Hadas Golan,M.S.

, CCC/SLP, BBE
Buteyko Educator and Trainer,
Speech-Language Pathologist,
Voice Specialist
Boston Medical Center
Department of Otolaryngology
Center for Voice and Swallowing

My name is Hadas Golan, and I will discuss the

Buteyko principles in the treatment of dysphonia.
I am a speech-language pathologist and a voice
specialist at Boston Medical Center. I am also a
member of the Buteyko Breathing Educators
Association (BBEA) and the Training Institute of
Buteyko Educators (TIBE). The information I'm
presenting today is part of the Buteyko method. I
do benefit financially from teaching the Buteyko
program and training educators. I do not receive
compensation for my roles at the BBEA and the
TIBE.

For this is a great secret: all the healing

forces reside originally in the human
breathing system.
anyone who truly understands the
whole dimension of the breath knows
the healing forces from the human side
Rudolf Steiner (1861-1925)

All chronic pain, suffering and diseases are caused

from a lack of oxygen at the cell level."
Prof. A.C. Guyton, MD, The Textbook of Medical Physiology*

Buteyko history & clinical trials

How does it work?
Asthma
PVFM
Stress
Dysphonia
Facial development
How to start normalizing the breathing today

Dr. Konstantin Buteyko was born

in 1923 in Ivanitsa (near Kiev)
As a medical student he was
assigned to monitor the breathing
of diseased patients
He noticed that illness and deep
breathing are correlated
Dr. Buteyko developed a breathing
program to correct dysfunctional
breathing and restore health

Breathing exercises specially designed to restore normal

breathing patterns combined with principles about
physical exercise, food and sleeping as they relate to
healthy breathing habits.
Buteyko provides a safe, simple, and natural means of
reducing the symptoms of asthma, allergies, chronic
bronchitis, emphysema, sleep apnea, hyperventilation
syndrome, panic attacks, bronchiectasis, hay fever,
chronic sinusitis, rhinitis, and other stress-related
diseases.

The Buteyko Method was developed in the 1950s.

It underwent extensive research and was finally
implemented into widespread use by the medical
community in Russia in the 80s.
The Buteyko Method is used widely in Russia,
Australia, New Zealand, and Great Britain. It is
taught in the U.S. since 1998
May 2008- the updated British Guidelines for the
Management of Asthma endorsed Buteyko
Technique so that GPs and asthma nurses can now
recommend it.

At 12 weeks, BBT:

70% less symptoms

90% less need for reliever medication
49% less need for ICS
Lung function- no change

Control group- taught physiotherapy

No change

Bowler, Green and Mitchell MJA 1998; 169:575-578

Results at six months;

Buteyko Group

Beta agonist decrease 85%

ICS decrease 50%

Control Group

Beta agonist decrease 37%

ICS no change

NZMJ 12 December 2003, Vol 116 No 1187

Improved asthma control from 41% to 75%

39% reduction of inhaled corticosteroids
100% elimination of inhaled corticosteroids by 21% of subjects

" I've been astonished and also very pleased with the excellent result. There
is no disruption of their life at all by their disease: normal activities; not
waking at night; not needing to use any reliever medications. It's just
great...75% control is about as good as anyone has got in any study of
asthma. The neat thing about it is that it has no side effects. It's very
safe. The Buteyko technique certainly has been shown to be an
important adjunct to treatment."

Cowie RL, Conley DP, Underwood MF, Reader PG , Respiratory Journal,

2008 May;102(5):726-32.

10

Breathing directly regulates body chemistry

Including pH, electrolyte balance, blood flow,
hemoglobin chemistry, kidney function, and
delivery of oxygen and nitric oxide

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Good breathing behavior means proper regulation

of body chemistry that ensures proper distribution
of oxygen
Bad breathing behavior means deregulating body
chemistry
The effects of deregulated chemistry on health and
performance can be dramatic and profound
causing serious physiological crisis involving
system-wide compromises

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First Assignment

Observe how many breaths you take in one

minute

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Gentle regular wave pattern

4-5 liters of air per minute with about 500ml each
breath
8-10 breaths per minute
Breathing through the nose
Using diaphragm
No upper chest movement
Initiated at 40 mm Hg of CO2 in the arteries
(PaCO2)

