Breathing Pattern Disorders

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Introduction

Breathing Pattern Disorders (BPD) are abnormal respiratory patterns. They range from simple upper chest breathing to, at the extreme end of the scale, hyperventilation.  This is not a disease process, simply alterations in breathing patterns that interfere with normal respiratory processes.  They can however, co-exist with disease such as COPD or heart disease.

BPDs are whole person problems, especially in long term conditions where dysfunctional breathing can destabilise mind and muscles, mood and metabolism.  They can play a part in, for instance, chronic fatigue, pain, fibromyalgia and some aspects of anxiety and depression.

Clinically Relevant Anatomy

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Epidemiology

It is often reported that around 10% of patients in a population are diagnosed hyperventilation syndrome. However, far more people have a more subtle, yet likely clinically significant, breathing pattern disorder. Dysfunctional breathing is more prevalent in women (14%) than in men (2%)

Etiology

Breathing pattern disorders involve being in a constant state of inhalation.  This leads to hypocapnia - the deficiency of carbon dioxide in the blood due to hyperventilation - leading to respiratory alkalosis, and eventually hypoxia or the reduction of oxygen to tissue.  As well as having a marked effect on the biochemistry of the body BPD can influence emotions, circulation, digestive function as well as musculoskeletal structures involved in the respiratory process. This diagram (from ) shows the stress-anxiety-breathing flow chart demonstrating multiple possible effects and influences of breathing pattern disorders.

Despite not being a disease, BPDs are capable of producing symptoms that mimic  pathological processes.  For example, overuse of accessory breathing muscles can lead to neck and shoulder pain/dysfunction. 

Clinical Presentation

There are a wide variety of symptoms, the most extreme 

Diagnostic Procedures

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Outcome Measures

Nijmegen Questionnaire

Management / Interventions

Management commonly requires the removal of causative factors and the rehabilitation of habitual acquired dysfunctional breathing patterns.  In order to achieve this most efficiently it may be necessary to restore normal function of the respiratory system such as thoracic mobility and muscle tone and length. 

Differential Diagnosis

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Key Evidence

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Resources

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Case Studies

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References

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