I cant breathe, said the woman, panic stricken and one hand clutched at her chest. Her forehead was lined with sweat and fear of death etched on her face. Breathing, after all, is essential for life.
We take breathing or respiration for granted. It is an involuntary, autonomous and automatic reflex that is present from birth to death. We can consciously take deep or shallow breaths, but we cannot stop breathing at will. In short, you cannot commit suicide by voluntarily ceasing to breathe.
Breathing difficulty is a perception. Some people may have fairly severe lung restriction, but be able to continue their normal activities. Others may feel breathless with the slightest unaccustomed exertion. This is more likely to occur if the person is unfit, obese and unaccustomed to exercise. A sudden panic attack owing to an external factor can be breath stopping. High altitudes and high temperature can also cause similar problems.
Breathing difficulty can occur suddenly because of a foreign body like a peanut which has got lodged in the food pipe. This then becomes a medical emergency. Immediately stand behind the person, make a fist with both hands and exert a sudden forceful upward thrust in the stomach area below the chest bone (sternum). This is called a Heimlich maneuver and it has saved many lives.
Mucous secretions — watery in case of viral infections and allergy, and thick and viscous in case of secondary bacterial infection — can clog the nasal passages and bronchi. Some of these secretions can drip backwards into the throat, causing a post nasal drip with a sense of suffocation.
The nasal passages can be cleared with nose drops. It is important to use saline nasal drops. This is commercially manufactured by many companies. It needs to be used every two hours. Nasal drops containing chemicals may provide faster relief. But as the effect wears off, they may cause rebound congestion with worse blockage. Long-term frequent usage of chemical nose drops may cause habituation, wherein the body stops responding to the medication. If the nasal block is due to an allergy, prescribed locally acting steroid nasal sprays are very effective.
The bronchi can narrow in response to exposure to ingested allergens like peanuts and food colour, or inhaled ones like cigarette or wood smoke, room fresheners and mosquito repellents. This is called reactive airways disease or asthma.
Smokers may have damaged their lungs structure permanently, causing a disease called COAD (chronic obstructive airways disease). This sets in around 20-30 years after the first puff. It attacks people in their 40s and 50s. They become breathless with exertion and sometimes even at rest. Some require continuous artificial oxygen supply.
Initially — that is, before damage sets in — airway constriction is reversible. Inhalers or rotahalers deliver relief producing bronchodilating medication directly to the bronchi. The respite is immediate and sustained if the medication is puffed as prescribed. Direct delivery systems make medication more effective and are less likely to cause side effects.
The rate of breathing increases during pregnancy because of the oxygen demand of the baby. Moreover, pregnancy causes the uterus to enlarge which pushes the abdominal contents upwards. This may cause a feeling of inadequacy while breathing. This is self-limited and disappears with delivery.
Congenital heart disease, heart failure and myocarditis (disease of the heart muscles) can cause difficulty in breathing and a feeling of air hunger. This is because a failing heart provides inefficient circulation of blood and insufficient oxygenation to the tissues of the body. The blood carrying capacity of the body itself may be compromised because of anaemia. Specific medication for the diseases will help with the problem.
Breathlessness needs to be evaluated if:
The difficulty occurred suddenly for no apparent reason
• It was accompanied by chest discomfort, pain or pressure
• It comes with a slight exertion or at rest
• There is an inability to lie down flat and sleep
• It is accompanied by fever
• There is pressure, fullness or a squeezing pain in the chest.
Good breathing techniques require the co-ordinated use of intercostals (groups of muscles that run between the ribs, and help form and move the chest wall), diaphragm and stomach muscles. As the breath goes in, the intercostals and stomach expand and the latter moves outwards. And as we breathe out, the chest contracts, the diaphragm moves up and the stomach moves in. Breathing is a natural response and occurs normally and naturally in children. As age advances, we tend to lose the ability to breathe efficiently.
Long hours at work seated in a sloppy posture, obesity or an inactive life without the mandatory one hour of aerobic activity (running, swimming, jogging or cycling) results in inefficient and inadequate breathing, even in a normal individual.
Place a hand on your abdomen, stand in front of a mirror and breathe in and out to check if your breathing is correct. Consciously correct deficiencies and practise breathing exercises (yoga pranayam) for a healthier tomorrow.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org