It’s all in the breath: An argument for improved outcomes and reduced costs in healthcare

Effective breathing may not be on many healthcare finance leaders’ radar as an important area of focus for healthcare providers. But ineffective breathing can be a prelude to more severe health problems.

​I have noticed that I have been experiencing occasional difficulty breathing recently. It seems to occur whenever I am near someone who coughs or who tells me they have interacted with someone who tested positive for COVID-19. Sure, it also occurs after I have sprinted up a flight of stairs to my office with my 15-pound backpack while wearing a mask — that’s to be expected. But in the first two instances, catching one’s breath is an only natural subconscious response to the gravity of COVID-19. 

My prescription in such cases remains the same: Perform deep breathing and chi gong, and of course, listen to the first few bars of Rush’s Tom Sawyer turned up to 11. (If you’ve seen “Spinal Tap,” you’ll know what I mean.) These things all help me expand my lungs, clear my head and find some peace amid the chaos.

A fundamental contributor to good health

Breathing is essential. We all know this. However, what many may not appreciate is that introducing a modicum of active control over our breath can have remarkable therapeutic advantages.

There’s one type of breathing that we all have seen: the expanded chest, military-like version seen in soldiers standing at attention. However, there is another approach to breathing that is more conducive to good health: It is the abdominal/diaphragmatic breathing that starts with the expansion from the lower waist up. Think newborn-baby breathing.  

Both approaches are effective. But abdominal/diaphragmatic breathing can provide a greater tidal volume (normal volume of air displaced between normal inhalation and exhalation) and total lung capacity (maximum volume of air the lungs can accommodate after maximum inspiration). It therefore provides more breath and oxygen to sustain the body.

Some expand this idea further, suggesting good breathing comes in through the nose and out through the mouth, creating a conscious cycle. This approach is sometimes enhanced with imagery (e.g., breathing in light with inhalation, breathing out darkness with exhalation) to further potentiate and maintain the remarkable therapeutic effect of the breath.^a

But it doesn’t stop there. Initiating slow purposeful breathing also provides a momentary mindfulness of one’s state of being, to calm the mind.^b Moreover, controlling one’s exhale has also been shown to engage and facilitate activity of the vagus nerve (described by some as the body’s master switch) in ways that improve relaxation and promote mental and physical health.^c A controlled exhale can engage the diaphragmatic muscles, further amplifying these anxiolytic responses providing a non-addictive calming effect without the need for prescription drugs. The more you remain active, engaged and conscious of your breathing, the better you feel and the better you are.

A place in healthcare for a focus on breathing?

Can we institute breathing modalities in our overworked, overbudget healthcare industry? Would it be cost effective? 

You may be surprised to learn that the answer to both questions is “yes.”

Breathing therapy has been implemented in some healthcare domains around the U.S. and has shown improved outcomes and function in select disease states.^d Furthermore, recent reports have also demonstrated improved outcomes in physiologic/quality-of-life parameters (e.g., asthma) and their reduction in related healthcare costs, which can translate into cost saving through decreased hospital visits and related morbidities.^e

Using this concept, healthcare leaders can introduce the following approaches in their healthcare settings:

1. Take a breathing break, and encourage employees, staff, faculty and others in the organization to employ breathing exercises to rejuvenate themselves. (Tutorials can be accessed via web-based apps, videos and tailored instruction.)
2. Teach the relevance of focused breathing exercises to medical students, residents, fellows and faculty to incorporate in their daily activities and impart to their patients, thereby initiating a culture of well-being at a low cost.
3. Provide portals on breathing exercises to patients to improve retention and visibility of patients under a less medical gestalt, thereby also fostering their greater receptivity.

It also can be useful to conduct brief satisfaction or other functional surveys to track the progress and value of the initiatives and to gauge how the targeted groups are responding to the focused intentional breathing and the extent that they report an improved sense of well-being. 

We often take breathing for granted. But consider: Is there any other activity accessible to our voluntary control that we must sustain every moment in order to continue living? By recognizing the subtleties of breath and its intrinsic role in keeping us alive, we raise our consciousness about the health benefits of one of life’s simplest activities, and we can improve it with minimal effort. So embrace the principles of effective breathing. Your mind and body will thank you for it.

Footnotes

^a Marusak, H.A., Ladipaolo, A.S., Cohen, C., Goldberg, E., Taub, J.W., Harper, F.W.K., Bluth, M.H., Rabinak, C.A., “Martial arts based-therapy reduces pain and emotional distress among children with cancer, other childhood chronic illnesses, and their siblings,” Journal of Pain Research, Dec. 29, 2020.

^b Sampaio, C.V.S., Lima, M.G., Ladeia, A.M., “Meditation, health and scientific investigations: Review of the literature,” Journal of Religion and Health, April 2017.

^c Gerritsen, R.J.S., and Band, G.P.H., “Breath of life: The respiratory vagal stimulation model of contemplative activity,” Frontiers in Human Neuroscience, Oct. 9, 2018.

^d Yokogawa, M., Kurebayashi, T., Ichimura, T., Nishino, M., Miaki, H., and Nakagawa, T. “Comparison of two instructions for deep breathing exercise: non-specific and diaphragmatic breathing,” The Journmal of Physical Therapy Science, April 20, 2018; Hamasaki, H., “Effects of diaphragmatic breathing on health: A narrative review,” Medicines (Basel), Oct. 15, 2020; and University of Michigan: Digestive Liver and Health, “Diaphragmatic breathing for GI patients,” Page accessed Feb. 17, 2021.

^e Bruton, A., et al., “Physiotherapy breathing retraining for asthma: A randomised controlled trial,” Lancet Respiratory Medicine, January 2018; 6:19-28.