Ineffective Breathing Pattern: Causes and Solutions

Ineffective breathing pattern is a term that is often used in medical articles for nurses in order to describe a breathing pattern with reduced respiratory rate and reduced tidal volume, as if this is the main respiratory problem for people with chronic health problems.

Usually such articles about ineffective breathing pattern (intended for nurses) do not provide any clinical evidence or references. What do we know about breathing in the sick? Do they indeed breathe too little air and require increased ventilation?

Minute ventilation rates (chronic diseases)

Condition Minute
Number of
All references or
click below for abstracts
Normal breathing 6 L/min - Medical textbooks
Healthy Subjects 6-7 L/min >400 Results of 14 studies
Heart disease 15 (+-4) L/min 22 Dimopoulou et al, 2001
Heart disease 16 (+-2) L/min 11 Johnson et al, 2000
Heart disease 12 (+-3) L/min 132 Fanfulla et al, 1998
Heart disease 15 (+-4) L/min 55 Clark et al, 1997
Heart disease 13 (+-4) L/min 15 Banning et al, 1995
Heart disease 15 (+-4) L/min 88 Clark et al, 1995
Heart disease  14 (+-2) L/min 30 Buller et al, 1990
Heart disease 16 (+-6) L/min 20 Elborn et al, 1990
Pulm hypertension 12 (+-2) L/min 11 D'Alonzo et al, 1987
Cancer 12 (+-2) L/min 40 Travers et al, 2008
Diabetes 12-17 L/min 26 Bottini et al, 2003
Diabetes 15 (+-2) L/min 45 Tantucci et al, 2001
Diabetes 12 (+-2) L/min 8 Mancini et al, 1999
Diabetes 10-20 L/min 28 Tantucci et al, 1997
Diabetes 13 (+-2) L/min 20 Tantucci et al, 1996
Asthma 13 (+-2) L/min 16 Chalupa et al, 2004
Asthma 15 L/min 8 Johnson et al, 1995
Asthma 14 (+-6) L/min 39 Bowler et al, 1998
Asthma 13 (+-4) L/min 17 Kassabian et al, 1982
Asthma 12 L/min 101 McFadden, Lyons, 1968
COPD 14 (+-2) L/min 12 Palange et al, 2001
COPD 12 (+-2) L/min 10 Sinderby et al, 2001
COPD 14 L/min 3 Stulbarg et al, 2001
Sleep apnea 15 (+-3) L/min 20 Radwan et al, 2001
Liver cirrhosis 11-18 L/min 24 Epstein et al, 1998
Hyperthyroidism 15 (+-1) L/min 42 Kahaly, 1998
Cystic fibrosis 15 L/min 15 Fauroux et al, 2006
Cystic fibrosis 10 L/min 11 Browning et al, 1990
Cystic fibrosis* 10 L/min 10 Ward et al, 1999
CF and diabetes* 10 L/min 7 Ward et al, 1999
Cystic fibrosis 16 L/min 7 Dodd et al, 2006
Cystic fibrosis 18 L/min 9 McKone et al, 2005
Cystic fibrosis* 13 (+-2) L/min 10 Bell et al, 1996
Cystic fibrosis 11-14 L/min 6 Tepper et al, 1983
Epilepsy 13 L/min 12 Esquivel et al, 1991
CHV 13 (+-2) L/min 134 Han et al, 1997
Panic disorder 12 (+-5) L/min 12 Pain et al, 1991
Bipolar disorder 11 (+-2) L/min 16 MacKinnon et al, 2007
Dystrophia myotonica 16 (+-4) L/min 12 Clague et al, 1994

Note that advanced stages of asthma can lead to lung destruction, ventilation-perfusion mismatch,
and arterial hypercapnia causing further reduction in body oxygen levels.

Ineffective breathing pattern reduces brain O2 A typical respiratory rate in the sick is about 15-20 breaths/min and the tidal volume is about 700-900 mL. When patients get even sicker, their respiratory rate is even higher, while the tidal volume may get reduced.

Therefore, we see that the term "ineffective breathing pattern" is used to confuse nurses with an attempt to promote an idea that sick people do not get enough oxygen because they breathe too little air. The real story is opposite. They do not get enough O2 in cells due to hyperventilation. There is no evidence that sick people and even severely sick people commonly breathe too little air (hypoventilation).

Cases with reduced ventilation or hypoventilation do exist, but they are rare. Hypoventilation normally leads to alveolar hypercapniap'> -->hypercapnia and arterial hypercapnia which can easily be confirmed by arterial CO2 measurements.

Over 95% of sick people suffer from too heavy and fast breathing that is the real ineffective breathing pattern. Let us consider it in more detail.

Young doctors For sick people, with their ineffective breathing pattern, the durations of inhalations and exhalations, breathing rate, amount of air inhaled per breath and other parameters are individual. Many sick people can have the following parameters of their breathing cycle (see the Figure below):
- inhalation (about 1.5-2 s)
- exhalation (1.5-2 s)
- no automatic pause (2 s in healthy subjects)
- the depth of inhalation or tidal volume is about 700-1,000 ml instead of 500-600 ml (the clinical norm)
- the respiratory rate is 15-20 breaths/min (usually over 25 breaths/min for the severely sick) instead of the normal 12 breaths/min at rest for a 70-kg person
- the body oxygen level (found with a special DIY breath holding time test) is less than 20 s. Hence, they breathe too deep and too fast in comparison with the normal breathing pattern.

There are 2 common aggravating factors of the ineffective breathing pattern, apart from hyperventilation, that drastically reduce O2 transport: mouth breathing and chest breathing. (For their effects, see links below.)

Ineffective breathing pattern (chart)

Fig. Ineffective breathing pattern, typical for the sick: deep and heavy breathing pattern; deep, forceful, and fast inhalations and exhalations, no automatic pause. Hypocapnia (CO2 deficiency) reduces blood oxygenation and the CP (cells oxygen level).

CO2 model Hence, all medical evidence and clinical experience show that sick people, with chronic health problems, have a heavy and deep ineffective breathing pattern.

This video clip from YouTube (Breathing Patterns and Buteyko Oxygen Test (Buteyko Technique)) explains the link between the ineffective breathing pattern (present in most sick people) and body oxygenation test results.

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