instruction: hi doctor my father is 90 years old he has congestive heart failure and chronic obstructive pulmonary disease he is generally in good spirits and is well taken care of he uses oxygen and his doctors have told him that when his oxygen count goes down to breathe in and exhale through mouth since his breathing is generally weak after every time he walks or climbs stairs he sits down with this oxygen tank and breathes in slightly and then exhales usually with more force than he inhaled I am trying to teach my mother about pranayama and the importance of exhaling through the nose her concern is that the doctors have taught them the breath in through nose technique and exhale through the mouth given that he is 90 with those conditions on oxygen is there a reason that he should use the technique the doctors are recommending would it be more beneficial to breath in through the nose and exhales slowing through the nose even with the tubes in his nose the latter makes more sense to me but since my mother only trusts her doctors she asked to get more information about this thank you so much for your time
output: hi 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 nazi suddhi and anuloma viloma or alternate nostril breathing is sometimes confusing for elderly people 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 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 while exhaling to be best for him 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 my sound and very minimal swi sound any other similar words or chants can be chosen 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