Advice from Queens Hospital re breathing with CV

[SmileEachDay]

Interesting advice from a doc and nurse at Queens - how to protect your lungs from further infection if you have CV.

I’m not a medics but my brother is a nurse and he says that it fits with ITU protocol re treatment of patients with pneumonia:

m.youtube.com/watch?feature=youtu.be&v=u7sJw5ecFUU

@changemynamechangemynamewhen - it made me feel awful! Dizzy and sore-throated and light-headed. The one BrokenBrit has posted is fine. I’ve googled and looked at various nhs trusts/Lung-related charities etc. advice on breathing for chest infection etc. since reading this and none of the guidance I have come across involves the holding breath for five seconds bit, which I think is the bit which probably makes people hyperventilate. Worth looking at other reputable sources for guidance I think.

I've been trained by the British Lung Foundation to deliver breathing for singing classes for those with lung conditions (singing is one of the best things you can do if you have a lung condition). One thing I noticed in the original video and the one with the two English physios is that they didn't appear to be taking low, relaxed belly inhalations, instead raising the shoulders and upper chest, creating a lot of tension in the upper body. This is what most people naturally do - you tell people to breathe in and they naturally want to make themselves slimmer. What we teach though is relaxing the abdominal muscles on the inhale and engaging the abs on the exhale - when they've completely run out of breath all they have to do is relax and the air comes back in effortlessly (technically known as splat). This means that they use all of their lungs not just the top part as they would do if they raised their shoulders and tightened all their muscles on the inhale. I'd also worry about holding the breath for 5 before exhaling. For anyone not used to doing breathing exercises this is going to cause dizziness.

As a classically trained singer one of the breathing exercises I was taught was to sit on the edge of a chair with my upper body over my knees to help me feel the expansion in my back on the inhale. If you're leaning on your elbows it's very difficult to lift the shoulders and cause tension. So anyone unable to lie on their front could try this.

The breathing exercises I teach during classes are good for the body and mind and can help calm anxiety etc. and members of groups across the country are reporting improvements in their health, fewer GP visits, less reliance on inhalers and fewer exacerbations of their conditions. Sorry, that sounded like an advertisement for the classes. If anyone would like more information please pm me (I am not a medical practitioner though).

I did it and I felt so dizzy! I did find it effective though as I hacked up some phlegm I didn’t realise was there and I think is to do with hay fever

I like the sound of your singing classes, @slartibartfastsbeard - I have 2 lung diseases and find singing hard because I never have enough breath. It sounds like something that could be really good for people like me.
I agree about the holding 5 seconds etc, that's not what I do in my physio regime, I'd pass out! - and the bit about breathing from deep in belly rather than more shallow from upper chest, my physiotherapist spent ages teaching me how to breathe from the deeper place because shallow breathing doesn't shift the stuff low down, and my lower lobes are my biggest problems. I do more what's in the bronchiectasis link I posted above.

There appears to be a dispute over whether the information in the video is useful or dangerous

link to the original reddit thread here

old.reddit.com/r/awesome/comments/fu9hfo/doctor_from_queens_hospital_gives_breathing/

