Breath Practices in Yoga: Kapalabhati, Bhastrika and Breath Retention Cautions

Breathing practices (pranayama) are part of yoga as it is taught in the US, along with postures and meditation, according to NCCIH.[1] Some are slow and gentle. Others are fast, forceful, or involve holding the breath. This page covers cautions for three of the stronger ones: kapalabhati, bhastrika and breath retention. It gives information only, is not medical advice, and does not teach these techniques. Instructions for forceful breathing or breath-holding are not given anywhere on this site.

What the terms mean

• Pranayama is the yoga tradition's name for breathing practices; the Indian roots of yoga are explained on What Is Yoga? and the wider topic is on Pranayama: Cultural Overview and Specific Practices.
• Kapalabhati is a fast breathing practice. A laboratory study described it as fast shallow abdominal respiratory movements at about 2 Hz (twice a second).[2] It is sometimes called "breath of fire", as in a case report.[3]
• Bhastrika is a bellows-type breath, described in a study as bellows breaths.[4]
• Kumbhaka is breath retention, meaning holding the breath.[4]

What research has found

Case reports (single or small numbers of people). One report described a healthy 29-year-old woman who came to an emergency department with a spontaneous pneumothorax (a collapsed lung) caused by kapalabhati. Its authors called it the only known such report of pneumothorax caused by pranayama, and said it shows adverse effects can occur when the body is pushed to physiologic extremes.[3] A single case cannot show how often this happens.

A 2013 systematic review of yoga case reports found 76 cases and noted that headstand, shoulder stand, lotus position and forceful breathing were the most common postures and breathing techniques cited.[5] A 2026 review of 84 adverse events from 70 studies found that the most frequently implicated practices were headstand (15 cases, 18%) and forceful pranayama (8 cases, 10%); its authors said yoga adverse events are uncommon but can cause significant harm, particularly in people with underlying risk factors.[6] Case reports show what is possible, not how common it is.

Small physiological studies. In 17 advanced practitioners, systolic and diastolic blood pressure rose during kapalabhati by about 15 and 6 mmHg.[2] In 15 healthy trained men, bhastrika and kumbhaka, each done for one minute, produced considerable and opposing effects on blood flow in a brain artery.[4] In 14 healthy volunteers doing abdominal exercises, breath holding (not a yoga practice) significantly increased the peak rise in blood pressure.[7] These findings describe body responses in small groups of healthy people. They do not tell us about harm or benefit in people with heart disease, pregnancy or other conditions.

Trials. A 2025 meta-analysis of six randomized trials (517 patients) in mental disorders found that pranayama reduced symptom severity compared with passive controls, but overall risk of bias was high in four studies, and adverse events were more frequently associated with fast than with slow breathing techniques. The authors said pranayama should not be used instead of standard therapies.[8]

Evidence labels: safety concerns about forceful breathing are supported by case reports and small physiological studies only (low-quality evidence); clinical benefit of kapalabhati or bhastrika specifically is insufficient evidence. Proper evidence not found for large trials of either technique; we searched PubMed for kapalabhati, bhastrika, pranayama adverse events and breath holding.

Who should ask a clinician first

• Heart and blood pressure conditions. NCCIH lists severe high blood pressure as a condition that may call for modifications in yoga.[1] See Yoga With High Blood Pressure or Heart Conditions.
• Pregnancy. NCCIH advises newcomers to avoid forceful breathing, and we found no pregnancy-specific studies of these techniques: Proper evidence not found. See Yoga and Movement in Pregnancy.
• Anxiety, panic or trauma. The trials in mental disorders linked adverse events more to fast breathing,[8] so go slowly and talk to your clinician. See Trauma-Sensitive Yoga and Breathwork for Stress, Sleep and Panic Sensitivity.
• Anyone with a lung, heart or other medical condition. NCCIH says people with health conditions should talk with their health care providers and the yoga instructor, and may need to avoid or modify some practices.[1]

Stop signs and urgent help

Stop any breathing practice if you feel dizzy, faint, short of breath, or have chest pain. Chest pain or severe difficulty breathing is an emergency (in the US, call 911). Overbreathing and dizziness are covered in Breathwork Safety, and stronger practices on Intensive Breathwork. Never practice breath-holding or forceful breathing in or near water.

Gentler options

Slower breathing practices are covered by the Breathwork and Relaxation pages: Breathing and Relaxation Basics, Gentle Breathing and Relaxation Practices and Breathing in Yoga for Beginners. Overall yoga trials: a review of 94 randomized trials found yoga appeared as safe as usual care and exercise.[9] A survey of German yoga practitioners linked adverse effects to hand-, shoulder- and head stands and to practicing only by self-study without supervision.[10]