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 and feel 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 often have differences in breathing patterns, ribcage position and mobility as well as quality of  speaking voice and singing voice. But, they can sing quite successfully!

What is Asthma?

Asthma is defined as a chronic, reversible 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 use a spacer with their inhaler and rinse their mouth out after using an inhaler to help their voice function a bit better.

The purpose of this post is not in any way, shape or form, advocating 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.

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.

Learning to work with the breath can be tricky even for those without asthma, so addressing it in an asthmatic requires patience, empathy and consistency. Asthmatics often have erroneous breathing patterns. They take more breaths per minute and breathe a higher volume of air than non-asthmatics. They also often breathe through their mouth and their diaphragm may not move as effectively.

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. Determining their breathing habits is crucial for developing an in studio plan.
  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 – simply observing how they are breathing while you chat with them will give you great insight. The singer may also indicate whether they are having a particularly challenging breathing day.
  5. Use the first 5-10 minutes to do some kind of gentle movement that targets the thoracic spine, ribcage and diaphragm. Increasing mobility in the ribs helps breathing – it seems obvious when you read it, but so often we don’t think that way! These are often best done standing or sitting. For many asthmatics, lying on the back can make breathing feel harder or even trigger an attack.
  6. Depending on the state of their breath on that day you may engage in a bit of breath work before moving into singing. This work might include working towards small breath holds after exhale, slowing the breath down and lightening the sense of air coming into the body. (please don’t try to do this if you are a voice teacher and haven’t been trained in how to work with asthmatics, I’m simply sharing these as an illustration.)

If you have a singer you are working with, or you are a singer with asthma you might be interested in joining the Aligned and Aware Library where we have an in depth workshop on Asthma and Singing and many breathing and movement explorations to help asthmatic singers and the voice teachers who teach them.

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