Asthma & Behavioral Medicine

Dr. Richard A. Wyckoff & Associates


An asthma attack occurs when tiny tubes in the lungs called bronchioles become inflamed and constricted. This makes it difficult for the air you breathe to get into tiny air sacs in the lungs where oxygen is passed to the red blood cells and carbon dioxide is passed back to the lungs to be exhaled. This is why it feels like you can’t breathe even though air is going into your lungs.

Asthma attcks can be triggerred by a number of things. Allergins and environmental pollution can trigger constriction of the bronchioles. So can, emotional stress and even exertion.

Treatment of asthma has always been focused on preventing or managing astma attacks.

Behavioral medicine has helped asthma sufferrers for many years by teaching general relaxation exercised and stress management. Now, one of the newest behavioral treatment discoveries is that you can reduce your suceptability to triggers by learning how to calm your sympathetic nervous system using a new kind of biofeedback called Heart Rate Variability Feedback.

What is biofeedback?

Biofeedback is the process of learning to control biological functions. This is done by watching and listening to the function changing moment by moment. A medical instrument measures the biological function and converts that information to a signal that can be understood such as a meter or graph or sound. Some biofeedback changes the signal into a computer game to make the process more enjoyable.

Over time the person learns to control the biological function even when not being monitored by the medical instrument. This has been used to treat and manage many medical concerns successfully.

Asthma is now being added to the list of conditions and diseases that can be effectively managed with biofeedback and other medical interventions.

Heart Rate Variability

How this discovery occurred is an interesting story in modern medicine. It involves what happens to our heart rate when we breathe in and out very slowly. Scientists studying the heart noticed that when we inhale our heart rate goes up slightly and when we exhale it goes down.

They later learned that each of us has a special rate of breathing which when coordinated or synchronized with our heart beat causes blood pressure to lower. They called this the resonant frequency and it is usually around six breaths per minute. Many studies confirmed that breathing at this resonant frequency causes the aorta to stretch and relax in a way that regulated blood pressure through a process they called the baroreflex.

Later they studied the effect of training this breathing strategy to people with asthma and found that it did produce fewer and less severe attacks in many people when they practiced it regularly after learning it in the biofeedback laboratory. We also have learned that this reduces high blood pressure 10 -15%. This same form of biofeedback may even help reduce depression in people who have had heart attacks.

What is it like?

Heart rate variability feedback uses a special elastic belt you wear around your belly. The belt measures respirations per minute by sending a signal to the biofeedback computer as it expands and contracts with your breathing. Sensors attached to your wrists and ankle with elastic bands measure your heart rhythm just as when you have an electrocardiogram.

After these are set up, you lie back in a comfortable chair and watch a color monitor. What you see is a yellow line going up and down across the screen. This is a pacer set by the doctor to find your personal resonant frequency.

You are instructed to breath in and out as the yellow line goes up and down. Soon you see a blue line which is your actual breathing pattern following the yellow pacer signal. A red line shows your heart rate variability and it soon starts going up and down in synchrony with your breathing.

As the Doctor slows the yellow line gradually, you discover your resonant frequency. This feels really good. You feel relaxed and pleasant all over like you do when you are waking up from a deep satisfying sleep.

The session lasts about 45-60 minutes. Most people require six to ten training sessions. As you learn, you are asked to practice at home on a daily basis. Many people like to practice as part of their daily work breaks. Instead of a coffee break they take a five minute breathing vacation. Many pople reduce the frequncy of asthma attacks and some are able to reduce medication with their doctor’s approval.

What is Behavioral Medicine?

Behavioral Medicine is the art and science of helping you to take control of your health and well being through learning how lifestyle, your emotions and stress management impact your health and quality of life. This is a specialty in the practice of psychology, social work and medicine. What about insurance? Many insurance companies cover new procedures as part of a code called health and behavior interventions. Call your insurance company and ask if they cover the health and behavior intervention codes “16151” through “16154.” These codes allow a licensed health provider in Health Psychology to treat certain medical conditions without requiring a psychiatric diagnosis. Helping you reduce asthma attacks through HRV biofeedback, relaxation training and lifestyle support is one example of why these codes were developed .

Call Dr. Wyckoff

If you have any questions, call for a free telephone consultation.