chemical receptor sensitivity for CO2, in a less than healthy way. These receptors become over sensitive to normal increases in CO2 – resulting in the inaccurate feeling of shortness of breath.  Breathing this way also changes the acid-base balance of the blood making it harder for hemoglobin to release oxygen to the cells. Correcting the breath for many is all about breathing slower, and lower in the body.  Breathing like this corrects the CO2 and pH balance.

In the case of COVID-19, blood oxygen saturation frequently drops because of lung inflammation. As CO2 levels rise to signal more breathing, most people will unknowingly breathe even faster and shallower. This can cause too big of a drop in CO2 levels. Again, making it hard for hemoglobin to release oxygen to the cells in need. So, the answer with COVID-19 is to take full, deep in the body, but not too big of breaths that are slow, and low in the body – using the diaphragm. This makes breathing more efficient and calms the nervous system.

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 Breathing

Nose breathing helps our immune system. 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). Nitric oxide produced in our nasal passages helps dilate the alveoli in the lungs and it acts as an anti-viral (anti-oxidant, anti-bacterial, and an anti-fungal).

Consider Humming!

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 walking, Qi Gong and Yoga. The trick is to avoid rigorous exercise – close to your level of tolerance – for this will stress the immune system. In the case of COVID-19, it may also help decrease the chance of blood clots.

Specifically, how can Breathe Your Truth help?

Objectify the Process

Habitual over breathing weakens the immune system and having COVID-19 may leave behind maladaptive breathing patterns. Breathe Your Truth uses technology to help people find their best baseline sitting breathing. 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 and O2 levels, then we take those practices into daily activity. Ultimately, we lean into advanced breath work to improve physical performance and deepen meditation practices.



  • Nose breath day and night
  • Keep breathing low in the body, and slow
  • Eat-Rest-Exercise well (within comfortable limits)
  • Decrease inflammatory cytokines produced by stress, as well as eating meat, and processed foods
  • Exercise the diaphragm with Piston Breathing
  • Consider Humming 10 minutes a day (for more nitric oxide)
  • Wear a mask and wash hands

Managing COVD-19 Symptoms

  • Breathe through the nose as much as possible – this cleans the air, helps the diaphragm stay in the game, and slows the breath for efficiency and better oxygenation
  • Sleep on your side if possible – this makes breathing easer at night
  • Take breaks and lie on your stomach – this helps the body breathe better
  • Stay hydrated
  • Take frequent short walks to minimize the risk of blood clots
  • Take slow full breaths into the abdomen. These activities may be helpful

Recovering from COVID-19 (when feeling better)

  1. Let us know if we can help.

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

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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.

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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.

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