Case study: Asthma and a stubborn chest infection

Jen (not real name) is a 50-year-old female with Asthma, a high stress job, a normal family life, and she had a lengthy exacerbation of pneumonia last year (2018).  She reported that in 2018 she fell sick with a fever and a worsening of her peak flow down to 250 (from a normal of 350).  She was already on medications of salbutamol and Seretide at a high level- and when she saw her GP, she had a fever, and lots of green phlegm that was difficult to cough up.  Her GP started treatment on an Antibiotic and steroid immediately, and increased her asthma medications, and she was given a medical certificate for 2 weeks off work.  Unfortunately, after 4 weeks of further medical treatment she still had a raging fever and was unwell.  She finally turned the corner at 6 weeks and made a steady recovery from this point.

Jen went on to have shortness of breath and irritability in her respiratory system after this, and went to specialist testing and review, but all was essentially normal.  Her specialist referred her to Breathing Works suspecting dysfunctional breathing.

On examination Jen was breathing at a very rapid at 24BPM, she was breathing very high in her chest, with minimal to no diaphragm motion.  On ultrasound examination of her diaphragm she had a very, very thin muscle which makes it hard to keep the diaphragm working in times of stress.  Her breathing in strength on testing was 45cmH20 which was very low (normal of 79cmH2O).  To put this in context – if you cannot use the diaphragm it is hard to clear the phlegm from your lungs. 

Over 6 sessions we went through proper perfect inhaler technique, improved her diaphragm breathing, gave her phlegm and sputum clearance techniques, and inspiratory muscle strengthening.  Jen now has good inhaler technique, a much healthier MIP of 75cmH20, and is able to ventilate her lungs more effectively at rest, and in sitting, standing and all functional positions.  She has a much more confidence in her ability to deal with another exacerbation, but hopefully will be able to steer clear of an event this winter

“People don’t realise how drastically a bad breathing technique can affect them, but by learning how to breathe properly the effects can be literally life changing.”