Asthma and difficulty breathing: resources for teenagers and young adults

Feeling breathless can happen for many reasons. For example, you may feel breathless after exercise, or after something stressful or upsetting that makes you breathe faster than normal. But being ‘out of breath’ is different than being ‘short of breath’.

For patients with asthma, breathing may feel more difficult in these situations and they may find relief using an asthma inhaler as part of their asthma action plan, as instructed by the team involved in their care. If you do not have an asthma action plan, or you are not sure what this is, please ask your healthcare team at your next clinic appointment.

Help calm your breathing

This video shows a technique you can learn to help calm your breathing, for example if you are feeling breathless after sport or exercise, or feeling the onset of asthma symptoms. Using the 'stop, drop and flop' method, the video features a breathing ladder exercise you can use to help settle your breathing.

Video transcript

Rescue breathing: "I'm stressed"

Stressful situations, panic, worry or any big emotion (such as anger, frustration and sadness) can cause your breathing to change. This can trigger symptoms such as breathlessness, dizziness, headaches, sweat, chest pain, and asthma.

This video shows you grounding and breathing control techniques to help control breathing in times of stress or big emotions. You can follow along with the video as many times as you need to help calm your breathing and emotions.

Video transcript

Rescue breathing: "I have just exercised"

Sport and exercise are really important for everyone, but especially if you have asthma. Catching your breath after sport or exercise can be hard and sometimes scary. This video shows how you can control your breathing and feel in control of your breath again. Follow along in real-time to practice, or use the techniques during or after exercise or sport so that you can continue to participate in the exercise or sport.

Video transcript

Rescue breathing: "My throat feels right"

When doing high intensity exercise or sport, some teenagers may find breathing in (inhaling) hard and feel as if their throat is tightening rather than their chest. This video shows some breathing techniques to help overcome this feeling so that you can catch your breath quickly and continue to participate in the exercise or sport.

Video transcript

You can also print the image below and use it as a tool to help control your breathing. Read the instructions in the green box before you start.

While doing the exercise, assess how you feel every 2-5 minutes – does your breath feel the same, better, or worse? Follow your asthma action plan and seek help when needed.

Once your symptoms have settled, there are ways you can try to help your symptoms go away in the longer term. You can also speak your healthcare team for more advice.

Please find below some useful handouts to help with breathlessness:

• When you're feeling like a superhero vs when things feel tough
• What can I do to help my symptoms go away?
• The 'Take 5' breathing hand for rescue breathing

Breathing checklist

This video shows how to check you are breathing as well as you can. There are many ways to breathe: some ways can be helpful, and some can make feelings of breathlessness and chest pain worse, making it more difficult to catch your breath. Use this video to practice breathing well, and/or to check your breathing when you are feeling breathless.

Video transcript

Below are some ways to help identify your breathing pattern. Do this simple exercise to pay attention to and observe how you breathe. Then, use the list below to spot any similarities with what you noticed about your breathing, comparing it what a good breathing pattern looks like.  

You may have one, two or all of the things in the table to work on. However, just work on one thing at a time.

A simple exercise to observe your breathing pattern

1. Set a timer for two minutes
2. Sit in front of a mirror and place one hand across your stomach (like you are giving yourself a hug) and the other on top of your chest
3. Start the timer and carefully observe and feel your breathing
4. Ask yourself these questions:

• am I breathing through my nose or my mouth?
• can I hear my breathing? Is it loud, quiet or silent?
• am I breathing to the top of my chest or down to my tummy and lower ribs?
• is there a gentle rhythm to my breathing? Would I compare it to a calm sea or a stormy sea?
• how am I sitting or standing? Are my shoulders round? Is my chin forward? Can I sit up straight with my chin in and shoulders back?

Please use the handout below to help guide you through your breathing pattern checklist: 

• Your good breathing checklist

This series of short videos have been created to support breathing retraining. Work through them one at a time to help you master your breathing. 

Over breathing vs slow breathing 

There are many ways to breathe. Breathing well can help us cope with stress, intense exercise and challenging situations. Breathing in an unhelpful way can limit what we do, which can make it more difficult to exercise, and cope with worry and emotions. It can also make you feel as if your breath is not under control.

This 4-minute video explains how over-breathing can lead to feeling breathless quickly, and how you can use slow breathing to manage breathlessness.

Relaxation with breathing

Breathing exercises can be key to helping you relax from the stresses of everyday life, and it can be a powerful mechanism to help relax the body and the brain. This video shows a body scan technique you can use to help you do this. 

