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THE NOSE
BY PATRICK MCKEOWN
MOUTH BREATHING PREVALENCE
MOUTH BREATHING PREVALENCE
bull To identify the prevalence of mouth breathing in children
at primary school ages from 6-9 years researchers in
Portugal examined 496 answered questionnaires from
parents It was found that 568 of children in this study
breathed through their mouth
bull Felcar Jm Bueno Ir Massan Ac Torezan Rp Cardoso Jr Prevalence of mouth breathing in children from an elementary school Cien Saude Colet2010 Mar15(2)437-44
MOUTH BREATHING PREVALENCE
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table
until 370 had been enrolled this number had been determined by
statistical calculation
bull 370 children enrolled
bull Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth
breathers
bullAbreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr (Rio J)2008 Sep-Oct84(5)467-70
MOUTH BREATHING PREVALENCE
150 children in the sample with ages ranging from 8 to 10
years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3
minutes
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Mouth breathing prevalence was of 533 There was no
significant difference between gender age and type of
breathing
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E
Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Facial alterations were incomplete lip closure (588 X
57) fallen eyes (400 X 14) High palate (388 X
29) Anterior open bite (600 Versus 300)
Hypotonic lips (38 X 00) Circles under the eyes
(975 Versus 771)
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
MOUTH BREATHING PREVALENCE
bull To identify the prevalence of mouth breathing in children
at primary school ages from 6-9 years researchers in
Portugal examined 496 answered questionnaires from
parents It was found that 568 of children in this study
breathed through their mouth
bull Felcar Jm Bueno Ir Massan Ac Torezan Rp Cardoso Jr Prevalence of mouth breathing in children from an elementary school Cien Saude Colet2010 Mar15(2)437-44
MOUTH BREATHING PREVALENCE
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table
until 370 had been enrolled this number had been determined by
statistical calculation
bull 370 children enrolled
bull Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth
breathers
bullAbreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr (Rio J)2008 Sep-Oct84(5)467-70
MOUTH BREATHING PREVALENCE
150 children in the sample with ages ranging from 8 to 10
years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3
minutes
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Mouth breathing prevalence was of 533 There was no
significant difference between gender age and type of
breathing
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E
Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Facial alterations were incomplete lip closure (588 X
57) fallen eyes (400 X 14) High palate (388 X
29) Anterior open bite (600 Versus 300)
Hypotonic lips (38 X 00) Circles under the eyes
(975 Versus 771)
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
bull To identify the prevalence of mouth breathing in children
at primary school ages from 6-9 years researchers in
Portugal examined 496 answered questionnaires from
parents It was found that 568 of children in this study
breathed through their mouth
bull Felcar Jm Bueno Ir Massan Ac Torezan Rp Cardoso Jr Prevalence of mouth breathing in children from an elementary school Cien Saude Colet2010 Mar15(2)437-44
MOUTH BREATHING PREVALENCE
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table
until 370 had been enrolled this number had been determined by
statistical calculation
bull 370 children enrolled
bull Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth
breathers
bullAbreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr (Rio J)2008 Sep-Oct84(5)467-70
MOUTH BREATHING PREVALENCE
150 children in the sample with ages ranging from 8 to 10
years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3
minutes
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Mouth breathing prevalence was of 533 There was no
significant difference between gender age and type of
breathing
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E
Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Facial alterations were incomplete lip closure (588 X
57) fallen eyes (400 X 14) High palate (388 X
29) Anterior open bite (600 Versus 300)
Hypotonic lips (38 X 00) Circles under the eyes
(975 Versus 771)
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table
until 370 had been enrolled this number had been determined by
statistical calculation
bull 370 children enrolled
bull Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth
breathers
bullAbreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr (Rio J)2008 Sep-Oct84(5)467-70
MOUTH BREATHING PREVALENCE
150 children in the sample with ages ranging from 8 to 10
years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3
minutes
