Respiratory physiotherapy isn’t new – most hospitals offer it to those with conditions such as asthma and cystic fibrosis. However, the idea of respiratory physio for patients with postural orthostatic tachycardia syndrome (PoTS) is relatively new, and Kings College London is one of the only hospitals currently offering the service.
I’ve been seeing Charlie – the physio specialising in this area at Kings – for a little while now, so I thought I’d write a bit about what to expect when undergoing respiratory physiotherapy with him.
Why do people with PoTS sometimes need respiratory physiotherapy?
As any PoTS sufferer will know, high heart rates become a norm until the right cocktail of medication and lifestyle changes is established – and often even then a high heart rate is common.
When our heart rates are high, our bodies often assume we are in ‘fight or flight’ mode. As a result, our bodies try to take in as much oxygen as possible through things like increased breaths per minute, persistent yawning and sighing, and breathing through your mouth.
The thing is, we don’t need that much oxygen because we aren’t actually facing a fight or flight situation, we’re just living our normal potsie life!
We end up constantly hyperventilating, and reinforcing that state of panic within our bodies.
Respiratory physio treatment aims to bring our awareness to our breathing and gives us exercises to do to bring our breathing back to something approaching normality.
What sort of assessment can I expect?
Assessment is very simple – you’ll answer a series of questions (some of which sound totally irrelevant but aren’t!) and they’ll take a look at your breathing. For once in our lives, nothing invasive or time consuming, hooray!
What exercises are prescribed?
Obviously a care plan will vary from patient to patient, but here are the ones I was given:
- Twice a day, spend 15 minutes paying attention to your breath, breathing through your nose with your mouth shut.
- Take a few normal sized breaths through your nose with your mouth shut. At the end of an out breath hold it for as long as you can until you need to breathe in, but only take a normal size, quiet breath in at that point (i.e. don’t gasp in a lung full of air). Time how long you can hold your breath for each one, aiming to hold a little longer whilst still taking that normal size breath in at the end each time. You’ll need to take a few recovery breaths in between each of these to allow your body to recover from the perceived stress/lack of oxygen.
- Spend time breathing in for 2 counts, out for 2 counts, hold for 2 counts (and repeat continuously – no breaks), gradually moving to in for 2 counts, out for 3 counts, hold for 3 counts to learn to control the in and out breath.
- For all of the exercises above, try to breathe so that your shoulders and very upper chest stays still, and your lower chest and abdomen move (i.e. you use all of your lungs, not just the top part).
Is it difficult to change breathing habits and has it helped?
Is it difficult? Yes and no. Learning to breath through my nose was something that I found easy to change, but the second exercise above still feels like absolute torture to me! I still yawn and sigh a fair amount too. That said, I made significant improvement in all the exercises between my first and second appointments and I’m definitely less prone to getting breathless than I was, and when I do (for example walking up the stairs), I know to force my breathing to slow and make sure it’s through my nose. In the end it’s like any physio – you’ll only see improvements if you do the exercises, but it’s worth doing them!
