Struggling to Breathe

Asthma is on the rise – in 2010 the CDC indicated there are 25.7 million people in the US living with asthma, and they indicated they expect an increase of 15% per decade (1). That’s a lot of people who are struggling to breathe and if your studio is like mine, you’ve seen an increase in singers who are dealing with this issue.

What singers with asthma have shared with me: they struggle to get through phrases, feeling like they are running out of breath. Higher notes feel harder to hit and to sustain. And, when their asthma is active, singing at all can feel like an impossibility.

Asthmatics have differences in breathing patterns, ribcage position and mobility as well as quality of  speaking voice and singing voice.

What is Asthma?

Asthma is defined as a chronic disease in which the airways can be inflamed, constricted and lined with too much mucus during an asthma attack.

The symptoms of asthma can be triggered by a number of stimuli including: pet dander, dust, pollen, tobacco smoke, emotional stress, cold air, exercise, fatigue, infection or food.

Symptoms of an asthma attack include coughing, wheezing, and shallow, fast, labored breathing as well as a rapid heart beat.

Asthmatics also have a greater likelihood of experiencing reflux, rhinosinusitis, sleep apnea, and they are more likely to experience anxiety – much more on this in a bit.

Medical management of asthma includes both bronchodilators and corticosteroids. Bronchodilators are ‘rescue’ inhalers, like Albuterol, used to bring quick relief of the symptoms of an asthma attack. Corticosteroids, like Prednisone, are used to manage the chronic inflammation that many asthmatics experience. As with most medicines, both types of treatment carry risks/side effects. Rescue inhalers can mask an increase in chronic airway inflammation and therefore mask the severity of asthma when they become overused. Corticosteroids can reduce the need for rescue inhalers, but can cause hormone changes, weight gain, glaucoma and bone loss as well as hoarse voice and thrush.

Many singers with asthma know to rinse their mouth out after using an inhaler to help their voice function a bit better.

To be clear, I am not advocating in any way, shape or form, abandoning the medical management of asthma. What I would like to suggest is there are some practices you can engage in that can help you manage your asthma, change your experience of breathing and how you experience your voice.

When I was first researching asthma back in 2008 I was fascinated to see that reflux, sinusitis and anxiety were all factors that were frequently concurrently present. To me, that suggested that a whole body approach was going to be an important one in managing this condition. Diet, stress management, weight, movement and general health all need to be considered in the treatment and management of the disease.

We know the breath is intimately linked to anxiety – when we get anxious the breath becomes higher and shallower. There is no doubt in my mind that feeling like you can’t breathe is an anxiety producing situation! It isn’t clear which came first, anxiety or asthma, and in some ways it doesn’t matter, we know the two go hand in hand. One of my goals in working with singers with asthma is to help them break the cycle of anxiety and breathing.

Working with Asthmatics in the Studio

Here is my action plan for working with an asthmatic in the voice studio. It is built on the following: Awareness, Skill Building, and Implementation. That process is rarely linear but it is a combination of those three areas that helps singers find success.

  1. Do an extensive intake questionnaire so you know from the first meeting what all the factors are in terms of asthma, allergies and acid reflux, anxiety and medications along with how much they are moving throughout the day.
  2.  Complete a breathing assessment in the initial lesson. Asthmatics are classic ‘over-inhalers’, meaning they are taking in more air than they are letting back out (not hard to see how that would impact singing, right?!).
    1. Within the assessment discover the breath ratio and explore mobility of the ribcage. Very often it is ‘stuck’ in the inhale position (called ribcage flare) and part of the work they need to do is to learn how to move the ribcage on the breath in AND the breath out.
  3. Give the singer the task for the week between when they will see you next of observing their breath in different situations – low stress, high stress, hanging out with friends, speaking in public and private situations, while they are singing, in the morning and at night.
  4. In the studio begin the lesson with gauging where the breath is that day. Use the first 5-10 minutes to do some kind of breath work to help balance the breath. ** DO NOT do this if they are symptomatic.
  5. If they are symptomatic begin here. If they are not, do this next, and incorporate it into vocally warming up. Use postures that target the thoracic spine, ribcage and diaphragmatic ability as well as deep relaxation through forward bends, spinal twists and psoas release.

If you have a singer you are working with, or you are a singer with asthma and I would like some support on your journey, don’t hesitate to reach out!

  1. https://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf

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