which contains this text

[–]loandbe -1 points 2 days ago*
DO NOT DO THIS!!!!!!
This is really, really, really shitty advice.
What he’s describing here is a recruitment maneuver which—correctly—gets more air into the bases of your lungs. If you’re suffering from atelectasis, or a collapse of parts of your lung due to inactivity, then this is a great maneuver
THIS IS NOT WHAT HAPPENS WITH COVID
Covid patients go into something called ARDS, or acute respiratory distress syndrome. The treatment for ARDS is the exact opposite of this maneuver. ARDS patients who are given big breaths get more lung injury. The best ARDS treatment is to ventilate them with very shallow breaths—like, half the normal breath volume
In addition, covid-specific ARDS comes with a significant air hunger. Meaning somehow the brain is driving the lungs to take even bigger breaths, the exact opposite of what the lung needs to do. This is detrimental to covid patients and one of the (many) reasons they’re intubated—so that we can control their breathing and prevent them from further injuring themselves due to this insane respiratory drive.
So, let me say it again:
If you’re concerned you have covid, do not do what this doctor is saying!
Source: MD, currently on the front lines in the US.
EDIT: since OP has decided that “the advice stands”, here’s the literature. This was a huge deal when it came out:
www.nejm.org/doi/full/10.1056/NEJM200005043421801
TL;DR: randomized controlled trial of ventilation volumes (how big a breath you take on the vent) with people with ARDS. The trial was stopped prematurely because low-tidal-volume (ie, shallow breath) patients didn’t die as frequently.
So, yeah, you can take advice from a random doc at a random UK hospital posted by an anonymous Redditor whose goal is karma
Or you can take advice from another random doc who’s also an anonymous Redditor but who can provide peer-reviewed sources.
EDIT 2: more literature, this one from 2017
jamanetwork.com/journals/jama/fullarticle/2654894
EDIT 3: I’m giving up on all of you know-it-alls. Good luck out there. Breathe however the fuck you want.
....................................................................

Do we have any consultants / doctors here who can take a look and provide information as to what we should believe?

I am not a doctor but the poster expressing concerns has linked to literature that appears credible and I would like some opinions from suitably qualified persons

Apologies if this has been posted before, very busy, no time to read the entire thread but thought it might be helpful to share this

I mean, the beginning of that Reddit thread is all about whether smoking weed increases your lung capacity....🤷🏻‍♀️

A few physios/nurses (including my ITU trained sibling) have sad it tallies with what happens when treating patients with pneumonia. The main drive is about opening lungs up rather than making it impossible for them to work by lying on your back.

I mean, the beginning of that Reddit thread is all about whether smoking weed increases your lung capacity

As you might expect from reddit yes?

However the post further down is from someone who claims to be an MD on the front line stateside (granted anyone can claim to be anything online) but s/he links to what appears to be redible peer reviewed trials.

I am not a doctor and I am not going to be able to debate this from a position of authority. Obviously.

With this new virus different experts seem to disagree on basic information. A video interview with an expert from a week ago is old and ancient news as everything chenages so quickly in terms of knowledge bases and research.

I feel we need some expert input here given that we have what appears to be one credible doctor making one claim and anotehr poster (may or may not be a doctor) linking to what appears to be credible peer reviewed trials stating that the first doctor's claims are actually dangerous.

It may be that the peer reviewed trials are excellent and helpful but htat the poster claiming to be an MD on the front line has misrepresented their relationship to the original video. I don't know. Thus the request for clarity from people better informed than me

thank you.

hoodathunkit

I agree that gathering views from experts is vital.

I think the other issue is that because patients with CV often then go on to develop other respiratory issues, there perhaps isn’t a one size fits all approach?

i also think swimming > and cycling are good, encouraging deep breathing.

Good post @hoodathunkit.

I think the take home is probably listen to what you’re told by medics actually treating you and not YouTube videos which may be harmful, helpful or neither - unless you are a medic in this field you have no way of discerning which one it is.

Having grown up being taught specialist breathing techniques from top respiratory Physiotherapists at one of the best heart and lung hospitals in the world, I wasn’t a big fan of that video.
ACBT is great for airway clearance and shifting the gunk.
Stacked breathing is also very gentle and easy to do to encourage more air into the lungs.
Prone position is good for various respiratory issues. I do postural drainage to clear my lungs- basically, I lie on my front with my upper body tipped down off the bed. It’s one of the best techniques I’ve found.

I came across this same video on my phone's news app of this Dr explaining the breathing exercise and in the article someone explained the pillow thing as i too was confused. This is what they said:

In the video Dr Munshi advised taking five deep breaths, holding each for five seconds. He then said to take a sixth breath, hold that for five seconds before coughing. Do this twice and then lie flat on your stomach for ten minutes, with your forehead on a pillow, while taking deeper breaths than normal, he said.
He said that that the advice was not for everyone and that pregnant women could harm their baby if they laid on their front.

Posted on Lungs thread too but thought this useful resource should be shared widely