Northern Ireland

Coronavirus: Leading physio reveals breathing techniques 'to enhance our immune system'

Petrina Scullion is a sports physiotherapist at Kingsbridge Physiotherapy Clinic, Queens PEC
Petrina Scullion is a sports physiotherapist at Kingsbridge Physiotherapy Clinic, Queens PEC Petrina Scullion is a sports physiotherapist at Kingsbridge Physiotherapy Clinic, Queens PEC

WHEN you think of sports physiotherapy, you do not automatically think of the lungs and breathing techniques.

It is easy to forget the very act of breathing uses the muscles of the diaphragm and the intercostal muscles at the ribs.

You may be surprised to learn there are also breathing muscles in the neck - the scalenes and the sternocleidomastoid. Technically, all muscles attached to the thoracic cage can act as an accessory muscle.

We are in the middle of the Covid-19 pandemic, the experts tell us we have not yet hit the peak here in Northern Ireland, I want to do my bit in whatever way I can.

For the majority of people with coronavirus, the battle will not be in intensive care but in their homes, self-isolating for 14 days.

When they find it is difficult to catch a breath and their work of breathing is greater - the tendency is for panic to set in, which further exacerbates the problem. There is a link between the speed of breathing and emotions.

Read More: Leading sports physiotherapist raises possibility that exercising lungs may help in fight against coronavirus

I hope this article gives people a sense of control and ability to try to minimise panic, to give techniques to keep your airways as clear as possible to ensure plenty of airflow to the lower lobes of the lungs.

The aim is to get air down to the bottom of the lungs to allow for good gaseous exchange and get airflow behind and around any secretions in the small airway sacs (alveoli) so a person can mobilise them up into the bigger airways (trachea) where they can be coughed up easily and discarded in a tissue.

It surprises me how many people tend to breathe using their upper lobes. Athletes are often amazed when I teach them to breathe quietly into the lower lobes of their lungs to enhance performance.

We can train to harness the power and goodness of the simple human breath.

Before I start, if you have aching muscles/high temperature/dry cough and perhaps a high respiratory rate - my advice is do what you can.

Covid-19 affects the lungs so it makes absolute sense to me to use our own breathe, own breathing muscles, own immune system to fight this - while also practising hand washing, social distancing recommended by the experts.

:: Why do we breathe in through the nose?

Simply put, the nose is our first line of defence.

It has a thicker mucous membrane and little cilia to trap pathogens so the immune system can deal with them before they get to the lungs.

The gas nitric oxide is produced in the nose - this is anti-viral. There is none produced in the mouth and so you're losing this advantage if you constantly breath through the mouth.

Nitric oxide is a vasodilator, meaning it relaxes the inner muscles of blood vessels, causing vessels to widen and increases blood flow and lowers blood pressure.

Surfactant maintains elasticity and movement of the lungs.

Nitric oxide improves the production of surfactant. Let’s harness this natural superpower produced in our own bodies.

There are three parts to the active cycle of breathing.

:: Part 1 - diaphragmatic breathing

Make your hand into a loose fist and place at the base of your sternum - that flat bone in the front of your chest.

Take a breath in through your nose and try to imagine air going straight down to where your hand is.

Your hand will be lifted gently as you breath in - deep/ slow/relaxed.

Then open your mouth wide and without force let the air out.

As you let the air out empty the lungs a bit more - this gives you the air hunger to breathe in through the nose again. There is a link between the diaphragm and emotions.

Three to 4 breaths, then relaxed breathing.

:: Part 2 - thoracic expansion exercise

Gently put your hands on your sides at the bottom two ribs area.

Breathe in through your nose and direct the air down to the base of the lungs to feel the ribs moving up and out as you fill the lungs up.

Open your mouth wide and let the air out without forcing it - 3 to 4 breaths, then relaxed breathing.

:: Part 3 - Huffing or forced expiratory technique

With Covid-19 people find they cough, which completely drains them of energy.

Some secretions (if present) are too far down for the cough to clear it. I feel this next part of the active cycle of breathing technique is very beneficial.

Called huffing or forced expiratory technique using an open glottis. Hold your hand in front of your face to imagine it’s a mirror - about 2 to 3 inches away - with the palm facing towards you.

As you breathe in through your nose allow the air right down to the bottom of the lungs and open your mouth very wide.

Use two short sharp blasts to 'fog up the imaginary mirror' - the idea is to get the air behind any secretions so the huff can get them to move into the larger airways so you can cough it up.

You may find you need to cough after one/ two huffs. Then relaxed quiet breathing.

Repeat this cycle two times and rest.

Other tips:

:: Positioning - simply prop yourself up with pillows or lean forward onto the back of a chair. Patients in intensive care are being put on their front. Do not do this if you are pregnant, frail or have mobility difficulties.

:: Nose pinch exercise - nice relaxed nose breathing then normal breath in through nose /normal breath out through the nose. Pinch your nose, hold for 3 to 5 seconds. Let nose go and breath in through the nose again.

:: Humming - it increases the production of nitric oxide.

:: Exercise, stop smoking, good nutrition, hydration.

There is no evidence to say this will stop you getting coronavirus or can help you when you have it, but as the experts (respiratory physiotherapists, doctors and nurses) are currently busy on the frontline, I hope this assists somebody. These are for generally fit/ healthy people, for anyone with underlying respiratory conditions, contact NHS 111.

To contact Petrina or Shea McAleer, email physio@kingsbridgehealthcaregroup.com