Glossopharyngeal Breathing: Difference between revisions
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== Glossopharyngeal breathing (GPB) == | == Glossopharyngeal breathing (GPB) == | ||
'''Glossopharyngeal breathing (also known as “frog breathing )''' is a form of positive pressure ventilation produced by the patient's voluntary muscles where boluses of air are forced into the lungs. | '''Glossopharyngeal breathing (also known as “frog breathing )''' is a form of positive pressure ventilation produced by the patient's voluntary muscles where boluses of air are forced into the lungs.<ref name=":0">Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition. Churchill Livingstone. 1998</ref> | ||
The muscles of mouth and pharynx to propel air into the larynx and traps the air using glottis in to the lungs while the next gulp of air is being processed. The process is repeated until a satisfactory breath is obtained. | The muscles of mouth and pharynx to propel air into the larynx and traps the air using glottis in to the lungs while the next gulp of air is being processed. The process is repeated until a satisfactory breath is obtained. | ||
It is a trick movement that was first described by Dail (1951) when patients with poliomyelitis were observed to be gulping air into their lungs. It was this gulping action that gave the technique the name 'frog breathing'. | It is a trick movement that was first described by Dail (1951) when patients with poliomyelitis were observed to be gulping air into their lungs. It was this gulping action that gave the technique the name 'frog breathing'.<ref name=":0" /> | ||
== Significance == | == Significance == | ||
'''GPB''' is useful in | '''GPB''' is useful in | ||
* Patients with a reduced vital capacity owing to respiratory muscle paralysis. | * Patients with a reduced vital capacity owing to respiratory muscle paralysis.<ref name=":0" /> | ||
* Patients with a neuromuscular disease, such as those who have sustained a high cervical SCI with neurologic deficit. | * Patients with a neuromuscular disease, such as those who have sustained a high cervical SCI with neurologic deficit. | ||
* Paralysed patients dependent on a mechanical ventilator may be able to use GPB continuously, other than during sleep, to substitute the mechanical ventilation. | * Paralysed patients dependent on a mechanical ventilator may be able to use GPB continuously, other than during sleep, to substitute the mechanical ventilation.<ref name=":0" /> | ||
* The most common use of GPB is in patients who are able to breathe spontaneously but whose power to cough and clear secretions is inadequate. The technique may enable these patients to shout to attract attention and it may help to maintain or improve lung and chest wall compliance. | * The most common use of GPB is in patients who are able to breathe spontaneously but whose power to cough and clear secretions is inadequate. The technique may enable these patients to shout to attract attention and it may help to maintain or improve lung and chest wall compliance.<ref name=":0" /> | ||
* Patients with high-level quadriplegia are often instructed in glossopharyngeal breathing (GPB), in which the patient swallows air into the lungs in order to increase vital capacity. | * Patients with high-level quadriplegia are often instructed in glossopharyngeal breathing (GPB), in which the patient swallows air into the lungs in order to increase vital capacity.<ref name=":1">Joanne Watchie. Cardiovascular and pulmonary physical therapy. 2nd edition. Saunders. 2010</ref> | ||
* Used to augment cough effectiveness, provide internal mobilization of the chest wall, and improve quality of life by allowing periods of ventilator or phrenic nerve stimulator independence and more effective phonation. | * Used to augment cough effectiveness, provide internal mobilization of the chest wall, and improve quality of life by allowing periods of ventilator or phrenic nerve stimulator independence and more effective phonation.<ref name=":1" /> | ||
* vital capacity could be increased from 60% to 81 % of its predicted value when using GPB.<ref name=":2">M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd. 2002</ref> | |||
* The use of GPB has been shown to be sufficient to maintain arterial blood gases within normal range<ref name=":2" /> | |||
== Techniques == | == Techniques == | ||
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# Accumulated air is exhaled by immediate opening of the glottis | # Accumulated air is exhaled by immediate opening of the glottis | ||
|} | |} | ||
This sequence should be practised slowly at first and then gradually speeded up until the movement flows. A leak of air may occur through the nose and, until it is prevented by the soft palate, a nose dip may be required. | This sequence should be practised slowly at first and then gradually speeded up until the movement flows. A leak of air may occur through the nose and, until it is prevented by the soft palate, a nose dip may be required.<ref name=":0" /> | ||
