Physiotherapy in the management of children with asthma and altered breathing patterns

Our physiotherapy service for children with asthma aims to help patients manage their condition and control the symptoms that can affect breathing. Physiotherapy for children with asthma can involve:

• Breathing pattern training, which involves techniques to control the breath and its rhythm
• How to loosen and clear secretions (mucus, phlegm) from the lungs to improve lung airflow
• How to clear the nasal passages to improve breathing through the nose
• How to tell symptoms apart
• How to look after the body and muscles to help the lungs work at their best

The role of physiotherapy in managing asthma

For patients with asthma, the role of a physiotherapist is to provide specialist advice and skills on how to manage asthma symptoms, improve breathing technique and incorporate physical activity and exercise into daily life.     

Physiotherapy breathing exercises are a good way to start addressing asthma symptoms which may appear at any point during physical activity and exercise – for example, some children may find it difficult to do any physical activity, exercise or sport because of their condition, while others may experience symptoms only when working at their hardest.

A physiotherapist can help them work out whether their asthma symptoms are caused by reduced fitness levels (deconditioning), tightening of breathing tubes (asthma), breathing pattern changes, or the tightening of vocal cords which may happen during exercise. Physiotherapists work with doctors and physiologists to put together the right plan for each patient, to help manage their condition.

Other things a physiotherapist might help with

Some people with asthma may get a build-up of sputum (mucus, phlegm, secretions) in the lungs which, if left, can cause chest infections.

A physiotherapist can demonstrate some simple breathing exercises your child can do to help clear any build-up of sputum. The exercises are tailored to each child and may change as they get older.

Treating sinus issues

Allergies that typically affect the nasal passage – like hay fever – can result in an irritated, runny or blocked nose and can make asthma harder to control. 

However, there are a number of ways to help clear the nasal passage, which a physiotherapist can demonstrate, for example effective nose blowing or sinus rinsing. Sinus rinsing is a method that uses normal saline solution (a mixture of salt and water) to gently rinse the nasal passages and help clear the sinuses, which can improve breathing through the nose and breathing pattern. Sinus rinsing can be effective at reducing symptoms of allergies, improving sense of smell and hearing and reducing the build-up of secretions which can lead to infections and sinus headaches, all of which can impact quality of life.

What is breathing pattern training?

Our brains act as a very fancy computer for our bodies, and the breathing centre of our brain is a coded programme. It is a special program because most of the time we do not have to think about breathing – it just happens, just like we do not have to tell our hearts to beat or our stomach to digest food – it just happens.

But if we want to, we can change how we breathe, by breathing bigger, smaller, faster or slower.

Children with asthma can experience more permanent changes to their breathing pattern. These changes may have been brought on by a particular event such as a bad asthma attack or a traumatic incident. Cases like these can ‘reprogram’ the breathing centre of the brain, telling the respiratory muscles to behave differently, so rather than breathing quietly through the nose and down to the lower ribs, it might tell them they should breathe through the mouth to the top of the chest – making breathing like this feel normal and natural. But this can be harmful for the body and can make breathing more difficult and asthma symptoms worse.

Is it asthma or something else?

While symptoms such as shortness of breath, feeling unable to control the breath, and tightness or pain in the chest may present like classic symptoms of asthma, other conditions can trigger similar symptoms (known as ‘asthma mimics’), which can make it difficult to tell if it is asthma or something else.

However, physiotherapy and breathing retraining can help your child to identify the difference between symptoms of asthma and those which simply mimic it. 

The science

Our brains act as a very fancy computer for our bodies, and the breathing centre of our brain is a coded programme. It is a special program because most of the time we do not have to think about breathing – it just happens, just like we do not have to tell our hearts to beat or our stomach to digest food – it just happens.

But if we want to, we can change how we breathe, by breathing bigger, smaller, faster or slower.

Children with asthma can experience more permanent changes to their breathing pattern. These changes may have been brought on by a particular event such as a bad asthma attack or a traumatic incident. Cases like these can ‘reprogram’ the breathing centre of the brain, telling the respiratory muscles to behave differently, so rather than breathing quietly through the nose and down to the lower ribs, it might tell them they should breathe through the mouth to the top of the chest – making breathing like this feel normal and natural. But this can be harmful for the body and can make breathing more difficult and asthma symptoms worse.

Resources - videos and leaflets

We have created some learning resources, including a series of videos featuring exercises and interactive demonstrations, that you can use with your child to help them learn about breathing patterns and breath training, techniques to help control asthma symptoms, and how exercise and physical activity can boost lung health and overall wellbeing. Visit our resources page.