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Mouth breathing prevalence was of 533 There was no
significant difference between gender age and type of
breathing
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E
Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Facial alterations were incomplete lip closure (588 X
57) fallen eyes (400 X 14) High palate (388 X
29) Anterior open bite (600 Versus 300)
Hypotonic lips (38 X 00) Circles under the eyes
(975 Versus 771)
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
150 children in the sample with ages ranging from 8 to 10
years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3
minutes
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Mouth breathing prevalence was of 533 There was no
significant difference between gender age and type of
breathing
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E
Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Facial alterations were incomplete lip closure (588 X
57) fallen eyes (400 X 14) High palate (388 X
29) Anterior open bite (600 Versus 300)
Hypotonic lips (38 X 00) Circles under the eyes
(975 Versus 771)
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
bull Mouth breathing prevalence was of 533 There was no
significant difference between gender age and type of
breathing
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E
Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull Facial alterations were incomplete lip closure (588 X
57) fallen eyes (400 X 14) High palate (388 X
29) Anterior open bite (600 Versus 300)
Hypotonic lips (38 X 00) Circles under the eyes
(975 Versus 771)
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
bull Facial alterations were incomplete lip closure (588 X
57) fallen eyes (400 X 14) High palate (388 X
29) Anterior open bite (600 Versus 300)
Hypotonic lips (38 X 00) Circles under the eyes
(975 Versus 771)
bullValdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
bull We defined subjects as mouth breathers during sleep
(MBS) if they had 2 or more positive items among the
following 3 items ldquosnoringrdquo ldquomouth is open during
sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese
Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
MOUTH BREATHING PREVALENCE
bull The prevalences of MB Day and MB Sleep were 355
and 459 respectively There were significant
associations between MBD and atopic dermatitis
bullHarutaka Yamaguchi et al Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study 27 2015
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull Land mammals breathe through their noses as the
windpipe goes from the back of the nose directly to the
lungs
bull The same is true for humans at birth but after a few
months the windpipe drops down to just below the back
of the tongue in order to allow the baby to breathe
through both its mouth and nose
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull Charles Darwin was puzzled by this adaptation in
humans how unlike most animals the openings for
carrying food to the stomach and air to the lungs are
placed side by side
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull This parallel position seems fairly impractical as it
increases the risk of food going down the wrong way
requiring the development of a complicated swallowing
mechanism The cause for this is likely to do with our
ability to speak and to enable us to swim since both
actions require voluntary control over breathing
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull Birds for example are predominantly nose-breathers
aside from diving birds such as penguins pelicans or
gannets
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull Experience tells the farmer that when a cow or sheep
stands motionless with their neck extended and mouth
open they are very sick and it is time to call the vet
bull Jackson P Cockcroft P (eds)Clinical Examination of Farm Animals 1st edWiley-Blackwell May 2008 p70
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull Nasal breathing is especially advantageous for horses
and deer since it allows them to graze and breathe at the
same time while their sense of smell alerts them of
approaching predators
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull bdquoOne of the first lessons in the Yogi Science of Breath is
to learn how to breathe through the nostrils and to
overcome the common practice of mouth-breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE NOSE
bull bdquomany of the diseases to which civilized man is subject
are undoubtedly caused by this common habit of mouth
breathing‟
bull Ramacharaka Yogi Nostril versus mouth breathing In (eds)THE HINDU-YOGI SCIENCE OF
BREATH By YOGI RAMACHARAKA Author of Yogi Philosophy and Oriental Occultism Advanced Course in Yogi Philosophy Hatha Yogi Psychic Healing etc Copyright 1903 ( Expired)
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
BENEFITS OF NOSE BREATHING
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
BENEFITS OF NOSE BREATHING
bullDr Maurice Cottle who founded the
