How Breathing Affects Inflammation: Understanding the BOLT Score and Exercises to Improve It

It’s well known that proper breathing is essential for overall health and well-being. It isn’t just important for maintaining good air intake, but it can also help reduce inflammation in the body. Improper breathing can lead to chronic inflammation and ultimately to diseases such as autoimmune disease, diabetes, heart disease, and cancer. Breathing techniques have been used for centuries to reduce inflammation, prevent disease, and improve overall health.

The BOLT score, described by Patrick McKeown, creator of The Oxygen Advantage, and described in his book, The Breathing Cure, is a helpful tool to measure your baseline breathing as well as the effectiveness of breathing exercises. BOLT stands for Body Oxygen Level Test and is used to help you understand how well you are breathing. Unfortunately, many individuals aren’t breathing correctly due to sedentary lifestyles, acquired poor breathing habits, or chronic disease. What I like about this book and his practices, is that they are intended to correct dysfunctional breathing and promote overall proper breathing function, whereas most techniques taught or coached are intended for more singular practices such as stress reduction, immune function, exercise performance, and sleep enhancement.

Your BOLT score is best measured when first waking up, or at least after 10 minutes rest. To determine your BOLT score, you need to inhale normally through your nose, exhale normally through your nose, then pinch your nose to hold your breath until you feel the first definite physical desire to take a breath. Using a stopwatch, measure the seconds from when you first pinch to when you feel the desire to breathe. A higher BOLT score indicates that you are using better breathing techniques. While individuals, especially those who are chronically ill may have low scores of a few seconds, the goal is to improve your breathing through exercises and techniques to achieve a BOLT score of 40 seconds.

Key concepts of proper functional breathing include:

  • Breathing through the nose and not the mouth
  • Breathing light (light, slow, deep). The acronym used for light, slow, deep breathing is LSD.
  • Achieving a slow rate of respirations at rest of 6 per minute
  • Breathing properly through the diaphragm
  • Using techniques to decrease mouth breathing or snoring at night such as mouth taping.
  • Use techniques for you that help support you best and your health condition.

Functional breathing focuses on improving breathing biochemistry (the level of carbon dioxide, called CO2, cadence (the speed or rate), and biomechanics (diaphragm function). It promotes your CO2 tolerance and opens your blood vessels to allow oxygen to be released by CO2 which has accumulated in the blood. It also supports an important chemical, nitric oxide (NO) to accumulate in the nasal cavity, travel to the lungs, sterilize the air, and open the airways and blood vessels within the lungs.

A slow cadence or respiratory rate has been shown to benefit the heart and lungs. It decreases the negative response to stress through increasing heart rate variability, vagal nerve tone, and oxygenation, as well as decreasing unused lung space. Using your diaphragm correctly while breathing is important for lung expansion and filling the volume of air in the lungs to its best capacity. Learning how to expand your belly on inhalation and relaxing it on exhale is essential to preventing chest breathing which can be implicated in hyperventilation, shallow breathing, and other biomechanical breathing issues.

What influences your BOLT Score?

  • Anxiety, panic, or other psychological or emotional disorders
  • Sensitivity to carbon dioxide
  • Restriction of the airways
  • Discomfort felt in the diaphragm during the breath hold.

Examples of exercises to improve your BOLT Score:

  • Breathe Light-these exercises focus on the biochemistry of breathing and creating light air hunger through taking in less air per breath.
  • Breathe Slow-these exercises focus on the cadence of breathing and trying to reduce the rate of breathing to 6 breaths per minute.
  • Breathe Deep-these exercises focus on the biomechanics of breathing and using the diaphragm.

Other examples of breathing techniques:

  • Breath holds-these exercises are another powerful tool for calming breathing and managing inflammation. They help to strengthen the diaphragm while increasing the length of time that a breath can be held.
  • Unblocking congested nasal passages-For those who have difficulty with nasal blockage and the ability to breathe through their nose, a breath-holding technique is used to both immediately and more gradually extend the length of nose decongestion.
  • Exercise nasal breathing
  • Panic attacks-breathing into cupped hands (not a paper bag) and trying to breathe slow and low with later expansion and contraction of the lower ribs to increase CO2 in the blood, which will help blood flow and oxygen to your brain.
  • Asthma attacks
  • Obstructive Sleep Apnea/Snoring
  • Insomnia
  • Breathing exercises for children

Tips for breathing exercises: The exercises and variations of breathing exercises are intended to improve your CO2 sensitivity and increase your BOLT score.

  • The first step is to practice breathing through your nose, alone.
  • Choose specific LSD exercises, following the instructions in the book (Note that there are many variations and examples based on your tolerance and condition, so please refer to the book).
  • Practice mindfully and consistently to develop or correct dysfunctional breathing habits.
  • Practice LSD exercises correctly at rest while walking or exercising or before going to bed. The goal is to feel some air hunger both on inhalation and exhalation, but not too strongly.
  • Avoid large, deep, or fast inhalation or exhalation. In the practices McKeown shares, he acknowledges that LSD is contrary to what most individuals are taught. He also notes that other breathing experts may use forms of rapid or deep breathing practices which can be useful for specific practices.
  • Monitor your BOLT score daily at least until you achieve a score of 40.
  • Be patient and look for a gradual improvement in your BOLT score with continued breathing technique practices.
  • Use aids when needed to support nasal breathing during the day or while sleeping. Lightly taping your mouth shut with Micropore tape is one way to remind you to breathe through your nose.
  • Set a timer or a task reminder to practice your breathing techniques.

You can improve your BOLT score with regular breathing practice over time. When done properly and consistently, breathing exercises can have a dramatic effect on inflammation in the body. Additionally, they can reduce stress levels and promote adequate rest which are important ways to decrease inflammation.  Done incorrectly, however, they can contribute to poor breathing techniques that promote inflammation and chronic health issues.

It is important to note that, while these exercises can be helpful in reducing inflammation, they should not be used as a stand-alone treatment and should always be done in conjunction with other medical treatments or therapies. If you are pregnant or have a chronic condition, it is especially important to consult your health provider prior to using any of these techniques.

By understanding the importance of proper breathing techniques and incorporating functional breathing exercises into your daily routine, you can take steps to reduce inflammation in your body and improve overall health. Taking control of your breath is an effective way to manage inflammation and restore balance to your body.


McKeown, P. (2021).  The Breathing Cure: Develop New Habits for a Healthier, Happier, and Longer Life. Humanix Books,

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