Specialist article: breathing
Asthma and nasal breathingWhy the airway begins at the front
Asthma takes place in the bronchi. But the air that arrives there has already travelled some distance. Here you can find out what the nose does for the lower airways, what studies show about mouth breathing, breathing patterns and breathing exercises in asthma, and why we see breathing, swallowing and head balance as one shared pattern.
Does this sound familiar?
Asthma treated, and yet your mouth is open?
What applies to you?
Tap whatever applies to you.
If several points apply, it is worth looking at two separate things. The asthma itself belongs in medical hands. How you breathe is a separate question: the pattern of breathing, swallowing and head balance helps determine the condition in which the air reaches your bronchi, and it can be trained.
What the nose preparesWhat studies show on breathing exercisesThe key points at a glance
- Asthma is a chronic inflammation of the bronchi, and its treatment belongs in medical hands. The medicines act in the bronchi, but they leave the breathing pattern untouched. If you follow this logic, breathing disorders can be addressed most deeply via breathing itself.
- The nose warms, humidifies and filters the air and adds nitric oxide to it. In studies, mouth breathing was associated with more asthma and, under exertion, with greater narrowing of the bronchi.
- In studies, breathing exercises mainly improved quality of life, and hardly lung function. In our view, breathing, swallowing and head balance are the prerequisite for a calm breathing pattern. There is no study on FaceFormer training in asthma.
Video
Asthma and respiratory diseases: the role breathing plays
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Fundamentals
Asthma: an inflammation of the bronchi
Bronchial asthma is one of the most common chronic diseases. It is located in the lower airways, the bronchi.
The German National Disease Management Guideline (Nationale VersorgungsLeitlinie) describes asthma as a chronic inflammation of the airways. Typical are symptoms that come and go and vary in severity: shortness of breath, wheezing, a feeling of tightness in the chest and coughing. Behind this lies bronchial hyperresponsiveness. The bronchi react more sensitively to stimuli than is the case in other people1.
of adults in Germany stated in a survey by the Robert Koch Institute that they had had asthma in the last twelve months, women more often than men2
of children and adolescents had asthma in the last twelve months according to the KiGGS Wave 2 study, boys more often than girls1
Asthma cannot be traced back to a single cause. The guideline speaks of an interplay of predisposition and external factors and distinguishes allergic from non-allergic asthma. It also recommends asking about diseases of the upper airways when taking the medical history, i.e. about the nose and sinuses1. This is exactly where this article starts, at the beginning of the airway.
Treating asthma is a medical task. Never stop your reliever inhaler or your maintenance therapy on your own, and never reduce them on your own initiative. Everything that follows in this article is in addition to your treatment and does not replace it.
The upper airway
The airway begins at the front
Before the air reaches the bronchi, it passes through a kind of antechamber in the nose. What happens there is lost with mouth breathing.
The nose is not a pipe but a functional organ. The turbinates and mucous membrane warm and humidify the inhaled air, and particles get caught in the mucus and are carried away. Why one side is often narrower is explained in the article Nasal septum.
On top of that comes a messenger substance. Nitric oxide is produced in the paranasal sinuses and reaches the lungs with nasal breathing. In six of eight healthy test subjects, the oxygen pressure measured through the skin was around 10 % higher with nasal breathing than with mouth breathing3.
Like the airlock in front of a cleanroom
Before air flows into a cleanroom, it passes through an airlock in which it is filtered, brought to temperature and humidified. That is how we see the nose. Breathing through the mouth means taking the side door. The air still arrives, but cooler, drier and unfiltered, and it hits sensitive bronchi directly.
The nose and bronchi belong to one shared airway. How an allergy can shift from the nose to the bronchi is described in the article Allergies and nasal breathing; for inflamed sinuses, see the article Sinusitis.
Research
Mouth breathing and asthma: what studies show
For a long time, it was only suspected that mouth breathing puts a strain on the bronchi. There are now data from a large population study and from small laboratory experiments.
