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nose breathing

Proper breathing can save your life!  Breathing experts are exploring the research behind the powerful anti-viral properties of nasal nitric oxide.  This is not the first time a new respiratory illness has hit the headlines.  One positive outcome of that is that much relevant research already exists and scientists have previously highlighted the importance of nasal breathing in preventing the spread of infections, indicating that where face masks fail, the nose may provide a natural filter for dangerous pathogens.  It is relatively obvious that the nose filter warms and humidifies air on its way into the body, whereas mouth breathing does not, but there is more to the nose than most realize.

COVID-19 is a new disease and very little direct research is currently available about its development.  Studies have, however, been published on similar illnesses, which may be significant.  A key paper from 2005, published shortly after the outbreak of the SARS (severe acute respiratory syndrome, coronavirus) reported that nitric oxide inhibits the replication cycle of the virus.  Although the total number of deaths relating to COVID-19 has now markedly exceeded that was recorded during the 2002-2003 SARS epidemic, the current mortality rate is still much lower than that of SARS, which killed 9.6% of those infected.

Many people have been asking why coronavirus is being seen as so much more serious than the annual outbreak of influenza.  It has become apparent that COVID-19 behaves very differently from flu, and it is much less well understood.  It has a very high viral load, and where flu results in a crippled immune system, this new virus attacks a very specific type of cell called the Type 2 pneumocyte.  Type 2 pneumocytes are responsible for the production and secretion of a molecule called surfactant, which reduces the surface tension of fluid in the lungs and contributes to the elastic properties of the alveoli, a small sac in the lung that exchanges oxygen and carbon dioxide.  It facilitates oxygen transport to the blood and prevents lung collapse and swelling (edema).  Now imagine that this function is compromised and it begins to make sense why coronavirus can be deadly for even a young, healthy person, and why it can cause damage to organs including the heart.  The authors of the 2005 study found that nitric oxide has an anti-viral effect, specifically inhibiting the replication of the virus during the early stages of infection.  Their research showed that nitric oxide inhibits viral protein and RNA synthesis, essential stages of viral reproduction in SARS.

The authors of the 2005 study found that nitric oxide has an anti-viral effect, specifically inhibiting the replication of the virus during the early stages of infection.  Their research showed that nitric oxide inhibits viral protein and RNA synthesis, essential stages of viral reproduction in SARS.

Nitric oxide (NO) is produced in the paranasal sinuses-  a group of 4 air-field spaces that surround the nasal cavity.  This means that by breathing through the nose, we harness various properties of NO including its pathogen-killing powers.  NO is understood to be a vasodilator-it plays a role in the dilation of the blood vessels in the lungs so that oxygen can be properly absorbed from the air.  Another biological function of nitric oxide is the effect it has on the group of various pathogens, including viruses.  What this tells us is that nitric oxide in the nasal passages could represent an important first line of defense against infection. The existence of nitric oxide in exhaled air was first discovered in 1991 and later studies clearly demonstrated that almost all of this nitric oxide originates in the upper airways with only minor input from the lower respiratory tract and lungs.

Nitric oxide is inhaled in large quantities during nostril breathing and has been proven to be important for its role in surfactant production.  It controls the production of surfactants by the alveolar cells and preserves surfactant function-an ability that is used in clinical settings to treat premature infants.  A paper published in 2009 by the scientist responsible for the research into the SARS virus, states that “nitric oxide is involved in local host defense in the upper airways.”  The research also suggests that while it is unclear whether nitric oxide acts directly on microorganisms or if it works in combination with other components to produce its toxic impact, it may help to keep the sinuses sterile.  Indeed, it is possible that very low levels of nasal nitric oxide in patients with cystic fibrosis or Kartagener’s syndrome may contribute to the increased susceptibility to respiratory infections.  Interestingly, the study also found that nitric oxide inhibits the replication of SARS in 2 distinct ways.

A 2013 publication called “EVIDENCE FOR THE CURE OF FLU THROUGH NOSE BREATHING” is equally affirmative, stating that nasal breathing is helpful for patients with flu.  The paper explains that nasal nitric oxide is harnessed during nose breathing and that since nitric oxide has been proven to destroy influenza viruses, inhibiting the early stages of the replication cycle, nitric oxide can kill the flu virus and therefore provide a “cure.”  This is consistent with research from 1999 and 2000 that found nitric oxide has “opposing effects” in viral infections including flu and pneumonia and that it inhibits the replication of a variety of viruses.  Research into the human rhinovirus (HRV), the primary cause of the common cold, concludes that humans may produce more nitric oxide in response to HRV infection, theorizing that the gas plays a key role in viral clearance.

