Do you feel very short of breath when you exercise? Have you got asthma? Have you ever experienced asthma during exercise? You are not alone.
Let me try and explain what may be happening to you and your breathing in these situations. I will explain using a case study how you should be able to help fix your shortness of breath and improve your asthma during running!
James* is an outgoing teenager who came into the clinic with his mum around 1 year ago. He is a competitive cross-country runner but was experiencing a number of difficulties when competing and training. His goal was the cross country national championships where he wanted to improve on his last years result of 10th.
James experienced shortness of breath while running especially at the 10 km distances, wheezing, and frequent lung infections throughout winter. James was going through a bit of a growth spurt and getting injured a bit and using his inhalers of salbutamol 3 times a day and fluticasone daily.
On objective testing, James had a low peak flow Asthma test for his age and height, his respiratory rate was rapid at 22 breaths per minute. James had a poor pattern of breathing using his shoulders when breathing at rest (this is called clavicle or apical breathing). Using a computerised testing device his Maximal Inspiratory Pressure was 45 cmH20. This is much worse than a 70 year-old woman and he should have been able to achieve around 90-100 cmH20. Finally James had a very poor breath hold of 15 seconds.
Further assessment of his diaphragm thickness and motion showed a very thin weak diaphragm, and poor excursion in diaphragmatic motion during baseline breathing and attempted deep breathing.
I first discussed the examination to James and his mum and then outlined some steps that we would need to take to improve his breathing. We set out a plan then got into it!
We first worked on improving his basic resting breathing pattern using ultrasound in a relaxed position. The next step was taking this pattern up into a sitting and then standing posture. We gave him tips to improved his alignment, as most teenagers are a bit floppy and tend to hang on their ligaments. James went home for a week and practised these fundamentals.
The next session then moved onto improving his breathing cadence while walking and jogging on the treadmill. This was hard initially but James did well after a few tips and cues changed his breathing style.
The next session we moved James onto POWERbreathe training to develop his inspiratory muscle strength. We really focus on making sure that the pattern of breathing is ideal before we strengthen.
After 12 weeks of working on these drills, James was feeling really good and all we had to focus on was improving his lactate and breath hold tolerance. We gave him some specific drills to challenge these systems and he noticed a huge improvement in his top end speed.
James went on to great result at the cross-country nationals and came second. All up our rehabilitation and exercises took a full year of work to succeed but James and his parents are thrilled with the results.
NB: * not clients real name