In the Japanese city of Nagahama, 9,804 adults answered questions about their breathing and medical history; blood values and a lung function measurement were added. 17 % said they breathed through their mouth. Mouth breathing was associated with asthma, regardless of whether someone had allergic rhinitis4.
this was how high the odds of asthma were with mouth breathing without allergic rhinitis4
they were when mouth breathing and allergic rhinitis occurred together. With allergic rhinitis alone, they were 2.2 times higher4
Even among participants without asthma, mouth breathing was more often associated with sensitisation to house dust mites, more eosinophilic inflammatory cells in the blood and lower lung function4. This is an association, not proof of cause and effect. The authors do, however, consider it possible that mouth breathing increases the burden of disease because it bypasses the protection of the nose.
A trial from Sydney tested this in the laboratory. Eight adults with mild asthma that was symptom-free at the time breathed for one hour on each of two days, either only through the nose or only through the mouth. With mouth breathing alone, lung function fell step by step, and three developed a cough or wheezing by the end. With nasal breathing alone, it remained stable and nobody had any symptoms5.
The nose is the antechamber of the bronchi. Anyone who bypasses it lets the air in unchecked.Asthma has many causes. In our view, mouth breathing deprives the bronchi of a protection that the body has provided for them, and the conclusion suggests itself that cold, dry and unfiltered air intensifies their complaints.
In the trial, the other route was closed off under supervision with a nose clip or tape. We do not recommend taping the mouth shut at night; the reasons are in the article Mouth taping.
Sport and exertion
Tight chest during sport: which route the air takes
Many people with asthma know the feeling of tightness after running. Here too, the airway plays a role.
Under exertion we breathe more air in a shorter time, and many switch to the mouth. The air then reaches the bronchi cooler and drier. In some people with asthma, the bronchi narrow after exertion; this is known as exercise-induced asthma.
In a trial from India, 15 people ran twice for six minutes, once with a nose clip and once with the mouth closed. In the five who were prone to exercise-induced asthma, the narrowing was considerably less after nasal breathing alone. In people with asthma without this tendency, there was no notable difference6.
You briskly climb three flights of stairs. How do you breathe when you get to the top?
Increase nasal breathing during sport gradually. If you have exercise-induced asthma, talk to your practice about your plan for sport, and stop as soon as your chest feels tight.
Breathing pattern
When the breathing pattern gets out of step
Not all breathlessness in asthma comes from the bronchi alone. Sometimes the pattern of breathing contributes.
The guideline speaks of dysfunctional breathing when the breathing pattern deviates from the physiological sequence and this leads to recurrent or chronic symptoms1. Breathing is often fast and high in the chest, frequently through the mouth. In a British general practice, 219 adults being treated for asthma completed a questionnaire that records such patterns7.
respondents reached scores suggesting dysfunctional breathing, regardless of how intensively their asthma was being treated7
of the women were above the threshold; among the men it was 20 %7
The German National Disease Management Guideline (Nationale VersorgungsLeitlinie) takes this up. In asthma with dysfunctional breathing, respiratory physiotherapy should be offered. It also considers an additional benefit plausible in people who react anxiously to breathlessness or habitually breathe mainly through the mouth1. The breathing pattern is thus recognised as an area of its own alongside drug treatment.
The pattern deviates
Mouth breathing, a low tongue and a head that drifts forward become habits, often as early as childhood.
The body compensates
The accessory breathing muscles of the neck and chest join in, and breathing becomes faster and higher. The nervous system stores this sequence as the norm.
The consequences add up
The air reaches the bronchi unfiltered, cool and dry, and the neck and shoulders are under tension.
Symptoms become noticeable
In our view, tightness and breathlessness can arise more easily in sensitive bronchi. When and how severely depends on many factors.
The triad
Breathing, swallowing, head balance: one shared pattern
In our view, calm nasal breathing is not a resolution but the result of an interplay.
Breathing
Through the nose, with the lips loosely closed, calmly and deeply into the belly. The diaphragm does the main work, and the neck and shoulders stay relaxed.
