1. Respiratory Tract Yoga Therapy Richard P. Usatine, MD Professor, Family Medicine University of Texas HSC San Antonio Co-Author, Yoga Rx with Larry Payne, PhD

2. Goals Give you the tools to understand the physiology of breathing to help you: –Understand the science behind yoga breathing –More effectively read the medical literature –Begin to apply this to your teaching, therapy and research

3. 12 -20 studies of Yoga and Asthma in Medical Literature 10 study abstracts are in my handout on the SYTAR website Includes the Pink City lung (PCL) exerciser that was used to replicate Yoga breathing Pink Cities: San Francisco Jaipur in India

4. Breathing Anatomy - structure Physiology – function –Change in lung volumes –Air flow –Gas diffusion across lung membranes –Regulation of breathing (brain and other chemoreceptors) Gas pressures pH

5. Pulmonary Function Tests Yoga in a Box?

6. Downloaded from: StudentConsult (on 14 August 2006 08:36 PM) © 2005 Elsevier

7. AIR FLOW Forced Expiratory Volume in 1 second – FEV1 Forced Vital Capacity – FVC FEV1/FVC important ratio - <80% = obstruction

8. Pulmonary Function Tests Spirometry – air flow Measure residual volume Diffusing capacity Arterial blood gas

9. Price: $19.99 Manual Peak Flow Meter

10. Electronic Peak Flow Meter Measures FEV1 and PEF $24.99 on ebay with free shipping

12. Regulation of breathing CO2 Chemoreceptors sensitive to blood pH and amounts of CO2 and O2 are located in medulla of the brain and in the aorta and carotid arteries. Changes in CO2 from breathing too much or too little change the pH of the blood and send signals to the brain to modify breathing rate and volume. Oxygen levels must go very low before this directly stimulates breathing

13. Anxiety Hyperventilation in anxiety causes carbon dioxide in the blood to decrease, and blood becomes more alkaline (higher pH) This causes oxygen to be bound more tightly to hemoglobin and tissues get less oxygen Low CO2 reduces blood flow to the brain This leads to dizziness, blurry vision, feelings of unreality, lightheadedness Low oxygen to extremities leads to tingling, numbness and cold sensation

14. Hyperventilation Thoracic breathing results in a hyperexpanded chest and high residual lung volume. Because of the high residual volume, they are then unable to take a normal tidal volume with the next breath and consequently experience dyspnea. Signals the brain with a "suffocation alarm" that triggers release of excitatory neurotransmitters that are responsible for many of the symptoms such as palpitations, tremor, anxiety, and diaphoresis.

15. Treating Hyperventilation and Anxiety Techniques of rebreathing into a paper bag are no longer recommended because it decreases oxygen intake and deaths have been reported. Best treatment is abdominal breathing to slow the respiratory rate and gives the patient a sense of self- control during the episode. Scientific evidence exists that this works for many patients with hyperventilation. This is why Yoga works for panic attacks – abdominal breathing can counteract all of this!!! http://www.emedicine.com/emerg/topic270.htm

16. Hatha yoga: improved vital capacity of college students. The study showed a statistically significant improvement in vital capacity across all categories over time. Altern Ther Health Med. 2000 Nov;6(6):55-63.

17. Effect of yoga training on exercise tolerance Forty six young asthmatics with a history of childhood asthma. Yoga training resulted in a significant increase in pulmonary function and exercise capacity. J Asthma. 1991;28(6):437-42.

18. Conclusions Respiration is gas exchange Breathing is about movement of air –Volumes, flows, pressures –This can be measured Buy a peak flow meter to measure changes in lung function with Yoga training Study what we can measure Yoga is wonderful even if when we don’t always have the numbers