DYSFUNCTIONAL BREATHING DISORDERS: WHAT DO WE KNOW?
Dysfunctional breathing or inappropriate breathing is persistent enough to cause symptoms, but there's no organic cause. Another type of definition is primary dysfunctional breathing, where there is no organic cause driving it or secondary dysfunctional breathing, where something like COPD or asthma is driving dysfunctional breathing to occur. There's currently no scientific consensus definition around dysfunctional breathing. So that's an area that many groups are working towards.
If you want to learn more about this topic, you can watch Scott Peirce's lecture here:
Prevalence
In terms of prevalence and incidents, in certain conditions, such as asthma, we're looking at anywhere from 30% overlap of asthmatics will have dysfunctional breathing up to somewherein the vicinity of 60% of asthmatics have dysfunctional breathing. In other areas, such as anxiety,might be as high as 80%, according to some studies.
Biomechanical factors
Aetiological biomechanical factors that are involved in breathing dysfunction can be around cultural factors. So particularly in dancers, for example, or young females who are trying to have a narrow silhouette or suck their stomach in really hard. What that will do is cause compression of the abdomen and mean hyperventilation or upper chest breathing occurs. We know that some people have an inability to breathe through their nose because of either trauma to the nose, or deviative septum, or from sinus disease where they've got elarged turbinates, and that will create chronic mouth breathing. We know that sustained use of poor posture like a really kind of slumped position doing an eye hunch at their desk will strongly contribute to poor ability to breathe through the abdomen and thus lead on to a breathing pattern disorder.
And then there's these occupational groups that we see commonly so people use their voice for work or teachers, musicians, and certain athletic groups such as swimmers and rowers and cyclists where their body is in a biomechanically disadvantaged position that will typically lead to formation of breathing pattern disorders at higher rates.
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Biochemical factors
Other sort of biochemical factors involved in breathing can be things like diet or anemia. Some people who are on a vegetarian diet won't have enough iron stored in their hemoglobin and then they basically are taking themselves to altitude. So because they don't have as much blood cells to carry the blood around their body they need to hyperventilate and more at rest and that can create blowing off of CO2 with just meeting basic oxygen needs. Being aware of that basic driver is very important. We know that humidity and heat can change the way people breathe and even mask wearing and sort of our environment. Changes in movement towards altitude. So, if you spent six weeks at altitude or went to Tibet or Peru or something like that, that's going to increase your breathing speed to adapt to that altitude environment, and then often people can sustain that faster breathing pattern when they return to sea level environments.
We also know that recreational drugs such as caffeine or stimulants can really make people breathe at an elevated rate and caffeine, for example, is used in ICU pediatric wards to help babies with label slow breathing rates increase their speed.
Psychological factors
Psychologically, we know there's plenty of overlap and plenty of factors that are going to influence a breathing pattern disorder. So people who don't allow trauma or emotions out and repress them and hold onto them ,they eventually find that stress or that emotion can come out in a different part of their bodies, so they might end up with retrosternal chest pain, for example. We know that anxiety by itself will increase respiratory rate for a lot of people and the same with sustained stress. So if you're sitting in front of a computer and you've got this big job you've got to do and you sustain your stress for weeks and months, what's going to happen is that posture and that stress internally will bring your respiratory rate up because it perceives you need more oxygen for these tasks, and then that might become habitual and you might get stuck in it.
We also know that pain and phobic avoidance of kind of places can also lead to formations of dysfunctional mental states and breathing states. So, say someone who avoids going to class after the COVID lockdown that they've stayed at home at school, reexposure back into a school environment might be incredibly stressful and might cause some breathing fluctuations as well.
Other factors
Then we have other factors or other disease states that definitely influence breathing as well. So Post-nasal Drips are classic one, Gastroesophageal Reflux, Chronic Heart Failure, Asthma, Diabetes. The list kind of goes on and on and on, but really being aware that they can drive the dysfunctional breathing, and the breathing can develop in a dysfunctional manner, sort of secondary to those initial complications. And so in those cases,we really want to be clear that those underlying conditions are well managed through medication. And if they're well managed through medication, then short add on treatment of their breathing disorder might be useful. So when someone comes into the clinic and we're doing a subjective assessment and they're telling us a story about all their symptoms, it's really important that we can work backwards and find some triggering or causative events.
These symptoms kind of evolve in many different categories. Some of them look neurological. Some of them look very musculoskeletal. Some of them may look like a true respiratory or an asthma type issue. And if we can look back and find some triggers that are causing that, then that will give us more confidence, and it will help the patient understand in more detail what we're trying to achieve.
If you want to learn more about this topic, you can watch Scott Peirce's lecture here:
SOURCES:
1. 'Breathing pattern disorders' lecture by Scott Peirce