Swallowing
Many hundreds to a thousand times a day, the tongue moves from the tongue reference position to lie against the palate. The back of the tongue seals the oral cavity off from the throat, and the air stays on its route through the nose. More under Swallowing and swallowing patterns.
Head balance
If the head balances above the body, the throat and chest remain free to move. If it drifts forward, the neck and shoulder muscles join in, and the mouth opens more easily.
A study from São Paulo shows that posture and asthma can be connected. 30 adults with persistent asthma held their head and shoulders further forward than 15 comparison subjects without asthma. Their chest expanded less, and they more often had pain in the neck, shoulders and thoracic spine8.
The study does not clarify whether posture is a consequence of the increased work of breathing or a contributing cause. In our view, each reinforces the other. More on this in the article Neck and back.
If the three functions are practised together, in our view this creates the conditions for a calm breathing pattern that runs through the nose without thinking. Muscles that are integrated into a function are used and keep their tone. What is not used goes slack. This does not target the asthma itself, but rather the route the air takes and the way you breathe.
Evidence
Breathing exercises for asthma: what has been tested
There are a number of controlled studies on breathing exercises for asthma. They paint a clear picture, including in what they do not show.
A Cochrane review pooled 22 studies with 2,880 adults, ranging from yoga and breathing training to the Buteyko method. After three months, asthma-related quality of life had improved somewhat more in the exercise groups than in the comparison groups. For asthma symptoms the result remained open, and for lung function the data were inconsistent and in part very uncertain9.
took part in a British study. Breathing training via DVD and booklet or in three sessions improved quality of life after twelve months; lung function and the inflammation marker remained unchanged11
compared breathing training in physiotherapy with asthma education. After six months, the breathing group was ahead in quality of life, anxiety and breathing symptoms; nothing changed in the inflammation and reactivity of the bronchi10
was the rise in the share of people whose asthma was considered controlled in a Canadian Buteyko group. In the comparison group with physiotherapy it was 44 to 72 %12
Breathing exercises therefore mainly change how people live with their asthma, and less so the lung measurements. Whether they reduce the need for medication is open. In the Canadian study, inhaled cortisone was reduced more in the Buteyko group12; the British authors consider this unlikely10. That decision rests with your practice alone.
There is no study on FaceFormer training for asthma. The studies mentioned test other methods, and none of them works with a device in the oral vestibule. Which studies exist on FaceFormer therapy and how they should be interpreted is set out on the page Studies and science.
The absence of a study does not mean the connection does not exist. It means it has not been tested.That is why we describe an explanatory model here and not a proven effect on asthma.
Context
Medicine and training: two levels that complement each other
Asthma therapy acts on the inflammation and width of the bronchi; the training works elsewhere.
Inhaled medicines dampen the inflammation and open the bronchi. They are the foundation of treatment, and the reliever inhaler is indispensable in acute breathlessness. Which medicines you need and at what dose is decided by your practice on the basis of your symptoms and measurements.
They do not change how you breathe. They act in the bronchi, while mouth breathing, a high breathing pattern and a head that moves forward remain unaffected. In our view, the treatment thus remains at the level of the complaints, and offerings that address the breathing pattern itself are rare. If you follow this logic, breathing disorders can be addressed most deeply via breathing itself. That is why we see training the basic functions as a level of its own alongside medication, and the two can be combined.
Medical asthma therapy
- Dampens the inflammation of the bronchi
- Opens the airways in acute breathlessness
- Is adjusted to symptoms and measurements
- In the hands of your medical practice
Training the basic functions
- Targets the breathing pattern, not the inflammation
- Practises breathing, swallowing and head balance in one sequence
- Creates the conditions for calm nasal breathing
- In your own hands
The two approaches do not replace each other; they work on different levels. More under FaceFormer and other treatments.
Have new or increasing breathlessness, waking at night from coughing or tightness, and a rising need for your reliever inhaler checked by a doctor. In severe breathlessness that does not respond to your inhaler, call the emergency number 112.
Training
Training nasal breathing: gently, with asthma
A breathing pattern does not change through insight, but through frequent and precise repetition.
