By Robert Grabko, R.P.F.T., B.S.

Athletes who experience airway tightening may feel anxious and as a result, find breathing uncomfortable. Breathing and muscle relaxation exercises are non-medication technques that athletes can use to relieve airway tightening and reduce anxiety.

Pursed-lip Breathing
Pursed-lip breathing is an excellent way for athletes to manage breathing when he/she experiences airway tightening. To perform, inhale through the nose for one second and exhale through pursed lips with a slow blowing action lasting about four seconds. Pursed-lip breathing works for several reasons: it leads to back-pressure to the airway, keeping it open; it forces needed oxygen through the lungs into the blood stream; and the prolonged exhalation slows the breathing rate. As breathing becomes more relaxed, athletes reduce anxiety. To practice pursed-lip breathing during activity, try inhaling through the nose for one step and exhaling against pursed lips for three steps. Use this in any sport.

Muscle Relaxation
Muscle relaxation can be used with pursed-lip breathing. Smooth muscle in the airway, when triggered, can contract and tighten. It is possible, however, to keep the muscles around the airway and chest wall relaxed, helping to keep the airway muscles relaxed. Targeted muscle groups include the neck, shoulder and chest wall. To perform, tighten these muscles voluntarily for five seconds, then release. Repeat several times. Use this technique in different environments, such as at home, at practice and in competition. Athletes often feel tense and nervous before competition, leading the airway to tense and tighten. Performing both breathing and muscle relaxation can ease pre-competition stress on the airway and an athlete’s state of mind. 

Mastering Techniques for Comfort
As a respiratory therapist who works with athletes, I recommend practicing these techniques five to 10 minutes every day, alternating pursed-lip breathing and muscle relaxation exercises for several minutes. Once mastered, use them during warm-up, during competition and anytime an airway-tightening episode starts to occur. This can relieve and prevent an asthma attack from escalating into a significant limitation. 

Case in point: I observed an athlete with asthma experience an oxygen saturation drop of 97 to 87 percent while on a treadmill. By using simple pursed-lip breathing, he returned his oxygen saturation to 95 percent. This is a significant non-medication treatment that is effective once it is learned and used properly.

Athletes with asthma can attain the highest level of performance if the asthma is well controlled. Asthma management includes: asthma triggers management; proper nutrition and hydration; breathing and muscle relaxation; management of airway tightness when it occurs; a proper warm-up; strategies to optimize fitness levels; and finally, customization of effective medication plans.