National Respiratory Care Week: Focus on Effective Breathing

This month we recognize National Respiratory Care Week (October 20-26). For people living with ALS, respiratory care is a key component in ones day-to-day life. To honor this week, we'll hear from the respiratory therapist at the ALS Association Certified Center of Excellence at Beth Israel Medical Center, Betsy Thomason.

Focus on Effective Breathing

By Betsy Thomason, BA, RRT

Breathing is everybody's most important activity of daily living! In our 21st century world, most of us are breathing too fast and too shallow. We've lost the understanding that breathing provides energy and promotes relaxation. Whether you are a person with ALS (PALS) or a caregiver, effective breathing is essential for your well-being.

A respiratory evaluation is part of the care given at any ALS Association Clinic in the region. There are two parts: the subjective viewpoint of the PALS and caregiver and objective information provided by four measures of pulmonary function. Both aspects are important—one corroborates the other. Patient subjective information includes sleep habits, daytime energy levels, presence of headaches or nightmares, shortness of breath, cough-ability, water intake, and secretion management. The four objective tests are pulse oximetry (SpO2) for blood oxygen level; end tidal carbon dioxide (ETCO2), an indicator of exhale-ability; negative inspiratory force (NIF) which measures the strength of the diaphragm; and forced vital capacity (FVC) which identifies the amount of air you can get into your lungs.

The role of the respiratory therapist is to use this information to provide recommendations about home respiratory equipment and choices to facilitate patient decision making. This includes the use of a cough assist device for chest wall expansion and secretion management, mechanical ventilation non-invasively for sleep and as needed during the day, and a suction machine. Oxygen is not part of the protocol because most PALS have healthy lung tissue.

In my practice for the past 12 years as the respiratory therapist at the Beth Israel's ALS Association Clinic, I emphasize the importance of relaxation and stress management for PALS and their caregivers. Effective breathing, that is the focus on the active outbreath and passive inbreath, promotes relaxation of the autonomic nervous system and thus the entire body. Whether you purse your lips and gently blow out long and slow, or hum or grunt, you can influence your body's response to stimuli and thus save energy.

For more information about effective breathing, go to www.btbreathingtraining.com. For free excerpts from Betsy's soon-to-be published book, Just Breathe Out—Developing a User-Friendly Body, featuring the BreatheOutDynamic system, email her at betsy@btbreathingtraining.com.