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In the last module the Breathing Trainer operation was described is detail, and operational ranges of the various parameters were suggested for COPD and Emphysema. Note that these same general parameters could be used by people with chronic symptomatic Asthma, and for all Asthmatics during an acute attack.
Note that on starting the Breathing Trainer, the default pattern on the setup screen has an equal Inspiration and Expiration Time, and no indication of an End-Inspiration and End-Expiration Pause. It is emphasized, this is not a good breathing pattern for COPD. In fact, it is a bad breathing pattern for COPD. Therefore, to obtain benefit it is imperative that you know how to make the adjustments to derive an appropriate Breathing Prescription for your particular needs.
For an average sized person with COPD, start with the following parameters:
Tidal Volume = 800 cc. (adjust this up or down 100 to 300 cc for larger or smaller people)
Respiratory Rate = 14 breaths per minute
Inspiration Time = 40% (therefore the Expiration Time will automatically be set to 60%)
Inspiration Hold = 5%
Expiration Hold = 10%
This is an approximate breathing pattern for a person with normal lungs. While it should give you some dyspnea relief, it is still not suitable for a person with COPD. However, it is a reasonable starting point to begin your training.
Practice with this breathing pattern for a few days, until feel you can accurately coordinate your breathing, both in and out, with the prompting cursor. As you practice, keep in mind that accurate timing of your breathing parameters is crucial, as permitting sufficient time on expiration to allow the stale air to get out is much of what dyspnea relief with breathing training is all about.
And remember, to synchronize your breathing with the prompting display, breathe out a comfortable large breath, and then simultaneously breathe in and press the Esc key on your computer. This will re-set the display back to the beginning, and your breathing will now be synchronized with the display.
A very important skill to learn is how fast you should inhale and exhale with different sized Tidal Volume breaths. To follow the prompting breathing cursor signal properly, you must start and stop your in and out breath exactly with the prompting signal, and during this time keep your flow of air steady and uniform. Done correctly, your breathing effort on inspiration should feel comfortable. Remember, expiration should be totally relaxed and passive, letting the air gently fall out of your lungs. If you are not getting the air back out of your lungs with relaxed exhalation, you may need further adjustments of your breathing pattern, or possibly some active expiratory effort. More on this subject later on.
For the first adjustment set the following parameters:
Tidal Volume = 900 cc. (100 to 300 cc's larger or smaller, depending on your size)
Respiratory Rate = 11 breaths per minute
Inspiration Time = 35% (therefore Expiration Time will automatically be set to 65%)
Inspiration Hold = 5%
Expiration Hold = 10%
For the second adjustment set the following parameters:
Tidal Volume = 1000 cc. (100 to 300 cc's larger or smaller, depending on your size)
Respiratory Rate = 10 breaths per minute
Inspiration Time = 30% (therefore Expiration Time will be set to 70%)
Inspiration Hold = 5%
Expiration Hold = 10%
This breathing pattern should be about right for most people with COPD. At this juncture you should fine tune your breathing pattern by experimenting with small adjustments. First try increasing your Tidal Volume up to 1100 to 1200 cc. It is important that you try to feel the sensation within your lungs of incomplete emptying by end expiration. If you have that sensation, try slowing down the Respiratory Rate by 1 or 2 breaths per minute, and/or gradually increasing the time of expiration, that is, by decreasing the Inspiration Time by 1 or 2 % at a time.
When you have established a comfortably large breath, the main trick is to then establish the correct balance between the conflicting requirements of a slower breathing rate, and the time of expiration, in order to fully empty your lungs before taking in the next breath. Your Respiratory Rate should be slower, but not too slow, or you will not have a sufficient time to get in enough breaths to meet your overall ventilation requirements. And your expiration time must be longer, but not too long, or this will slow down your breathing rate too much. Experiment with small adjustments (1 or 2 breaths per minute, and 1 or 2 percent increases or decreases of the time of expiration) to see what is most comfortable, while at the same time not developing any sensation of incomplete emptying of your lungs, i.e. not developing Air Trapping.
In your experimentation seeking a comfortable breath, you might also try increasing or decreasing your Tidal Volume by 100 to 200 cc'c. As a general rule, while practicing your breathing, you should feel that you are taking in larger breaths than is necessary. This will help in stretching and mobilizing your chest, and therefore help to increase your "Breathing Reserve," that is, your ability to take in a larger breath if you need to do so when short of breath. Setting too large a Tidal Volume breath can be recognized by excessive straining and difficulty in taking in the last part of a big breath.
When not practicing, your normal breathing regulatory mechanisms will appropriately adjust the size of your Tidal Volume. What you are really training for is the all important timing of a pattern of breathing, that will be more efficiently improve your ventilation down at the alveolar level, as well as not allowing Air Trapping and secondary Dynamic Hyperinflation.
When you have settled into a breathing pattern that is comfortable for you, it is very important you pay close attention as to how it feels in your chest and lungs as you breathe in and out. Memorize these sensations. If you know how correct breathing feels, you will be able to reproduce your breathing pattern, without the Breathing Trainer prompting. This skill will be very helpfull if you have an acute attack of shortness of breath.
For the third adjustment, for people with severe airway obstructive disease (e.g. an FEV ! of 0.5 or less), try setting the following parameters:
Tidal Volume = 1000 cc. (100 to 300 cc's larger or smaller, depending on your size)
Respiratory Rate = 10 breaths per minute
Inspiration Time = 25% (therefore Expiration Time will be set to 75%)
Inspiration Hold = 5%
Expiration Hold = 10%
As noted above, it is very important that you try to feel the sensation within your lungs of incomplete emptying by end expiration. If you have that sensation, try slowing down the Respiratory Rate by 1 or 2 breaths per minute, and/or gradually increasing the time of expiration, by decreasing the Inspiration Time by 1 or 2 % at a time.
If you still have a feeling of incomplete emptying of your lungs, then try gentle active expiration effort. This should be started about 2/3 to 3/4 of the way through expiration, and be done with minimal force of your chest and abdominal muscles, in order to minimize the problem of Dynamic Bronchial Compression. Generally however, forced expiration should only be done as a rescue technique for acute dyspnea attacks.
The breathing pattern you define initially will not be ideal as your condition changes, or if you are exercising, and re-definition of your basic breathing pattern may be needed. For example:
It should be apparent that breathing is a very dynamic function, and needs to be adjusted to your life style, various levels of exertion, and various medical conditions.
We will show you in other modules various additional tricks and tips for COPD, Emphysema and Asthma patients.