American Rhinologic Society in 1954
your nose performs at least 30
functions all of which are important
supplements to the roles played by the
lungs heart and other organs
bullTimmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed Springer 1994
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
BENEFITS OF NOSE BREATHING
bull Nose breathing imposes approximately 50 percent more
resistance to the air stream than mouth breathing
resulting in 10-20 percent more O2 uptake
bull Warms and humidifies incoming air
bull Removes a significant amount of germs and bacteria
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
BENEFITS OF NOSE BREATHING
bull Increased risk of developing forward head posture and
reduced respiratory strength
bull A dry mouth also increases acidification of the mouth and
results in more dental cavities and gum disease
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
BENEFITS OF NOSE BREATHING
bull Mouth breathing causes bad breath due to altered
bacterial flora
bull Proven to significantly increase the number of
occurrences of snoring and obstructive sleep apnoea
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull Nitric oxide (NO) was discovered in 1772 by Joseph
Priestley It is a colourless and odourless gas also known
as nitrogen monoxide and has the chemical formula NO
For over two hundred years this gas was viewed only as
being a highly toxic environmental pollutant
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull Nobody anticipated that in small quantities it would also
have crucial functions in the human body as a very
important signalling molecule NO carries messages at
the cellular level and is able to efficiently penetrate
cellular membranes
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull It is abundant in the body in that it has been found to be
produced by virtually every cell type that exists in the
body However it is unstable and short-lived with a half-
life of only a few seconds It therefore has to be renewed
continuously
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull NO can play different physiological roles depending upon
where it‟s released in the body It can be a
neurotransmitter when it‟s generated by the neurons of
the central and peripheral nervous systems It can
regulate blood pressure and inhibit blood coagulation
when it is generated in the endothelium
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull NO can also act as a cytostatic agent (ie it can inhibit
cell growth and multiplication) when it is biosynthesized
by the immune system Its presence may halt the
proliferation of cancer and pathogens
bullDr Alan Ruth ndash The Breathing Issue (2) 2016
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull In 1992 NO was named ldquoMolecule of the Yearrdquo by the
journal Science and in 1998 three American scientists
were jointly awarded a Nobel Prize for their discoveries
concerning NO as a signalling molecule in the
cardiovascular system
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull According to one of these Nobel laureates Dr Louis
Ignarro
bull ldquoThough nitric oxide‟s structure is simple nitric oxide is
now regarded as the most significant molecule in the
body absolutely crucial to your well-beingrdquo Dr Ignarro
also referred to NO as the body‟s internally manufactured
ldquowonder drugrdquo
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers at the National Heart and Lung Institute
London demonstrated that the mechanism which keeps
the bronchioles open is largely controlled by NO
bull Another team of UK researchers showed the production
of NO in the airways of the lungs They speculated that it
serves to counteract constriction of the bronchioles in
asthma
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull Researchers from the Karolinska Institute showed
increased amounts of NO in the air exhaled by
asthmatics This was subsequently confirmed and
explained to be related to the inflammatory process by
researchers at the National Heart and Lung Institute
London
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull According to Dr Robert Fried (1999)
bull NO is produced in insufficient quantity in diseases such
as asthma
bull Increasing NO availability by inhaling it has therapeutic
effects in other lung and lung-related diseases such as
pulmonary hypertension and adult respiratory distress
syndrome
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDEbull Research indicates that new born babies with respiratory
failure improve significantly when given NO to inhale
bull According to Murad and Chen (2013)
ldquoBy dilating pulmonary vessels endogenous nitric oxide
plays an important role in regulating the physiological and
pathological process of pulmonary circulation Therefore
exogenous inhalation of nitric oxide is of crucial
importance to the treatment of different types of
pulmonary hypertensionrdquo
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull In a study of a group of 33 men with nasal polyps the