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Anything that happens to the human body that the

system wants to resist or reject sets up a stress
response
All stressors cause the same response in the body.
(Mini) Fight or Flight reaction causes the release of
adrenalin from the adrenal glands and our
breathing rate rises

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Fight or flight response

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Hyperventilation
Dr. Buteyko considered the 'Disease of Deep Breathing'

to be the root cause of many health conditions

Hyperventilation simply means breathing more than

metabolism requirements

He recognized chronic low grade over-breathing

(hyperventilation) that goes unnoticed most of the time

The Buteyko breathing method is designed to normalize

ventilation minute volume to normal levels, leading to

improvement of symptoms

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Hyperventilation
Da Costa, L.C Lum, Magarian describe the Hyperventilation

Syndrome-a collection of bizarre, apparently unrelated

symptoms at any organ or system

This is a profound biochemical disturbance. Patients labeled

with anxiety and implication that they are inadequate

Symptoms can be reproduced by voluntary hyperventilation
Hyperventilation Syndrome: A Diagnosis Begging for Recognition; GREGORY J. MAGARIAN, MD; DEBORAH A.
MIDDAUGH, MD, and DOUGLAS H. LINZ, MD, Portland; Topics in Primary Care Medicine

HYPERVENTILATION: THE TIP AND THE ICEBERG; L. C. Lum*

Journal of Psychosomatic Research, Vol. 19, pp. 375 to 383. Pergamon Press, 1975. Printed in Great Britain

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Chronic Hyperventilation is subtle

Litres of air breathed per minute when
resting:
12 x 0.5 = 6
(Normal)
20 x 0.5 = 10
Add effort: 20 x .75 = 15
Unrecognised because of the lack of obvious
overbreathing and minimal discussion in
medical school and textbooks

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12 breaths per minute of 0.5

litre of air equals:

20 breaths per minute of 0.5

litre of air equals:

6 litres of air breathed each

minute

10 litres of air breathed each

minute

360 litres per hour

600 litres per hour

8,640 litres per day

14,400 litres per day

60,480 litres per week.

100,800 litres per week.

720 breaths per hour

1200 breaths per hour

17,280 breaths per day

28,800 breaths per day

120,960 breaths per week

201,600 breaths per week

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Recognize chronic hyperventilation:

Mouth Open
Hearing breathing during rest
Sigh regularly
Sniff
Taking large breaths prior to talking
Yawning with big breaths
Upper chest movement
Lots of visible movement
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Normal breathing minute volume is 4-6 litres

(W.H.O.)

Minute Volume for asthma -14.1, 12, 15

litres.
(Bowler, McFadden, Johnson)

1. Loss of CO2 ?
2. Cooling of airways?
3. Drying of the airways?

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"Noisy and deep" breathing of an

asthmatic had always been considered an
outcome of the disease. Nobody could
even suspect that "deep breathing" was
the cause of bronchial asthma, and
increased depth of breathing could
provoke the appearance of the symptoms
of the disease.
K P Buteyko MD

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Breathing too much air maintains

the normal pressure of oxygen, but
it lowers carbon dioxide in both the
lungs and the bloodstream

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Is based on the importance of CO2 in

many of the functions of the body,
including:
Triggering the breathing mechanism
Maintaining the correct pH (acidity or
alkalinity)
Smooth muscle function
Low levels constrict, high levels relax
Smooth muscle constricts at 30 mm Hg
PaCO2
Affecting airway, blood vessels, and guts

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Traditional common sense has misguided us into

believing that CO2 is poisonous.
Proper exhalation of CO2 at rest~ 12-15% of the
total CO2 arriving in the lungs
The remaining 85-88% of the CO2 is retained in
the blood, and is absolutely vital to pH regulation.
Exhalation of more than this results in a CO2
deficit in the blood and other body fluidshypocapnia.
Hypocapnia disrupts fundamental biochemistry.

