Diaphragmatic breathing (Pranayama) as a complementary therapy can markedly improve lung function in patients suffering from Myasthenia Gravis (MG) and improve overall quality of life.

Goal: The goal with this client will be to teach pranayama techniques to help improve lung function (as a result of MG), decrease risk of Myasthenia Crisis and to help improve her overall quality of life through improved breathing and reduced dyspnea. The plan will be to work with this client for 30 min 2x/week for 2 weeks in order to teach the techniques and make sure they are learned and performed correctly and safely. The metric used to determine efficacy will be a simple pre- and post- questionnaire (0-6 scale) outlining before and after improvements in breathing on a daily basis and perceived breathing improvements / reduction in chronic dyspnea.

Description: 81y old female, diagnosed 4 years ago w/ Myasthenia Gravis Medical History: Hypertension, Hypoactive Thyroid, MG, MG Crisis April 2019 (after Prednisone was dropped from 10mg to 5mg), post hip replacement and osteoarthritis; uses walker and “Rollator” for mobility; Medications: Cellcept, 12.5 mg Prednisone, Mestinon and “Ultomiris” (unapproved infusion as part of a clinical trial) - also on medications for hypertension, thyroid and anxiety Symptoms: Ptosis, difficulty breathing, systemic muscular weakness, unusual facial expressions, fatigue and depression Current Treatment and Plan of Care: On various medications (listed above), clinical trials (unsure if on placebo or the trial drug), breathing exercises daily, and intermittent yoga and home exercise

I envisioned working with this client weekly for 30 min each session 2x/week for 2 weeks implemented via Zoom.

PLAN
5 min: Centering in order to ground and relax the client.

20 min: pranayama (deep belly breathing, extended exhalation, Nadi Suddhi) in order to improve her quality of breathing and help to increase lung capacity.

5-8 min: Meditation in order to spend some time in relaxation after the practice was completed.

The branch(es) of Yoga used was mainly Hatha Yoga using Pranayama as the main tool to work with this client. The Hatha branch of Yoga supports the use of pranayama in order to relate to the key teaching and the overall goal of the sessions.

This particular client is someone who has already been working on breath work (using an at-home spirometer) in order to increase lung capacity and reduce dyspnea. It was a natural transition to incorporate pranayama with her due to her yogic background as well as western approach to the breath. She is compliant with her morning breathing routine and I am confident will continue incorporating the additional tools I was able to teach her during our time together.

Suggestions include continuing with her morning breathing exercises using her spirometer as well as to add in 10-20 min 2x/weekly of pranayama as a replacement or in addition to her current routine.

Yes, the intended plan was applied, and the goal was achieved. My intention was to give this client additional tools to use to expand her skills using the breath to manage her current diagnosis of Myasthenia Gravis and to help to reduce symptoms of shortness of breath and dyspnea.

I did not have to adapt anything in my plan. From these sessions and my time with this client I learned that adding in yoga therapy tools in conjunction with western and more allopathic approaches can be a very synergistic approach for a variety of conditions and disorders.

I think if I were faced with a similar client moving forward I would approach it much in the same way but hopefully have the time to continue working with the client for a longer duration. It wold be good to have a longer period of time to track the clients’ progress possibly even using the spirometer to see if there are quantitative increases in lung capacity. I would not necessarily change anything but would have a longer period of time to work with the client, collect data and possibly see more dramatic results.

Moving forward I’d also incorporate working on extended exhalation as part of the protocol as research shows a markedly improved increase in respiratory strength and endurance when there is a focus not just on the inhalation, but the exhalation as well.

https://pubmed.ncbi.nlm.nih.gov/9706726/
https://pubmed.ncbi.nlm.nih.gov/33467286/