authors found that erectile dysfunction was significantly
higher in this group Furthermore when the men
underwent surgery to remove the polyps and allow
restoration of nose breathing erectile dysfunction was
significantly ameliorated
bullGunhan K1 Zeren F Uz U Gumus B Unlu H Impact of nasal polyposis on erectile dysfunction Am J Rhinol Allergy 2011 Mar-Apr25(2)112-5
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull Nitric oxide (NO) is released in the nasal airways in
humans During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs
Nasally derived NO has been shown to increase arterial
oxygen tension and reduce pulmonary vascular
resistance thereby acting as an airborne messenger
bullLundberg JO Nitric oxide and the paranasal sinuses Anat Rec (Hoboken)2008 Nov(291(11))1479-84
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated Thus nasal NO
concentrations are higher at lower flow rates
bullLundberg J Weitzberg E Nasal nitric oxide in man Thorax1999(54)947-952
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull Most NO in normal human breath derives locally from the
nose where it can reach high levels during breath-
holding NO is synthesized at least in part by a steroid-
inhibitable nonbacterial NO synthase presumably
iNOS
bullDillon WC Hampl V Shultz PJ Rubins JB Archer SL Origins of breath nitric oxide in humansChest 1996 Oct 110(4) p930-938
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull Among the various biological properties of NO are its
effects on the growth of various pathogens including
bacteria fungi and viruses
bullLundberg J Weitzberg E Nasal nitric oxide in manThorax1999(54)947-952
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NITRIC OXIDE
bull The surprisingly high concentrations of NO in the nasal
airway and paranasal sinuses has important implications
for the field of otorhinolaryngology
bullNitric oxide in the nasal airway a new dimension in otorhinolaryngology Am J Otolaryngol 2001 Jan-Feb 22(1)19-32
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THEDIAPHRAGM
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE DIAPHRAGM
bull Mouth breathing is considered an abnormal and
inefficient adaptation of breathing mode and it may
induce functional postural biomechanical and occlusal
imbalances
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE DIAPHRAGM
bull To evaluate diaphragmatic amplitude (DA) in nasal and
mouth-breathing adults The study evaluated 38 mouth-
breathing (MB group) and 38 nasal-breathing (NB group)
adults from 18 to 30 years old and both sexes
bullDiaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE DIAPHRAGM
bull Mouth breathing reflected on
lower recruitment of the accessory
inspiratory muscles during fast
inspiration and lower diaphragmatic
amplitude compared to nasal
breathing
bullDiaphragmatic amplitude and accessory inspiratory muscleactivity in nasal and mouth breathing adults a cross-sectionalstudy 2015 Journal of electromyography and kinesiology 25 463-468
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE DIAPHRAGM
bull 16 athletes during an exhaustive training session After
the exercise athletes were divided in two equivalent
groups of eight subjects Subjects of the studied group
spent 1thinsph relaxing performing diaphragmatic breathing
and concentrating on their breath in a quiet place
bullMartarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE DIAPHRAGM
bull Results demonstrate that relaxation induced by
diaphragmatic breathing increases the antioxidant
defense status in athletes after exhaustive exercise
These effects correlate with the concomitant decrease in
cortisol and the increase in melatonin
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE DIAPHRAGM
bull Diaphragmatic breathing reduces
heart rates increases insulin
reduces glycemia and reduces
free-radical production as indicated
by the higher antioxidants levels
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
THE DIAPHRAGM
bull The consequence is a lower level of oxidative stress
which suggests that an appropriate diaphragmatic
breathing could protect athletes from long-term adverse
effects of free radicals
bull Martarelli D1 Cocchioni M Scuri S Pompei P Diaphragmatic breathing reduces exercise-induced oxidative stress
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
RESPIRATORY WATER LOSS
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
RESPIRATORY WATER LOSS
bull To compare the difference in respiratory water loss during
expiration through the nose and through the mouth in healthy
subjects
bull The study included 19 healthy non-smoking volunteers
without any present history of non-infectious rhinitis
presenting with symptoms of rhinitis asthma or previous nasal
surgery
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
RESPIRATORY WATER LOSS
bull During the nasal breath condensate sampling the subjects
were breathing into a transparent face mask covering the nose
and the mouth with the mouth closed During the oral breath
