Bhastrika and a Panic Response in an Asthmatic Student

Immediate management

• Stop the practice for the whole room, not just for him; keep your voice calm and the room quiet.
• Sit him on a chair, back supported, feet flat, and let him hold his own inhaler; do not take over his breathing or ask him to hold his breath.
• Hands on the lower ribs, encourage a soft, slightly longer exhale through the nose; count out loud to give him something to follow. Do not coach deep breaths - that would reinforce hyperventilation.
• Reassure, name what happened ('This is a breathing pattern response, and it settles'), and stay with him.
• Observe for at least 10 minutes. If wheeze, chest tightness, difficulty speaking in full sentences, or no improvement, treat as a possible asthma event: reliever inhaler as prescribed and seek medical help.
• An immediate recovery with normal speech, no wheeze and normal breathing strongly suggests hypocapnia from hyperventilation with panic, not bronchospasm - but that is a judgement, not a diagnosis, so document it and tell him to raise it with his physician.

From now on, exclude

• Bhastrika, kapalabhati and any forceful or rapid breathing.
• Antar kumbhaka at eight counts, and long holds generally: retention in asthma risks air trapping and adds to anxiety.
• Long breath-holds with a full or empty lung, and any practice taught in a competitive or 'push through it' framing.

He should not resume structured pranayama until the morning wheeze has been reviewed by his physician - that is the first step, and it should be a documented plan, not a suggestion.

Weeks 1–2 (8 minutes, seated, end of class)

• Breath awareness with hand on the belly, 3 minutes.
• Diaphragmatic breathing with a gentle 4-in / 6-out, no counting beyond comfort, 3 minutes.
• Bhramari, 5 rounds, then silence.

Weeks 3–4

• Ujjayi with a soft whisper and an exhale twice the inhale length, working only to a 4:8 ratio if that stays easy.
• Anulom vilom at 1:1, 4 counts each side, no retention, 5 minutes.
• Keep savasana after.

Weeks 5–6

• Anulom vilom 4:4 with a 2-count internal hold only if he has been symptom-free for two weeks and his physician is comfortable.
• Add a short body scan for anxiety management.

Rules across all six weeks

• Comfort is the ceiling, never the target; if he has to sniff or gasp, the count is too long.
• No practice when he is wheezing, unwell, or in cold dry air.
• Practice only seated and with his reliever within reach.
• Ask for a simple weekly log: reliever use, night waking, morning wheeze, sleep.

Referral triggers

• Morning wheeze continuing for a week, or reliever use more than twice a week.
• Night waking with cough or breathlessness; breathlessness at rest or on minimal exertion.
• A reliever that no longer works, or needing it repeatedly within a few hours.
• Any further episode of dizziness with tingling or panic during breathing practice - that is a reason to pause the practice and refer, not to push through.
• Escalating anxiety symptoms, or fear of breath practice that is starting to restrict daily life.

Documentation (same day)

• Date, session number, time, class length, who was present.
• Exactly what was taught: Bhastrika, number of rounds, eight-count antar kumbhaka.
• Symptoms as reported, in his words, plus observed signs: rapid shallow breathing, no wheeze, conscious and speaking, tingling in fingers and lips, duration of recovery (about five minutes).
• Action taken: practice stopped, seated, calmed breathing, inhaler available, monitored for 10 minutes, outcome.
• Advice given: pause pranayama, see physician about morning wheeze, bring back clearance.
• Consent to contact his physician if he agrees, and a copy of the referral note.
• Record the change to his plan and the review date. Report upward to the studio's incident process, and do not discuss his health with other students or staff who are not involved in his care.