Restart nose breathing

Our noses not only help us to breathe but they clean, warm and wet the air to keep our lungs happy and help the right breathing muscles work. This is important for controlling your breathing during exercise and times of stress, and for helping the brain to function.

If you have dry lips, it may be a sign you are a mouth breather. Ask someone to see if you breathe through your nose or mouth.

Watch this video to learn about how to start breathing through your nose again, which isn’t always as easy as it sounds.

Exploring how you breathe

Join in with this video to learn how you can breathe into many places in your chest to help you improve your breathing and feel your breathing fully. 

For this exercise, you will need some space on the floor, and a mat, if you have hard floors.

People with asthma may find that their breathing feels fine when they are resting but becomes harder to control when they take part in physical activity.  

This could be due to how they are breathing (their breathing pattern) or their fitness level. Understandably, feeling breathless after exercise or physical activity can be uncomfortable, scary and frustrating and because of this it is not uncommon for teenagers to reduce their activity, which can lead to a decrease in fitness levels and overall wellbeing.

Research shows that regular exercise improves asthma control. However, we also know that up to a third of people with asthma experience exercise-induced asthma symptoms. But there are steps that can be taken to help reduce the onset of symptoms, including:

• having an asthma action plan that includes guidance on inhaler use before and/or during exercise
• learning techniques to control breathing during exercise
• getting advice from your healthcare team 

Watch the videos to learn how to breathe well when exercising or participating in sport.

Breathing training for sport: The warmup

Breathing well during warm up before exercising or sport can help you to continue breathing well when you start the main activity.   

This video shows you how to set up your breathing during a warm up.

Breathing training for sport: Interval training

Once you have learned how to set up your breathing during a warm up, it is important to continue breathing well when exercising or participating in sport.

This video teaches you how to use treadmill interval training to manage your breathing. This can be particularly helpful for activities and sports like sprinting, football, and athletics, where you have bursts of intense movement, but which isn’t always constant. This video also teaches you how to rate your breathing so you can help recover your breathing quickly.

Breathing training for high intensity exercise and sport

High intensity exercise and sport, like swimming, require different breathing techniques.

This video shows breathing techniques you can use to help control your breathing during high intensity exercise. These techniques can also help with completing a high intensity activity.

Please find below some useful handouts to support breathing during exercise:

• Top tips for staying in control of your breathing when exercising

The video below will help explain:

• The mechanics of breathing; you will learn how the body was designed and ‘programmed’ to breathe and how this can change with asthma
• How the body responds when you exercise and how your breathing should change. We will explore different ways people breathe and how these can help control asthma symptoms of breathlessness and difficulty in breathing and how they could make them worse.
• With the help of Charlotte (aged 18) we will try out some different ways of breathing and get you thinking about how you breathe in a whole new way.

We recommend watching the video in 10 minute blocks.  

Posture is the position in which you hold your body. How you breathe can change your posture and your posture can change how you breathe. There is no way to get your breathing perfect if your posture is not right. The trick is to think about this little and often – initially it may not be comfortable to hold a good posture for long if the muscles are not used to holding your body in a certain way. But, if you keep correcting yourself throughout the day, your muscles will adjust and slowly get used to a different posture.

Too slumped                                                                                                    

Shoulders and back rounded and chin poking out. It is hard to breathe down to your lower ribs as they are squashed. In this posture you will tend to breathe to the top of your chest.

Too straight

The back is over-arched, shoulders are up and the tummy is in. Sometimes you might do this when doing lung function or peak flows – but it doesn’t help get bigger numbers.

Just right

Back is straight but keeps its normal curve, shoulders are back and down and the chin is in.

The lower ribs are free to move and breathe without being squashed.

How to exercise safely

• Please make sure someone knows you are exercising, your parents, coach or family member. If you are exercising alone make sure you have your mobile phone with you in case you feel unwell.
• Always follow your personalised asthma action plan and take your prescribed asthma inhaler(s) (e.g. preventer or reliever inhalers) before exercising.

Other things to think about

• Before you start any exercise make sure you are feeling well
• Wear comfortable clothing (not to tight around your stomach or ribs) and supportive shoes
• Make sure there is enough room to exercise safely if exercising indoors/ at home
• Make sure you are well hydrated, have a glass of water before exercising and keep a bottle of water near you during exercise
• Start exercising gradually, a warm up is important for your heart, lungs and muscles. Build up the energy levels during the exercise as you feel comfortable
• If you are diabetic, check your blood sugar levels before and after exercise and make sure you have a fast-acting energy snack or drink (e.g. Lucozade), and a slow-acting snack (e.g. a sandwich) to hand if needed.
• Make sure you have your reliever inhaler and spacer to hand, in case you need to use it before, during or after exercise.

