How to inhale and exhale, and why it’s getting harder and harder.

Andrew Sullivan

Jun 30, 2023

Among my very first memories was struggling to catch a breath. Every spring in the Sussex woodlands I grew up around, the pollen descended like an invisible mist, and my lungs seized up. I’d be in my bed unable to lie down flat because if I did, the suffocation would overwhelm me. I would prop my head up on two pillows and try to sleep, my lungs wheezing back and forth like a battered accordion.

At first, I tried leaning out of my bedroom window, to breathe fresh, cooler air — but, of course, that could make things worse. I had cloth handkerchiefs to cough up into, as I bobbed along in a sea of seemingly endless phlegm. On some nights, I ran out of hankies and found myself coughing onto my sheets and bed spread and pillows. Snot was everywhere. My mum would occasionally round up all the hankies, and boil them in a pot, like a pudding, to somehow sanitize them, the steam hanging in the kitchen, fused with cigarette smoke.

The treatments back in the ‘60s and 70s were rudimentary. One was a little plastic gizmo with a tiny propeller wheel in it; you placed a capsule of white powder in the machine, put it in your mouth, and took a breath, which set off the propeller, sending these little particles into my lungs. Most of it, of course, stuck on the roof and back of my mouth, and it tasted like talcum powder.

From time to time, I would simply panic, start to hyperventilate, and run into my parents’ bedroom, scared to death, and my dad would pick me up in his arms, hold me against his chest, pace back and forth, stroking my head in rhythmic circles. He told me to calm down — completely counter-intuitive when you feel your breath being literally taken away. But over time, I learned. I trained my mind to quiet itself, and my lungs to breathe more slowly.

The asthma improved a lot as I got older, but it returned in my thirties. My husband, Aaron, would be scared when my wheezing wouldn’t quit, and I’d have to stop everything and focus just on getting the next breath out; but by then, I took it all in stride. Humidity, mold, pollen and exercise were the triggers, which was one reason I always sucked at sports. Within a few minutes I’d be doubled over trying to catch my breath as the rugby ball hurtled toward me. Even now, as I type these words, I am attached to a nebulizer, which provides me with a mist of albuterol, to open up the bronchial passages. Maybe three times a year, I have to go on prednisone on top of my daily, preventative steroid inhalers. “Worst lungs in the practice!” my doctor joked recently. Every night, I use a CPAP machine to prevent my airways from clogging up — the same CPAP that President Biden has just adopted.

I mention all this not just because I’m in the middle of one of those episodes, but because I’ve just finished a 2020 book by James Nestor, called Breath. I wish I’d read it years ago. It’s a lively, if occasionally over-written book about the science of breathing, and also a history of breathing techniques pioneered by the Asian ancients who saw in the mastery of breathing the secret to a long and healthy life.

And one of the revelations in the book, at least to me, is that almost all human breathing difficulties are of relatively recent origin. Skulls of humans in the distant past “had enormous forward facing jaws … expansive sinus cavities and broad mouths … and they all had straight teeth.” Inhaling and exhaling was as easy for them as it is for most mammals. And have you ever seen an animal with bad teeth?

How did we evolve to have difficulty breathing? The same reason we are the only species whose females die in childbirth: our brains grew faster than our bodies could evolutionarily adapt, our noses grew forward to compensate for the loss, our larynxes descended as we communicated, and our mouths and jaws got smaller, reducing the size of our airways.

In due course, in the transition to farming and agriculture, we also simply chewed far less as we cooked and grilled food. Less chewing meant weaker, smaller jaws, and even smaller mouths. As agriculture grew more sophisticated in the last few centuries, and we stored and preserved more food, and food became softer, we chewed even less, and diseases of the airways took off. It turns out you need to exercise your mouth and your nose to keep them properly functional. Who knew?

Since we can’t reboot evolution, and we’re not going to chew raw meat every day anymore, the worst cases today require surgery, excavating the sinuses to create space in your nasal cavities for air to travel in and out. For most people, however, the best remedy is simple: routinely inhaling through your nose and exhaling through your mouth. It’s a division of labor between your two facial cavities — something that every child should be taught (and in some ancient cultures were). Yet we barely pay any attention to it.

No surprise then that asthma is now the most common chronic disease in the developed world, especially for children. The rate among Americans rose about 43 percent during the first two decades of the 21st century. Theories vary — from the overuse of antibiotics to the lack of Vitamin D to increased obesity to the “hygiene hypothesis” — that we’re too removed from natural immunities. Covid certainly didn’t help, and neither have all the wildfires in recent years. But increasingly I have comrades in the phlegm wars.

READ MORE