Pranayama Request from a Student with Asthma and Panic Attacks
Ravi (34) has had asthma since childhood and carries a salbutamol inhaler. He also has a history of panic attacks, usually triggered by feeling short of breath. He has practiced yoga for three months and asks you to teach him Bhastrika and a 1:4:2 breathing ratio with breath holds, saying he read online that forceful breathing 'cures asthma.' You are teaching a 45-minute pranayama session to eight students in a small room with carpets and no windows open. Another student has controlled glaucoma. Ravi's baseline breath is shallow and fast; he becomes anxious when asked to close his eyes for long. He wants a strong practice and says gentle breathing feels like 'doing nothing.' You have his inhaler within reach.
1. Do you teach Bhastrika and breath retention to Ravi in this session? Justify using contraindications.
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No. Bhastrika is forceful, rapid breathing. It can increase sympathetic arousal, cause dizziness or hyperventilation, and trigger bronchospasm or panic in a student with asthma and a panic history. Breath retention is also inappropriate today: it can increase anxiety and intrathoracic pressure, and in asthma prolonged holds may worsen air trapping.
Ravi has only three months of practice and is acting on an online claim. I would explain that pranayama is not a substitute for his inhaler or medical care and that forceful techniques are not the starting point. I can teach safe foundations and revisit advanced practice only after medical clearance and stable technique. This is a scope-of-practice and contraindication judgement, not a test of his willpower. The controlled glaucoma in another student is also a reason to avoid inverted postures and forceful breath work in the room.
2. What alternative pranayama sequence and instructions would you give, and how would you monitor him?
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Sequence: supported sitting with a blanket; abdominal-diaphragmatic breathing with hands on the belly; gentle Ujjayi with a soft sound; Nadi Shodhana without retention at an equal ratio; extended-exhale breathing only if comfortable (for example inhale 4, exhale 6); then Savasana. Avoid Bhastrika, Kapalabhati, ratio breathing with holds and rapid breathing.
Instructions: 'Do not force the breath. Let the exhale be longer and softer. If you feel dizzy or tight, stop and breathe normally.' Keep his inhaler at hand. Monitor breath rate, accessory muscle use, wheeze, lip pursing, agitation and his self-rated tightness before and after. Keep the room ventilated and avoid dust or smoke. Frame success as steady, unforced breath, not intensity. Tell him he should not practice Bhastrika alone.
3. How would you respond if he becomes dizzy and panicky during practice?
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Stop the technique. Lower his gaze, ground his feet, place his hands on his belly and say: 'Let the exhale be longer and softer; do not force.' Coach four to six slow breaths, then allow normal breathing. Do not ask him to 'calm down' or hold his breath, because that can increase panic.
If panic persists, guide simple sensory grounding or counting, keep your voice low and slow, and stay with him. Check whether he needs his inhaler if there is wheeze. Seek medical help if breathing worsens or does not settle. Afterwards, debrief: dizziness is a warning, not a milestone. Document the episode and suggest he discuss pranayama with his physician. Reintroduce only gentle breath awareness next session.