condensate sampling the subjects inhaled through the nose
and exhaled through a mouthpiece connected to the
condenser Sampling was stopped after 100 litres of expired
air for each breathing mode
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in
healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
RESPIRATORY WATER LOSS
bull The mean loss of expired water was 42 less by nasal
expiration before decongestion than by oral expiration
(19 x 10(-3) gL min compared to 27 x 10(-3) gL min p
lt 0001) The mean expiratory minute ventilation was 90
Lmin by nasal respiration and 98 Lmin by oral
respiration
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
RESPIRATORY WATER LOSS
bull This study showed that the net water loss increased by
42 when the breathing mode was switched from nasal
to oral expiration during tidal breathing in healthy
subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms
seen in patients suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
DENTAL HEALTH
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
DENTAL HEALTH
bull 35 triathletes who trained almost 10 hours a week
bull Significant correlation was found between caries
prevalence and the cumulative weekly training time
bull Athletes produced less saliva and it was acidic Degree
of acidity increased with the length of time exercising
Saliva is considered important to good tooth health
bull (Sports drinks dry mouth)
bullFrese C1 Frese F2 Kuhlmann S1 Saure D3 Reljic D2 Staehle HJ1 Wolff D1 Effect of endurance training on dental erosion caries and saliva Scand J Med Sci Sports 2015 Jun25(3)e319-26
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
OXYGEN CONSUMPTION
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
OXYGEN CONSUMPTION
bull During exercise nasal breathing causes a reduction in
FEO2 (fraction of expired air that is oxygen (O2))
indicating that on expiration the percentage of oxygen
extracted from the air by the lungs is increased
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
OXYGEN CONSUMPTION
bull While breathing through the nose-only all subjects could
attain a work intensity great enough to produce an
aerobic training effect (based on heart rate and
percentage of VO2 max)
bull Morton King Papalia 1995 Australian Journal of Science and Medicine in Sport 27 51-55
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NASAL BREATHING
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HOW SHOULD WE BREATHE
bull To determine if mucosal surface heat and water loss
influence the nasal functional response to cold air we
measured nasal resistance by posterior rhinomanometry
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HOW SHOULD WE BREATHE
bull During the challenge period the subjects breathed either
in and out of the nose or in through the nose and out
through the mouth
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HOW SHOULD WE BREATHE
bull No changes in nasal resistance developed when subjects
breathed exclusively through the nose
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HOW SHOULD WE BREATHE
bull However when subjects breathed in through the nose
and out through the mouth nasal resistance was
increased 200 at 1 min (P less than 001) after the
challenge and returned to baseline values by 10 min after
cessation of the challenge
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HOW SHOULD WE BREATHE
bull If the heat given up from the nasal mucosa to the
incoming air is not recovered during expiration (as is the
case with inspiration through the nose and expiration
through the mouth) nasal obstruction will occur
bullStrohl KP1 Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Pharyngeal airway dimensions are
higher in nasal-breathers than
mouth-breathers
bullInternational Journal of PediatricOtorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Once detected airway constriction multidisciplinary
approach involving pediatricians physicians dentists
and earndashnosendashthroat specialists is required The
treatment aim should be the improvement of the children
breathing condition and consequently all its associated
medical social and behavioral problems
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Our study confirms that the oral breathing modifies head
position The significant increase of the craniocervical
angles in patients with this altered breathing pattern
suggests an elevation of the head and a greater
extension of the head compared with the cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Respiratory biomechanics and exercise capacity were
negatively affected by Mouth Breathing
bull The presence of moderate forward head position acted
as a compensatory mechanism in order to improve
respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Mouth breathing children had cervical spine postural
changes and decreased respiratory muscle strength
compared with Nose Breathing
bullBraz J Otorhinolaryngol 2011 Sep-Oct 77(5)656-62 Exercise capacity respiratory mechanics and posture in mouth breathers