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Chemical receptors monitor CO2 levels in the blood. They

keep these levels normal.
The receptors reset to trigger breathing at a lower level
through constant exposure to CO2 levels lower than 40mm
Hg
Breathing is activated far earlier, causing overbreathing
If over-breathing continues, the receptors continue
resetting to lower and lower levels
41 mm Hg PaCO2
40 mm Hg PaCO2

Breathing increases up to an extra 3 LPM

Normal levels

33 mm Hg PaCO2
30 mm Hg PaCO2

Asthma symptoms
Asthma attack

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Buteyko reverses the process by changing the

level those chemo-receptors trigger
The breathing exercises slowly get the body to
adapt to trigger at higher levels of CO2
By reversing the process and sending messages
of increased CO2 levels, it is possible to reset the
trigger and return the breathing pattern to
normal
The result is breathing less air per minute

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As your pH goes higher than

7.45

Hemoglobin (oxygen- carrying blood cells) form a tighter

bond with oxygen. (Bohr effect)

Less oxygen is released to the tissues.
Tissues begin anaerobic respiration, creating lactic acid and
lowering the pH
Kidneys extract bicarbonates to help lower pH
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BAD DREAMS

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What Does Asthma Look Like?

35

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When we feel stressed F&F is activated.

Adrenaline revs up the body to survive a threat to
life - a body that is pumped up and a mind that is
hyper alert.
Saves us from life threatening events.
For some of us stress hormones wash through the
body almost continuously

37

Present day chronic Fight or Flight Response

Sighing, yawning, gasping, dry mouth, blocked

nose, runny eyes
Brain fog, irritability, anxiety, fear, lack of
concentration, light-headed, dizziness
High blood pressure, palpitations, cold hands and
feet, headaches

Poor digestion, constipation, IBS, flatulence

Aching muscles, stiffness, fatigue

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Rest and Digest Response

We have another choice

When activated heart rate drops, blood pressure falls,
respiration slows down, blood flow to the core of the
body is re-established improving digestion, immune
system function, sense of well being
Breathing is the easiest way to activate the R&D system
This should be our normal mode and F&F for
emergencies

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Dr. Buteyko perceived it as another defense

mechanism against hyperventilation
Symptoms are very similar to hyperventilation
syndrome: cant take deep enough breath, SOB,
dizziness, lightheadedness, numbness, tingling,
chest/throat tightness/pain, throat clearing, cough,
asthma meds dont help
Use current protocols through a Buteyko filter

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CONSENSUS: Proper management of breath is

essential to good singing production and vocal
health
There is no agreement in re the best approaches
and techniques to achieve this.
The vast majority of injured singers present in
clinic employing excessive respiratory effort
Excessive respiratory effort can manifest as both
cause and effect in a disordered voice.
The vast majority of injured singers say that they
are trying to use more support

41

Typical pattern of topping off the tank!

Tidal Breathing

Normal Speech Breathing

Lung Volume

Resting Expiratory Level

Typical pattern of speaking too long on one breath!

Residual Volume
Time
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Subglottal pressure determined by

the degree of expiratory muscles contraction

on the resistance against airflow provided by
the glottis

The extent to which the vocal folds close,

and the length of time they remain closed
will influence subglottal pressure
Directly related to
Loudness

43

Breath mileage- how you valve the breath at the

level of the glottis is as important (or more) than
the size of the breath you take
Sundberg: A minimum airflow is often considered
a quality criterion for good singing- the less air
consumption, the more skilled the singer
Constant glottal leakage is a sign of poor voice
technique

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For the face and consequently teeth to develop

correctly:
Mouth closed with lips gently together;
Three quarters of the tongue resting in the roof of
the mouth, with the tip of the tongue placed
behind the front teeth;
Breathing through the nose;
Correct swallowing;

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Children whose mouth breathing is untreated may develop long,

narrow faces, narrow mouths, high palatal vaults, dental
malocclusion, gummy smiles, and many other unattractive facial
features, such as skeletal Class II or Class III facial profiles.
These children do not sleep well at night due to obstructed airways;
this lack of sleep can adversely affect their growth and academic
performance.
Many of these children are misdiagnosed with attention deficit
disorder (ADD) and hyperactivity
General dentist: Mouth breathing: adverse effects on facial growth, health, academics and
behaviour. Jefferson Y, 2010 Jan- Feb; 58 (1): 18-25