When to avoid exercise:

• If you are feeling unwell with a cough, wheeze, chest pain or temperature
• If you have been awake overnight because of your asthma symptoms
• If you have been prescribed a new course of steroids (prednisolone) or antibiotics for your asthma
• If your peak flow volumes dropping (if you keep a peak flow diary)
• If you have not taken your regular inhaler medications as prescribed, or you have run out of any of their regular or rescue medications
• If your personalised asthma action plan is over a year old.

Identifying a possible asthma attack

You should stop exercising and seek help if:

• You cannot talk in full sentences or walk easily because of your breathing
• Your symptoms (wheeze, chest pain, cough) are getting worse quickly
• Your extra reliever inhaler medications are not helping

This advice is in line with the green, amber, red system on your personalised asthma action plan. If you do not have an asthma action plan or need further guidance on following your asthma action plan, please speak with your healthcare team.

How should activity make you feel?

Sometimes it is hard to tell the difference between asthma symptoms and what is normal for our breathing when we exercise.

When exercising, you may feel:

• More breathless, but still able to talk
• Warmer or slightly sweaty
• Their heart beating faster

This is a normal response to physical exertion and does not necessarily indicate symptoms of asthma.   

Monitoring the intensity of your activity

When you are exercising or taking part in physical activity, it is important to measure its intensity to make sure you are safe and get the most benefit out of the activity. For example, if you are not slightly breathless during exercise, it is likely you are not exercising hard enough. On the other hand, if you cannot talk because you are so breathless, it is likely you are exercising too hard.

The rate of perceived exertion (RPE) scale below can be used to indicate how hard the exercise feels for you and what your breathing pattern ‘should’ be.

You can use the RPE scale with your parents, PE teachers and coaches or on your own. They should ask you how you would score your breathlessness (0-10).

• If the score is less than 4 (i.e. the exercise feels light) you should INCREASE the pace of your exercise.

• If the score is 7 or greater (i.e. the exercise feels hard) you should SLOW the pace of your exercise.

• The score should fall somewhere between 4 and 7.

During exercise sessions...

You should slow down if:

• Your breathlessness score is higher than 7 (‘somewhat hard’)
• Your breathing seems very heavy
• You are looking or feeling very tired

Stop if:

• You feel dizzy or nauseous
• You feel clammy or cold
• You get chest pain or tightness, or a new cough
• You feel increasingly wheezy
• A specific exercise increases your pain or discomfort

These signs are not ‘normal’ responses to exercise and may indicate that the intensity of the exercise is too high for you.

Remember, it is normal to feel slightly out of breath when you exercise. You may also feel a little warmer and sweaty. If you experience any of the symptoms above, you must discuss this with your asthma team at Royal Brompton Hospital.

If you experience chest pain or tightness, or are feeling unwell, you should:

• Stop exercising
• Sit down and rest
• Follow your personalised asthma action plan and take your rescue inhalers using a spacer as prescribed by your asthma team.

If your symptoms do not go away or get better after following the advice above or they are worsening, seek emergency help.

Symptoms such as shortness of breath, feeling unable to control the breath, and tightness or pain in the chest may present like classic symptoms of asthma but can actually be symptoms of something else, for example stress and anxiety, or dysfunctional breathing. This can make it difficult to pinpoint exactly what is causing the symptoms.

We can, however, look to our body for clues to try and work out what is causing certain symptoms. Watch the video below to find out how.

This video will explain: 

• How to identify what is causing your symptoms
• What you can do to help relieve and manage your symptoms 

To learn more, you can also watch the following video:

Please find below some useful handouts to support you with telling symptoms apart:

• What could my symptoms be?
• What can I do to help my symptoms go away? 

Below you will find a list of all the handouts associated with this page and sections above. Please click each title to open and download the relevant handout. You can save to your device and also print for your personal use. 

• How to help a child when they have asthma or asthma-like symptoms
• Your good breathing checklist
• What could my symptoms be?
• What can I do to help my symptoms go away?
• When you're feeling like a superhero vs when things feel tough
• The 'Take 5' breathing hand for rescue breathing
• Top tips for staying in control of your breathing when exercising