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Cancer: Heavy Breathing and Dyspnea

As we found before, the respiratory rate for the normal breathing pattern for adults is only 12 breaths/min at rest, while Dr. Buteyko's norm is only 8 breaths per minute (see Parameters of Normal Breathing or Buteyko Table of Health Zones). What about respiratory rates in people with cancer?

Cancer patients breathe much faster than the medical norm

We can see that cancer patients breathe much more than both norms. Furthermore, respiratory rate (breathing frequency) of cancer patients, as many studies have found, is an independent predictor of their mortality (Chiang et al, 2009; Groeger et al, 1998; de Miguel Sanchez et al, 2006). Those cancer sufferers, who breathe faster or more frequently, has higher mortality rates and poorer prognosis. This link (between slow spontaneous breathing and higher chances of survival) relates to all cancer patients, those with and without dyspnea.

Conclusion. Cancer patients: the faster they breathe, the sooner they die.

In 2008, the Journal of Applied Physiology published a study (Travers et al, 2008) from the Department of Medicine, Queen's University (Kingston, Canada). It was revealed that forty patients with cancer breathed around 12 liters of air per minute at rest, instead of 6 l/min (the medical norm). The average breathing frequency of these cancer patients was 20 breaths per minute (the norm is only 12 breaths per min at rest). Tidal volume of these cancer patients (600 ml of air per one breath) was also more than the norm (which is 500 ml). Hence, these cancer patients had both, fast and deep breathing, in comparison with the medical norms. 

We also learned that normal breathing is invisible and inaudible since it is very slow in frequency and tiny in tidal volume. What about visual breathing parameters of cancer patients at rest? In other words, what do the doctors see? Heavy breathing and nearly gasping for air.

After these overwhelming testimony of medical clinical doctors, it is more than clear that terminal cancer patients have heavy breathing pattern. (As we are going to learn later, that causes severe cell hypoxia that causes devastating effects on the immune system due to free radicals and oxidative damage.)

But normal breathing, as we discussed, (see Homepage links) is invisible, inaudible, and imperceptible. Moreover, according to physiological laws, normal breathing provides humans with superior tissue oxygenation. Hence, healthy people do not feel their breath at all. These cancer patients breathe at least 3-4 times more than the norm in order to be uncomfortably aware about their breathing.

What is the typical breathing frequency in cancer patients with dyspnea? US medical doctors from the Massey Cancer Center (Virginia Commonwealth University in Richmond, Virginia, USA) tested 35 cancer patients (of the 35 patients, 34 were using oxygen) and found that their average breathing rate was 28.4 breaths/minute (Coyne et al, 2002). A 1993 study done by Italian and Canadian doctors revealed the respiratory rate of around 23 breathes per minute (Bruera et al, 1993) in a group of terminal cancer patients with dyspnea. A Swiss study conducted in the Division of Palliative Care, University Hospital, Lausanne found about 26 breaths per minute in elderly patients with advanced cancer (Mazzocato et al, 1999).

In two recent German studies (Department of Anaesthesiology, Intensive Care Medicine, Bonn), average breathing rates in 2 groups of cancer patients were stunning 42 and 39 breaths per minute (Clemens et al, 2007; Clemens et al, 2008). It is indeed physiologically shocking numbers since the normal respiratory frequency is only 12 breaths per one minute. (Old medical textbooks suggest 8-10 breaths per minute as normal.)

The next topic is: What are the effects of overbreathing on oxygenation of the human organism and tumors?

Or return to diseases: Cancer webpage

References

Dyspnea references

Ripamonti C. Management of dyspnea in advanced cancer patients. Support Care Cancer. 1999; 7: p. 233-243.
"Dyspnea has been defined as an “uncomfortable awareness of breathing"

Coyne PJ, Viswanathan R, Smith TJ, Nebulized fentanyl citrate improves patients' perception of breathing, respiratory rate, and oxygen saturation in dyspnea, J Pain Symptom Manage 2002; 23: p. 157–160.
“Dyspnea is exceedingly common. Ruben and Mor found that 70% of 1500 cancer patients suffered dyspnea during their last four weeks of life.”

Reuben DB, Mor V, How much of a problem is dyspnoea in advanced cancer? Palliat Med 1991; 5: 20–26.
“Introduction. Although a number of articles on dyspnoea in terminal cancer have appeared, [1-8] in terms of publications, this symptom remains a poor relation when compared with pain. Anyone, however, who has looked after dying people will be aware that dyspnoea is a common and often distressing symptom, particularly if severe. In such cases patients may feel that they may die from lack of air - even pain does not have this connotation. This is demonstrated in Comroe’s definition of dyspnoea as ’difficult, laboured, uncomfortable breathing; it is an unpleasant type of breathing, though it is not painful in the usual sense of the word. It is subjective, and, like pain, it involves both perception of the sensation by the patient and his reaction to the sensation.”

Dudgeon DJ, Managing dyspnea and cough, Hematol Oncol Clin North Am 2002 Jun; 16(3): p.557-577.
"Dyspnea, like pain, is a subjective experience that incorporates physical elements and affective components. Management of breathlessness in patients with cancer requires expertise that includes an understanding and assessment of the multidimensional components of the symptom, knowledge of the pathophysiologic mechanisms and clinical syndromes that are common in cancer, and familiarity with the indications and limitations of the available therapeutic approaches. Relief of breathlessness should be the goal of treatment at all stages of cancer. Good control of dyspnea will improve the patient's quality of life." 

Reuben DB, Mor V, Dyspnea in terminally ill cancer patients, Chest 1986; 89: p. 234–236.

Dudgeon DJ, Lertzman M, Dyspnea in the advanced cancer patient, J Pain Symptom Management 1998 Oct; 16(4): p.212-219.

Bruera E, MacEachern T, Ripamonti C, Hanson J, Subcutaneous morphine for dyspnea in cancer patients, Ann Intern Med. 1993; 119: p. 906-907.

Travers J, Dudgeon DJ, Amjadi K, McBride I, Dillon K, Laveneziana P, Ofir D, Webb KA, O'Donnell DE, Mechanisms of exertional dyspnea in patients with cancer, J Appl Physiol 2008 Jan; 104(1): p.57-66.


References for the cancer respiratory rate chart

Chiang JK, Lai NS, Wang MH, Chen SC, Kao YH, A proposed prognostic 7-day survival formula for patients with terminal cancer, BMC Public Health. 2009 Sep 29; 9(1): p.365.

Clemens KE, Klaschik E, Effect of hydromorphone on ventilation in palliative care patients with dyspnea, Support Care Cancer. 2008 Jan; 16(1): p.93-99. Epub 2007 Oct 11.

Clemens KE, Klaschik E, Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients, J Pain Symptom Management 2007 Apr; 33(4): p.473-481.

de Miguel Sanchez C, Elustondo SG, Estirado A, Sanchez FV, de la Rasilla Cooper CG, Romero AL, Otero A, Olmos LG, Palliative Performance Status, Heart Rate and Respiratory Rate as Predictive Factors of Survival Time in Terminally Ill Cancer Patients, J Pain Symptom Managem. June 2006; 31(6), p. 485-492.

Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK, Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model, J Clin Oncol. 1998 Feb; 16(2): p.761-770.

Mazzocato C, Buclin T, Rapin CH, The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial, Annals of Oncology. 1999 Dec; 10(12): p.1511-1514.

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