The breathing exercise JK swears by? It may do more harm than good
IT’S the three-minute breathing exercise that can ease debilitating coronavirus symptoms – and, by now, thousands of Britons will have tried it. A video posted by urgent care specialist Dr Sarfaraz Munshi showing him demonstrating the technique has gone viral – raking in more than three million views on YouTube, no doubt bolstered by the high-profile backing of J. K. Rowling. Last week, the Harry Potter author encouraged her 14.5million Twitter followers to watch the video, saying she’d been suffering symptoms of Covid-19.
‘I am fully recovered and this technique helped a lot,’ she wrote.
Dr Munshi, who treats patients with severe respiratory illness at Queen’s Hospital in Romford, Essex, has since been on national radio detailing the method.
He claimed he made the video for close friends and never intended it to reach the public. It was supposed to simply help his mother, 58, who was struggling to breathe ten days after coming down with Covid-19. Using FaceTime, he coached her to practise the technique, which, he says, improved her respiratory symptoms.
He says, however, that the exercise is ‘not a cure’.
Several online news sites have provided step-by-step guides to how to practise it. But leading respiratory experts have warned that Dr Munshi’s method – intervals of deep breathing and coughing – may, at best, do little good and, at worst, cause problems.
He claims that the method can ease the painful cough and breathlessness seen in patients with Covid-19. The idea is that it increases the amount of oxygen that penetrates deep into the lungs, helping breathlessness.
The oxygen then gets picked up by red blood cells and is distributed to vital organs around the body.
The coughing clears the airways of any fluid or mucus that might obstruct air flow.
Low blood oxygen levels are one of the hallmarks of Covid-19 and can eventually lead to potentially fatal organ failure.
The director of nursing at the intensive care unit at Queen’s Hospital – where patients with severe respiratory illness are treated – reportedly told Dr Munshi of the exercise. Yet Laura Breach, a representative from the Association of Chartered Physiotherapists in Respiratory Care (ACPRC), warns: ‘Doing this could exacerbate cough symptoms and induce dizziness and shortness of breath.
‘It could be harmful for those with underlying conditions.’
The video advises taking five deep breaths, inhaling for a count of five seconds each time, then resting. Then, you cough, covering your mouth. Dr Munshi advises completing this cycle twice. But the ACPRC says that patients must only take three or four deep breaths in quick succession – too many can disrupt the delicate balance between oxygen and carbon dioxide in the body, making you feel light-headed.
The ACPRC says this isn’t likely to cause harm to most healthy people, it is risky for those with underlying conditions, especially when done without medical supervision.
‘This looks like a version of a simple breathing technique many intensive-care nurses use to help severely ill patients breathe after coming out of major surgery,’ says Ema Swingwood from the Chartered Society of Physiotherapy (CSP) and a specialist respiratory physiotherapist who treats patients with Covid-19. ‘But we do not advise taking so many deep breaths in one go without supervision. [In the video] he appears to be breathing in through his mouth, too, which won’t be effective.’
Other experts say inhaling through the mouth in this way may exacerbate coughing. In a statement the ACPRC said: ‘Breathing through the nose instead warms and humidifies the air and is less likely to make the cough worse.’ Experts have also raised concern about another key element of Dr Munshi’s method. After the second cycle of deep breaths, he instructs: ‘Lie flat on your front with a pillow in front of you, taking slightly deeper breaths for the next ten minutes.’ Lying on your back, he says, can increase the risk of pneumonia. It is true that turning patients on to their front is often used to treat patients in intensive care suffering with Covid-19. This improves oxygen flow into the bloodstream by stopping other organs – such as the stomach and bowel – squashing the back of the lungs. As a result, there is an increase in the amount of oxygen reaching the tiny sacs called alveoli deep inside the airways where the gas gets transferred into the blood.
Lying on the stomach also expands the diaphragm, the main muscle we use to breathe. However Breach is worried about the risk to elderly, frail patients who may attempt to do this at home, without the help of a medical team: ‘Some people may struggle to get in or out of this position without help, for very little benefit.’
She adds: ‘Safer positions can be used to help relieve breathlessness, such as leaning forward on to the back of a chair.’
Other experts have since expressed fears that the routine could delay people with severe symptoms from seeking medical treatment. Dr Alison Pittard, dean of the Faculty of Intensive Care Medicine and a consultant in intensive care medicine at Leeds NHS Trust, says: ‘My biggest concern is that they then delay going to hospital as a result. ‘People watching this video might think, if they do this, they can avoid seeking medical attention completely.’ So is there any benefit? Unlikely, say the experts. According to the CSP, with regards to treating coronavirus patients, the technique is fundamentally flawed. Swingwood says: ‘The cough associated with coronavirus is usually dry and non-productive, so taking deep breaths and coughing is unlikely to help at all.
‘There is no evidence that doing this when you have mild symptoms, or even before you get any symptoms at all, will lessen the severity of them.
‘The virus is still going to run its course and your immune system will still respond in the same way.’ And Dr Nick Scriven, former president of the Society for Acute Medicine, says: ‘Most coronavirus patients who are well enough to be treated at home will still have normal oxygen levels in their lungs anyway.’
The only possible slight benefit may be for those who have recovered from the infection, says Swingwood. ‘This could help to build the lungs back to full capacity by giving them a bit of a workout,’ she says. ‘But gentle exercise will have exactly the same effect – and is proven to be safe and effective.’