46

If mouth breathing is treated early, its negative

effect on facial and dental development and the
medical and social problems associated with it can
be reduced or averted.
General dentist: Mouth breathing: adverse effects on facial growth,
health, academics and behaviour. Jefferson Y, 2010 Jan- Feb; 58 (1):
18-25

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Facial Characteristics

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Face and Jaw Development

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Buteyko therapy is a simple education program

aimed at reversing chronic (hidden)
hyperventilation
The therapy compliments and improves
conventional respiratory management
Benefits of the treatment manifest initially as a
reduction in symptoms and therefore a reduction in
the need for medications/machines
Buteyko is SAFE and EFFECTIVE

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Improved asthma control and considerably less

symptoms
Considerably less allergic reactions in the airways,
skin and gut, less mucus and congestion
Dramatic reduction in medication
Improved performance in sport and exercise
Improved stress management and stress- related
symptoms
A good night's sleep
Better voice
Muscle relaxation

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The fastest and best way to retain your CO2 is to

BREATHE ONLY THROUGH YOUR NOSE!

This means ALL THE TIME!

Day and Night

During Exercise

In fact, you should breathe through your mouth

only as often as you eat through your nose!

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Hadas Golan
Phone: 617-610-2662
Email: info@breatheon.com
Website: www.breatheon.com

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Backup Slides

58

Fight for Flight kicks in when we take a breath

through our mouths
It triggers the sympathetic nervous system to
activate quicken heart rate, faster breathing, pale,
etc.

59

Minimizes hyperventilation of speech

Decreases gasping and anxious presentation
Improves dry throat and mouth and laryngeal
irritation
Decreases effort of breathing and speech
Decreases vocal fatigue
Improves sense of control
Reduces upper chest involvement
Allows the speaker to re-center and gives
processing time for the listeners

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Count to 50 breathing every 5 numbers

When you need to breathe close your lips first

Pause and allow the air to come in without sucking

it in (take your time)

Continue

Practice reading the Rainbow passage

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When the sunlight strikes raindrops in the air,

they act like a prism and form a rainbow. ^ The
rainbow is a division of white light into many
beautiful colors. ^ These take the shape of a long
round arch, with its path high above, and its two
ends apparently beyond the horizon.^ There is ,
according to legend, a boiling pot of gold at one
end. ^ People look, but no one ever finds it. ^
When a man looks for something beyond his
reach, his friends say he is looking for the pot
of gold at the end of the rainbow.

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Breath Retraining

Faulty breathing patterns are characteristic of

people with respiratory disorders
The aim is to achieve physiologically normal
breathing- to retrain/reprogram the respiratory
center
Normalize each aspect of breathing (rate, rhythm,
volume, mechanics), for all situations (awake,
asleep, at rest, during exercise, during eating, and
speech)
Breathing is retrainable- habits can be changed

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Breath Retraining

First step is developing awareness to poor

breathing habits- pay attention to breathing in
different daily situations: how often do you breathe
from your mouth, clear your throat, sigh, yawn,
sniff, cough, breath hold, gasp when talking?
Work towards a full-time nose breathing
Work on relaxed, lengthened, upright posture
Teach diaphragmatic breathing
Work on breathing control during speech and
exercise

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Diaphragmatic Breathing

Means drawing air in predominantly through

diaphragm movement
The size of the breath is appropriate for the
situation
Is often associated with a deliberate increase in
breath size and filling more of the lungs

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Diaphragmatic Breathing

Normal tidal volume is 500 ml. Lungs have capacity

for over 4000 ml
Compared to breathing full lung capacity, normal
resting breathing is small-volume diaphragm
breathing
Deep (full capacity) breath is only appropriate for
vigorous physical exercise
In common practice, deep or abdominal breathing
exercises are large-volume diaphragmatic
breathing

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Breath Retraining

Allow the exhale to occur on its own accord,

without assistance from other muscles
Allow for transition time between the exhale and
the inhale
Experience brainstem respiratory reflexes during
transition time
Breathe quietly, making the inhale satisfying and
comfortable

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When normalizing CO2 - no need for protective

mechanism of narrowing nasal passages
Fewer irritants inhaled
Excessive histamine production reduced resulting
in less inflammation and mucus production
By breathing less protective mucus does not dry
out
The immune system is working more efficiently

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