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Asthma children presented higher head extension and a
higher frequency of changes in hyoid bone position
compared to non-asthma children and that greater the
asthma severity greater the extension of the upper
cervical spine
bullChaves TC de Andrade e Silva TS Monteiro SA Watanabe PC Oliveira AS Grossi
DBCraniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull The results indicate that adults with mouth-breathing
childhood have postural alterations mainly in the head
and lumbar column which keeps for the whole life
bullEur J Pediatric Dent 2012 Dec 13(4)321-3 Impact of the mouth breathing occurred during childhood in the adult age biophotogrammetric postural analysis
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Neck accessory respiratory muscles and mouth breathing
suggest a direct relationship among asthma
Temporomandibular (TMD) and Cervical Spine (CSD)
Disorders This study was performed to evaluate and
correlate TMD CSD in asthmatic and non-asthmatic
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-
asthmatic predominantly mouth breathing children
(Mouth Breathing Group - MBG) (880 plusmn 161 years) and
30 non-asthmatic predominantly nasal breathing children
(Nasal breathing Group ndash NBG) (900 plusmn 164 years)
participated in this study
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
FORWARD HEAD POSTURE
bull Both AG and MBG groups demonstrated palpatory
tenderness of posterior TMJ medial and lateral
pterygoid and trapezius muscles when compared to
NBG Results showed a positive correlation between the
severity of TMD and cervical spine disorders signs in
asthmatic children
bullChaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin PediatrDent 200529(4)287-92
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
Oral Breathing in Childrenvideo
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HYPERVENTILATION SYNDROME
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HYPERVENTILATION SYNDROME
bull 14 patients presented complaining
of nasal congestion after previous
nasal surgery and who appeared to
have an adequate nasal airway with
no evidence of nasal valve
collapse were evaluated for HVS
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HYPERVENTILATION SYNDROME
bull All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
bullAm J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
HYPERVENTILATION SYNDROME
bull Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly
after failed nasal surgery
bull Am J Rhinol 2005 Nov-Dec19(6)607-11
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NOSE VERSUS MOUTH
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NOSE VERSUS MOUTH
bull Competitive athletes who regularly take part in high-
intensity training will need to alternate nasal breathing
with mouth breathing for an overall improvement to
breathing patterns High-intensity training helps to
prevent muscle de-conditioning and will require an
athlete to periodically breathe through their mouth
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NOSE VERSUS MOUTH
bull This is to be expected and can be combined with nasal
breathing to attain the best results For less-than
maximum intensity training and at all other times nasal
breathing should be employed For example competitive
athletes may spend 70 percent of their training with the
mouth closed harnessing the benefits of nasal breathing
and adding an extra load to their training to increase
BOLT score
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NOSE VERSUS MOUTH
bull They may also devote a smaller portion of training to
working at an all-out pace in order to maintain muscle
condition for which brief periods of mouth breathing will
be required
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NOSE VERSUS MOUTH
bull During competition there is no need to intentionally take
bigger breaths nor is there a requirement to breathe
less Instead bring a feeling of relaxation to your body
and breathe as you feel necessary However breath-
holding exercises during your warm-up can be very
advantageous as can practicing breathing recovery
during your warm-down
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NOSE VERSUS MOUTH
bull Competition isn‟t the ideal time to focus about how well
or poorly you are breathing as your full concentration
should be devoted to the game The best way to improve
breathing for competition is to improve your everyday
breathing and the key to this is obtaining a higher BOLT
score
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
NOSE VERSUS MOUTH
bull Recreational athletes who are not taking part in
competition or high-intensity exercise however are far
better off maintaining nasal breathing at all times While
reducing your breathing during physical exercise try not
to overdo it If you find that your need for air is so great
that you need to open your mouth simply slow down and
allow your breathing to calm once more
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