For Those With Asthma, What Is Normal Breathing?

Asthma is usually characterized by coughing, sometimes wheezing, and often shortness of breath. Many people with asthma are used to having difficulty breathing or "breathing abnormally." But what does it mean to experience normal breathing, especially with asthma? We asked some of our contributors at Asthma.net to share their thoughts. Here is what they had to say:

Pay attention to frequency

Response from Theresa Cannizzarro, RRT:

Textbook normal breathing is spontaneous. The normal respiratory rate is anywhere between 12-20 breaths per minute.¹ Your breathing should feel relaxed and you shouldn’t even really notice it. When you breathe in room air (which contains 21% oxygen) gas exchange happens in the lungs and then you breathe out/flush out carbon dioxide.² When your asthma starts to act up you become more aware of your breathing as it becomes more difficult. This is when it is a good idea to have your asthma action plan handy to know what steps to take to get your breathing back under control and when to give your doctor a call.

Asthma disrupts normal breathing

Response from Lorene Alba, AE-C:

During normal breathing, air enters the body when you inhale through your nose or mouth. This air travels down your airways into your lungs and air sacs. The airways are open and clear, allowing air to flow in and out easily. When you have asthma, the airways become narrow from swelling on the inside and muscle tightening on the outside, while excess mucus clogs the airways. The air becomes trapped in the air sacs and cannot get back out through the narrow airways.³

Paying attention to how you are breathing when you have asthma can help with symptoms. First, try to always inhale through your nose; this helps warm and filter the air before it goes into your lungs. Practice breathing from your belly instead of your chest. This helps get more oxygen to your bloodstream and helps you relax. It’s easy:⁴

1. Take a slow deep breath in through your nose
2. Hold for a few seconds
3. Purse your lips (like you’re blowing bubbles) an exhale slowly
4. Repeat!

Think of when you're not in a flare-up

Response from John Bottrell, RRT:

Normal breathing is how you should feel between asthma episodes. It's what you should experience on most days. Normal is when your breathing is effortless; it's when each breath comes in effortlessly. In fact, usually, it's so effortless that you don't even think about it. It's the goal of any asthma treatment regimen. Good asthma control means your breathing is normal (or close to normal) on most days.⁵

"Normal" is different for everyone

Response from Leon C. Lebowitz, BA, RRT:

The hallmark of asthma, regardless of the type, is hypersensitivity of the airways. The most common symptoms of asthma include wheezing, shortness of breath, coughing and chest tightness. These symptoms can vary over time, in terms of how often they occur, as well as their intensity. Intensity levels can vary for patients as well - at times an exacerbation may be controlled and limited through self-medication regimens the patient has learned to use.

For the asthmatic patient in remission, breathing should be normal, which is referred to as eupnea. Eupnea is characterized by normal tidal breathing – one’s chest and shoulders will exhibit minimal movement while breathing at rest. There is easy, quiet, and unobstructed airflow both into and out of the lungs. Breathing is calm and not noticeable – one is not distinctly aware of their breathing pattern as it is effortless and without asthma symptoms. A standard breathing rate is considered to be between 12- 20 breaths per minute.^1,5

Of course, for those in whom symptoms are low grade or worsening, the tendency may be for wheezing during exhalation and the sensation that it's difficult to take a breath in. An asthmatic patient may come to see this as being 'normal' for them, although that would be considered to be an incorrect viewpoint. The goal of all asthma treatment programs should be to keep one’s breathing normal and to lessen the number of exacerbations over time. Even though many in our community have various asthma diagnoses and widely differing levels of the condition, the asthmatic in remission should have a standard breathing pattern.

Normal occurs without thinking

Response from Lyn Harper, MPA, BSRT, RRT:

During a symptom-free time period, normal breathing should be something you don’t even think about – it just happens.⁵ It should be as natural as, well, breathing. There should be no wheeze, no chest tightness, and no shortness of breath. If our medication regimen is working this is how we should feel most of the time. If that’s not the case, we may need to tweak something. The goal of therapy is to allow a person with asthma to live a regular life, which includes breathing.