An unusual case of a healthy woman who had to check into emergency care as a result of vigorously performing yogic breathing exercises raises a cautionary note. A case report, published in Chest, The Cardiopulmonary and Critical Care Journal, (2004; 125 [5], 1951–2), describes a healthy 29-year-old woman who had spontaneous pneumothorax caused by
the yoga breathing technique Kapalabhati pranayama or “breath of fire.” Pneumothorax occurs when free air is present in the pleural cavity, with secondary lung collapse.

Kapalabhati pranayama is a cleansing breathing exercise performed by exhaling forcefully after a passive inhalation, all
through the nostrils. The purpose is to rid
the lungs of stale air and fill the lungs with
oxygen-rich air. Yogic masters insist that
any pranayama techniques, including Kapalabhati, should be performed only
under the instruction and direction of an
experienced and knowledgeable instructor.

Doctors noted that limited research on
yogic breathing practices has demonstrated
improvements in heart rate, glucose and cholesterol levels, blood pressure and exercise tolerance; a decrease in urea levels; and positive effects on asthmatic patients. At the same time, this case, although isolated, prompted the physicians involved to alert other medical professionals that with the increasing popularity of yoga, many doctors may be asked for advice from their patients about the benefits and risks of yogic practices. This case report illustrates that adverse side effects can occur if a person pushes the body to physiologic extremes. While the woman’s and her instructor’s level of training are unclear from the case report, note that this is the only such case on record.