Without regular inhalation and exhalation through the nostrils, nitric oxide in the nasal airways goes unused therefore the simplest way to naturally increase nitric oxide use is by nostril breathing.  Evidence suggests that humming is effective in emptying the paranasal sinuses of accumulated nitric oxide, leading to far greater production of the gas. A 2005 review of nasal nitric oxide found that humming creates 7 times more nitric oxide than normal exhalation.  This was discovered by researchers in 2002 and is thought to be due to oscillations in the air, which accelerate the exchange of air between the sinuses and nasal cavity.  The fact was reiterated in a 2003 study by the same authors, which concluded: “single-breath humming causes a great and reproducible increase in nasal nitric oxide output in healthy subjects.”  This paper also reported that during breath-holding, the concentration of nitric oxide increases to a greater extent in the nose than in the throat, indicating that the majority of nitric oxide is produced in the nose.  Researchers in a 2013 trial involving 9 scuba and 5 breath-holding divers, also observed an increase in circulating nitric oxide for the breath-hold group.  Additionally, a study from 2006 found that humming was an effective therapy in chronic rhinosinusitis, a fungal condition that creates inflammation and infection in the nose and sinuses.  Scientists hypothesized that strong prolonged humming increases the production of nitric oxide in the nose and that this eliminated rhinosinusitis by antifungal means.  While no research exists to support this idea, it may be possible that since nitric oxide has proven anti-viral properties, humming could provide similar results in the treatment of respiratory viruses.

Much of the worry around coronavirus stems from uncertainty.  However, what is certain is that large amounts of nitric oxide are constantly being released in the airways during nasal breathing and that this gas has been found to have important anti-viral functions that defend against the replication of flu-like illnesses.  The mechanism of COVID-19 is still unknown, and it would be cavalier to state that nasal breathing will kill the virus.  However, it has been consistently proven that nasal breathing leads to better overall health, and it makes logical sense, given that the primary defense to airborne viruses is in the nose and not the mouth, that breathing through the nose can support the body’s natural resistance to infection.

How does the virus spread?  Just like other respiratory infections, the virus travels from person to person in droplets of bodily fluid such as mucus or saliva.  When an infected person sneezes or coughs, the virus disperses into the air and onto surrounding surfaces.  Droplets from coughs and sneezes can travel several feet and stay suspended in the air for up to 10 minutes, increasing the likelihood of infection for anyone who comes in direct contact with a sick person or touches a contaminated surface.  Because COVID-19 is a brand new virus in humans, no one has immunity to it, and this increases both the fear factor and the potential for infection.

Preventative Measures:  Much of the advice around coronavirus focuses on hygiene practices such as frequent and thorough hand washing, self-isolating, and catching sneezes in the crook of the elbow.  The use of face masks has become synonymous with outbreaks of this type, but these will not prevent you from becoming ill.  While people who are already not well should wear a mask to avoid the passing of the virus, most masks are too loose to be effective, and even medical-grade masks can offer a false sense of security.  In the US, the CDC Surgeon General initially had urged to the public not to buy masks, warning that it would not help against the spread of the illness, but will take away vital resources from healthcare professionals.  The CDC now recommends everyone to wear a mask when out in the public. The advice in the United Kingdom is conflicting, but the UK government still does not recommend the use of masks.  However, many people feel safer wearing a mask as an additional precaution to social distancing.  This has prompted a wave of misinformation on social channels.

The takeaway about the above nitric oxide information is that we should all be breathing through our nose and not our mouth.  Breathing through our nose enhances oxygenation by a whopping 18% and improves the health of all systems in our body, including the brain, heart, and immune system.  Many children and adults have become mouth breathers, which increases the risk of developing a number of health issues.  Many illnesses can be prevented and/or reversed by proper breathing through the nose.  If you would like more information about the importance and techniques of proper nasal breathing, please contact me at kvrbicky@midwesthealthpartners.com.