The resolution to breathe through the nose often lasts only until the next exertion. That is why in FaceFormer training you practise lip closure, nasal breathing, the tongue reference position, the act of swallowing and head balance simultaneously in the same sequence. The FaceFormer sits in the oral vestibule, behind the lips and in front of the teeth. Instructions are provided on the exercise pages and in the free FaceFormer app.
The breathing exercise from module 7 is added to the basic training from around week 6. One hand rests on your belly. You breathe in through the nose for six seconds, hold your breath briefly, bite down once and swallow while doing so, and breathe out for six seconds.
Extend the subsequent breathing pause in small steps, with asthma particularly gently and only as far as it stays comfortable. The pause is meant to accustom your body to calm breathing, not to shortness of breath. Later, the head balance rotation with breathing combines both functions, ideally in consultation with a practice.
- From day 1
Basic exercise
A few minutes three times a day with the FaceFormer ZERO; you increase the repetitions week by week.
- From around week 3
Pull exercise and night
The pull exercise is added. At night you wear the FaceFormer ZERO as soon as you have mastered the basic exercise.
- After a few weeks
Switching to the ONE
During the day, you train with the FaceFormer ONE. It is the same size and shape as the ZERO, just made of firmer material.
- From around week 6
Breathing exercise
Calm nasal breathing with a pause and a swallow; extend the breathing pause gently.
- Over 6 to 12 months
The pattern runs by itself
This is how long the exercise manual expects it to take until the new sequences run without thinking. After that comes maintenance training.
When to pause or talk to a doctor first: Do not train during an asthma attack or when tightness is increasing; your emergency plan applies then. The same goes for acute inflammation in the mouth, throat or airways, a completely blocked nose and after recent surgery in the mouth. With degenerative neuromuscular diseases such as ALS or advanced Parkinson’s, train only after consulting a doctor. Children under 4 practise only with expert supervision.
Everyday life
Nasal breathing in everyday life with asthma
Lips closed, tongue up
The lips rest loosely together, the tip of the tongue at the reference point behind the upper incisors. This keeps the oral cavity sealed, and the air takes the route through the nose by itself.
Increase exertion gradually
Start by breathing through your nose while walking or cycling gently, and build up from there. If your chest feels tight, stop and follow your emergency plan.
Have your nose treated as well
If your nose is often blocked, for example with hay fever, mention it at your practice. A clear nose is the prerequisite for nasal breathing.
Breathe out slowly
A calm, long exhalation through the nose slows down hurried breathing. How breathing and the calming nerve are connected is explained in the article Vagus nerve.
Pay attention to your mouth at night
If you wake up with a dry mouth, you are probably breathing through your mouth at night. If you also snore or have pauses in breathing, read on under Snoring and sleep apnoea.
Head balance at the screen
Set up your screen and seat so that your head balances above your body and your shoulders do not hunch up.
Questions
Frequently asked
Does nasal breathing replace asthma treatment?
No. Asthma is a chronic inflammation of the bronchi and requires medical treatment. Training the basic functions addresses the breathing pattern and can be combined with it.
Why is mouth breathing unfavourable in asthma?
With mouth breathing, the air bypasses the nose, which warms, humidifies and filters it and adds nitric oxide from the sinuses. In a Japanese study with 9,804 adults, mouth breathing was associated with asthma, independently of allergic rhinitis. The conclusion suggests itself that cold, dry and unfiltered air intensifies the complaints and that the bronchi lack the nitric oxide that, in our view, also plays a part in their width. By a second route, mouth breathing changes the microbial environment in the mouth and throat, which is constantly swallowed with saliva, and the gut and lungs are in exchange via the immune system, the so-called gut-lung axis. This chain has not been demonstrated for asthma, but in our view it follows the same logic.
Do breathing exercises help with asthma?
Controlled studies mainly show better asthma-related quality of life; lung function hardly changed. The guideline recommends breathing physiotherapy where there is additional dysfunctional breathing. There is no specific study on FaceFormer training in asthma.
Can I train with the FaceFormer if I have asthma?
