I emailed the following to Dr. Grossan:

Murray Grossan, MD.
Board Certified Otolaryngology and Head and Neck Surgery
8631 W. 3rd Street Suite 440 E
Cedars Sinai Hospital Medical Towers
Los Angeles, Ca 90048

Re: Message posted to alt.support.asthma.

Dear Doctor Grossan,

In the past you have often posted to the asthma usenet group advising
asthmatics to take a look in the mirror and see how asthmatic breathing
(barrel-chested and with the shoulders drawn up by muscles not used in
normal breathing) makes a person appear.

This implies two things: firstly that you believe in teaching breathing
techniques, whereas many asthma authorities would hold that this does
not make sense.  Secondly you think that such typically asthmatic
breathing is pathological.

However the barrel chest and the pulling up of the shoulders is
remarkably similar to the respiratory maneuver for taking a maximum
deep breath - say like using a try your strength machine at a
fairground with a massive hammer.  See
http://www.lrz-muenchen.de/~s3e0101..a/Hofbauer.doc, a
book dated 1948.  The author at the time commented that athletes able
to breathe like this got a second wind. Other later writers took the
view that the maneuver was paradoxical and self-defeating, because by
drawing the abdomen in there would be, logically, less room for air.

The drawing (inward and upward) drawing of the umbilical region is
confirmed by no lesser an authority than Gray: see:

"Halls Dally (/op. cit./) gives the following figures as representing
the average changes which occur during deepest possible respiration.
The manubrium sterni moves 30 mm. in an upward and 14 mm. in a forward
direction; the width of the subcostal angle, at a level of 30 mm. below
the articulation between the body of the sternum and the xiphoid
process, is increased by 26 mm.; the umbilicus is retracted and drawn
upward for a distance of 13 mm."(http://www.bartleby.com/107/117.html).

I know from experience that a serious obstruction to breathing (pea in
the lung) does not induce breathing muscle activity in any way like
that occurring in asthmatic breathing.

It is therefore tempting to believe that asthmatics are not in some way
crazy and self-destructive in an attack, but are simply failing to do
the deep inspiration maneuver correctly.  You say that they breathe
incorrectly, but while one is about it, it would be at least equally
likely that they are failing at an attempt to do something (a deep
inspiration) which is commonsensical, when you look at it.
Significantly, recent asthma research (Gwen Skloot) shows that in a
provocation test asthmatics only differ from normal subjects by their
failure to take a deep breath.  If normal subjects are prevented from
sighing or otherwise deeply inhaling, they respond to a provocation
test (as used in asthma diagnosis) like an asthmatic.

The logical treatment, based on the above assumption, would therefore
be to look at asthma with more empathy and physiological insight (not
simply logically) and painstakingly teaching patients to copy the deep
breath maneuver in full deatil, i. e. with the nose resistance
increased by pressing the tip of the tongue against the gums behind the
front teeth while simultaneously thrusting the upper abdomen up into
the rib cage, which is expanded.

I guess that you yourself as a non-asthmatic, might like to try
breathing asthmatically, namely attempting to breathe deeply with
minimum resistance in the nose or, respecttively, the throat and mouth,
and then analyzing the difference when taking a genuine deep
inspiration as described above. You will see the principle.

Also, a physician should surely lean over backward to avoid
unnecessarily belittling patients, which would occur on telling the
asthmatic sufferer that he is breathing stupidly, which does not seem
to be the case.

As indicated I've posted the above to alt.support.asthma.

Regards, Richard Friedel

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