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)
| 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.
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.
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.
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