The training can be carried out alongside medical treatment. Do not train during an attack or when tightness is increasing. Only extend breathing pauses as far as they remain comfortable. At the start, muscle fatigue or pressure on the teeth are common; in that case, take a short break and continue with fewer repetitions.
What is dysfunctional breathing?
A breathing pattern that deviates from the physiological sequence and thereby causes recurrent or chronic complaints, for example rapid, high breathing into the chest, often through the mouth. According to the guideline, breathing physiotherapy should then be offered in asthma.
Can I reduce my asthma medication if I breathe better?
That is decided solely by your practice on the basis of your symptoms and measurements. Even if you feel better, do not change your long-term therapy or reliever inhaler on your own.
Does this also apply to COPD?
COPD is a separate disease with permanent narrowing of the airways and requires treatment by a lung specialist. How you breathe remains unaffected by it. In our understanding, training the basic functions therefore also belongs alongside the treatment of COPD, because according to our logic we see no other way of training breathing, swallowing and head balance as a shared pattern. In the event of an acute deterioration, pause. There are no studies on the FaceFormer in COPD, and what the training achieves in the individual case cannot be predicted.
My child has asthma and breathes through the mouth. What can I do?
Asthma belongs in paediatric care. Mouth breathing deserves a look of its own; it may be due, for example, to a blocked nose or enlarged adenoids. Children train with the FaceFormer ZERO, which is made of softer material, and under 4 only with expert supervision. More under FaceFormer for children and Polyps and adenoids.
More articles from the knowledge section
Where to go next
Sources
- Bundesärztekammer, Kassenärztliche Bundesvereinigung, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (2024). Nationale VersorgungsLeitlinie Asthma, Langfassung, Version 5.0. AWMF register no. nvl-002. Chapter 1 (definition, epidemiology, comorbidities) and 6.4 (respiratory physiotherapy). Source
- Steppuhn H, Kuhnert R, Scheidt-Nave C (2017). 12-month prevalence of asthma among adults in Germany. Journal of Health Monitoring 2(3):34-42. PMID 37168951. Source
- Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E (1996). Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiologica Scandinavica 158(4):343-347. PMID 8971255. Source
- Izuhara Y, Matsumoto H, Nagasaki T et al., Nagahama Study Group (2016). Mouth breathing, another risk factor for asthma: the Nagahama Study. Allergy 71(7):1031-1036. PMID 26991116. Source
- Hallani M, Wheatley JR, Amis TC (2008). Enforced mouth breathing decreases lung function in mild asthmatics. Respirology 13(4):553-558. PMID 18494947. Source
- Mangla PK, Menon MP (1981). Effect of nasal and oral breathing on exercise-induced asthma. Clinical Allergy 11(5):433-439. PMID 7318162. Source
- Thomas M, McKinley RK, Freeman E, Foy C (2001). Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. BMJ 322(7294):1098-1100. PMID 11337441. Source
- Lunardi AC, Marques da Silva CC, Rodrigues Mendes FA, Marques AP, Stelmach R, Fernandes Carvalho CR (2011). Musculoskeletal dysfunction and pain in adults with asthma. Journal of Asthma 48(1):105-110. PMID 21189115. Source
- Santino TA, Chaves GS, Freitas DA, Fregonezi GA, Mendonça KM (2020). Breathing exercises for adults with asthma. Cochrane Database of Systematic Reviews 3:CD001277. PMID 32212422. Source
- Thomas M, McKinley RK, Mellor S, Watkin G, Holloway E, Scullion J, Shaw DE, Wardlaw A, Price D, Pavord I (2009). Breathing exercises for asthma: a randomised controlled trial. Thorax 64(1):55-61. PMID 19052047. Source
- Bruton A, Lee A, Yardley L et al. (2018). Physiotherapy breathing retraining for asthma: a randomised controlled trial. The Lancet Respiratory Medicine 6(1):19-28. PMID 29248433. Source
- Cowie RL, Conley DP, Underwood MF, Reader PG (2008). A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Respiratory Medicine 102(5):726-732. PMID 18249107. Source
Get started
Ready for the training?
The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
