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)
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|
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 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.
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.)
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).
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.
Reference pages: Breathing norms and medical facts:
- Breathing norms: Parameters, graph, and description of the normal breathing pattern
- 6 breathing myths: Myths and superstitions about breathing and body oxygenation (prevalence: over 90%)
- Hyperventilation: Definitions of hyperventilation: their advantages and weak points
- Hyperventilation syndrome: Western scientific evidence about prevalence of chronic hyperventilation in patients with chronic conditions (37 medical studies)
- Normal minute ventilation: Small and slow breathing at rest is enjoyed by healthy subjects (14 studies)
- Hyperventilation prevalence: Present in over 90% of normal people (24 medical studies)
- HV and hypoxia: How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
- Body-oxygen test (CP test) : How to measure your own breathing and body oxygenation (two in one) using a simple DIY test
- Body oxygen in healthy: Results for the body-oxygen test for healthy people (27 medical studies)
- Body oxygen in sick : Results for the body-oxygen test for sick people (14 medical studies)
- Buteyko Table of Health Zones: Clinical description and ranges for breathing zones: from the critically ill (severely sick) up to super healthy people with maximum possible body oxygenation
- Morning hyperventilation: Why people feel worse and critically ill people are most likely to die during early morning hours
References: pages about CO2 effect:
- Vasodilation: CO2 expands arteries and arterioles facilitating perfusion (or blood supply) to all vital organs
- The Bohr effect: How and why oxygen is released by red blood cells in tissues
- Cell oxygen levels: How alveolar CO2 influences oxygen transport
- Oxygen transport: O2 transport is controlled by vasoconstriction-vasodilation and the Bohr effects, both of which rely on CO2
- Free radical generation: Reactive oxygen species are produced within cells due to anaerobic cell respiration caused by cell hypoxia
- Inflammatory response: Chronic inflammation in fueled by the hypoxia-inducible factor 1, while normal breathing reduces and eliminates inflammation
- Nerve stabilization: People remain calm due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
- Muscle relaxation: Relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
- Bronchodilation: Dilation of airways (bronchi and bronchioles) is caused by carbon dioxide, and their constriction by hypocapnia (low CO2)
- Blood pH: Regulation of blood pH due to breathing and regulation of other bodily fluids
- CO2: lung damage: Elevated carbon dioxide prevents lung injury and promotes healing of lung tissues
- CO2: Topical carbon dioxide can heal skin and tissues
- Synthesis of glutamine in the brain, CO2 fixation, and other chemical reactions
- Deep breathing myth: Ignorant and naive people promote the idea that deep breathing and breathing more air at rest is beneficial for health
- Breathing control: How is our breathing regulated? Why hypocapnia makes breathing uneven, irregular and erratic.
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