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Thanks for posing this question. Please find my suggestions below.
At age 90, it becomes very important to keep the things simple for the patient. Your effort to teach pranayama is appreciable.
I would advise you not to go for any difficult pranayama which is tedious to understand. Nadi suddhi and anuloma viloma or alternate nostril breathing is sometimes confusing for elderly people.
- Something very simple like abdominal breathing or just deep breathing can be useful. This can be done in sitting or in the lying posture also.
- Introduce it in lying first and then plan it in sitting with support. Finally, we can also think of it being done in sitting without support with back erect.
If the above option is also found to be difficult, then just ask him to follow breath awareness, where one just needs to focus on breath without any active effort for its manipulation either sitting or lying.
- All fast breathing practices will be considered as contraindicated. For example kapalbhati, bhastrika and mukha dhouti. Very slow kapalbhati can be initiated under strict medical supervision under guidance of a trained yoga therapist and not yoga teacher.
- Any breathing practice where inhalation is suggested through the mouth is contraindicated. Inhaling through mouth increase risk of respiratory infections. It is even more risky for patients with congestive heart failure and COPD (chronic obstructive pulmonary disease), as in your case. So, all cooling pranayama (sitali, sitkari and sadanta) are to be avoided.
Exhaling through the mouth is perfectly fine as far as the patient is comfortable. But, there is nothing wrong in exhaling through the nose also. Let it be decided by the patient whether he wants to exhale through the mouth or through the nose.
Both ways of exhaling seems to be equally good with a bit extra priority to exhaling through the mouth. Let us not trouble him by putting any unnecessary rules.
I will consider bhramari pranayama (chanting of Nnnn while exhaling) to be best for him.
- Chanting or nada-anusandhana can be especially good for him, but definitely without any unnecessary stress on prolonged exhalation as is usually suggested by yoga Instructors. Some examples of chanting will be Om chanting, Aaa chanting, Uuu chanting and Mmm chanting.
If any religious concerns are there about any of the chanting, then these can be replaced with either only bhramari pranayama or instead of Om some other words like swim can be followed with emphasis on ''Mmmm'' sound and very minimal ''swi'' sound. Any other similar words or chants can be chosen.
- Singing is something generally beneficial for such patients. Follow his interest and let him try something.
- Graded physical exercise under supervision should be encouraged and need to be a part of the routine.
- I will put practices in order of preference here: Chanting and bhramari, breathe awareness and slow breathing practices.
- Retention of air in the lungs is common in respiratory disorders, so prolonged exhalation is common advise.
- At any stage, if there is a sudden worsening of breathlessness with or without pranayama practice, then contact your nearby hospital immediately.
Treatment proposed here is to be followed under supervision and several modifications or omissions and replacements may be needed for different individuals with same ailment or same individual at different stages of ailment.
For further information consult a yoga specialist online --> https://www.icliniq.com/ask-a-doctor-online/yoga-specialist