DIMENSIONS OF DYSFUNCTIONAL BREATHING
HYPERVENTILATION hypocapnia bicarbonate pH disturbance
CO2
Biochemical
Types of DB DB is sometimes categorised as thoracic or extrathoracic breathing pattern disorders , abnormal breathing habits , hyperventilation or as unexplained breathing symptoms ( see Table 1 ).
How common is DB ?
DB is one of the most common disturbances of function presenting in clinical practice and can affect up to 10 % of the general population . ( 5,6 ) Patients with respiratory
Psychophysiological emotions
Biomechanical
INTEROCEPTION sense of control
VAGAL TONE conditioned behaviours
HRV breathing pattern disorder
HYPERINFLATION rib cage restriction respiratory muscle
© Dr . Rosalba Courtney 2017
Figure 1 . The three dimensions of dysfunctional breathing and their impact on homeostasis
tension conditions such as asthma and chronic obstructive pulmonary disease ( COPD ), cardiovascular disease , psychological conditions such as anxiety , post-traumatic stress disorder and panic disorder , stress , exhaustion , burnout and other chronic and complex conditions associated with general disruption of homeostasis are particularly prone to DB , with somewhere between 30 % and 75 % of patients with these conditions affected ( 6 ) ( see box below ).
Why does breathing go awry ?
Breathing often becomes dysfunctional in response to pathology or other conditions that overload or disrupt feedback and feed-forward processes that normally maintain the homeostasis of breathing control . A patient ’ s history will sometimes reveal a background of obstructed lower or upper airways in childhood . They may also have a history of anxiety , overload , stress , trauma or chronic pain .
Conditions such as heart disease , asthma and COPD are common triggers for DB . It is not uncommon for people to develop DB after a viral illness , chest infection or pneumonia , with a recent study reporting that 88 % of patients with long COVID suffer from DB .( 7 ) Neuromuscular factors can also contribute to perpetuating breathing symptoms and abnormal breathing behaviours , largely because of the abnormal feedback provided to the respiratory control system by shortened , hypertonic and functional weak respiratory muscles .
Table 1 . Categorisation of Dysfunctional Breathing
TYPE OF BREATHING DYSFUNCTION DETAILS COMMON PRESENTATIONS
Thoracic breathing pattern disorders
Related to movement of the rib cage and abnormal function of the diaphragm and muscles of chest wall
Inappropriate / excessive upper thoracic and vertical breathing , excessively rapid or irregular breathing
Extrathoracic breathing pattern disorders |
Related to the larynx , pharynx and upper airway |
Paradoxical vocal fold motion , exer-cise-induced |
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laryngeal obstruction , supraglottic and subglottic |
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laryngeal dysfunction |
Abnormal breathing habits |
Conditioned and learned breathing behaviours |
Mouth breathing , aerophagia , excessive sighing , yawning |
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and gasping during speech , over-control of breathing |
Hyperventilation
Unexplained breathing symptoms
Can be acute , chronic or intermittent . Often related to increased central and peripheral chemoreceptor sensitivity and pH disturbance
Can exist when lungs and heart are healthy but can also occur in patients with respiratory or cardiovascular disease . Symptoms are inadequately explained or disproportionate and not responsive to usual medication
Breathing in excess of metabolic requirements leading to depletion of arterial and end-tidal carbon dioxide
Dyspnoea and breathing discomfort
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