The next stage is to take a maximum breath in and, while holding this breath, to add several glossopharyngeal gulps, to augment the vital capacity. When correct, the patient will feel his chest filling with air, and the physiotherapist can test the 'GPB vital capacity' by putting a mouthpiece attached to the expiratory limb of a Wright's respirometer in the patient's mouth before he exhales. The respirometer can be used to measure the volume per gulp; the patient will require less effort and reach his maximum capacity more quickly if he develops a bigger volume per gulp | The next stage is to take a maximum breath in and, while holding this breath, to add several glossopharyngeal gulps, to augment the vital capacity. When correct, the patient will feel his chest filling with air, and the physiotherapist can test the 'GPB vital capacity' by putting a mouthpiece attached to the expiratory limb of a Wright's respirometer in the patient's mouth before he exhales. The respirometer can be used to measure the volume per gulp; the patient will require less effort and reach his maximum capacity more quickly if he develops a bigger volume per gulp | ||
== Indication == | == Indication == | ||
* GPB was first described as a trick movement seen in patients with poliomyelitis (Dail 1951).<ref name=":0" /> | |||
* GPB is an effective maneuver to augment tidal volume in any patient who is unable to voluntarily alter tidal breathing.<ref name=":2" /> | |||
* Dail & Affeldt (1955) taught GPB to 100 patients with poliomyelitis. They found that 69 patients used this technique to assist normal breathing and 31 to assist speech and coughing. 42 patients found that GPB allowed them to discontinue respiratory support (c.f. mechanical ventilation, NIPPV).<ref name=":2" /> | |||
* GPB may prove useful in improving cough effectiveness in patients with tetraplegia or neuromuscular disorders, impaired tracheobronchial clearance<ref name=":2" /> | |||
== Contraindication == | == Contraindication == | ||
* GPB is contraindicated in patients with a tracheostomy when the cuff is inflated.<ref name=":2" /> | |||
* GPB must be avoided in patients with airflow obstruction or pulmonary disease, due to the risk of air trapping.<ref name=":2" /> | |||
* GPB should not be attempted in patients with neuromuscular disorders affecting swallowing, and, in patients with a progressive disorder, intermittent positive pressure breathing ( I P P B ) may be more appropriate than GPB.<ref name=":0" /> | |||
Revision as of 12:52, 26 April 2020
Glossopharyngeal breathing (GPB)[edit | edit source]
Glossopharyngeal breathing (also known as “frog breathing ) is a form of positive pressure ventilation produced by the patient's voluntary muscles where boluses of air are forced into the lungs.[1]
The muscles of mouth and pharynx to propel air into the larynx and traps the air using glottis in to the lungs while the next gulp of air is being processed. The process is repeated until a satisfactory breath is obtained.
It is a trick movement that was first described by Dail (1951) when patients with poliomyelitis were observed to be gulping air into their lungs. It was this gulping action that gave the technique the name 'frog breathing'.[1]
Significance[edit | edit source]
GPB is useful in
- Patients with a reduced vital capacity owing to respiratory muscle paralysis.[1]
- Patients with a neuromuscular disease, such as those who have sustained a high cervical SCI with neurologic deficit.
- Paralysed patients dependent on a mechanical ventilator may be able to use GPB continuously, other than during sleep, to substitute the mechanical ventilation.[1]
- The most common use of GPB is in patients who are able to breathe spontaneously but whose power to cough and clear secretions is inadequate. The technique may enable these patients to shout to attract attention and it may help to maintain or improve lung and chest wall compliance.[1]
- Patients with high-level quadriplegia are often instructed in glossopharyngeal breathing (GPB), in which the patient swallows air into the lungs in order to increase vital capacity.[2]
- Used to augment cough effectiveness, provide internal mobilization of the chest wall, and improve quality of life by allowing periods of ventilator or phrenic nerve stimulator independence and more effective phonation.[2]
- vital capacity could be increased from 60% to 81 % of its predicted value when using GPB.[3]
- The use of GPB has been shown to be sufficient to maintain arterial blood gases within normal range[3]
Techniques[edit | edit source]
| Step 1 | Air enters oral pharynx (concurrent events) |
|---|---|
| |
| Step 2 | Air is trapped in oral pharynx |
| |
| Step 3 | Air enters lungs |
| |
| Step 4 | Air is trapped in the lungs |
|
This sequence should be practised slowly at first and then gradually speeded up until the movement flows. A leak of air may occur through the nose and, until it is prevented by the soft palate, a nose dip may be required.[1]
The next stage is to take a maximum breath in and, while holding this breath, to add several glossopharyngeal gulps, to augment the vital capacity. When correct, the patient will feel his chest filling with air, and the physiotherapist can test the 'GPB vital capacity' by putting a mouthpiece attached to the expiratory limb of a Wright's respirometer in the patient's mouth before he exhales. The respirometer can be used to measure the volume per gulp; the patient will require less effort and reach his maximum capacity more quickly if he develops a bigger volume per gulp
Indication[edit | edit source]
- GPB was first described as a trick movement seen in patients with poliomyelitis (Dail 1951).[1]
- GPB is an effective maneuver to augment tidal volume in any patient who is unable to voluntarily alter tidal breathing.[3]
- Dail & Affeldt (1955) taught GPB to 100 patients with poliomyelitis. They found that 69 patients used this technique to assist normal breathing and 31 to assist speech and coughing. 42 patients found that GPB allowed them to discontinue respiratory support (c.f. mechanical ventilation, NIPPV).[3]
- GPB may prove useful in improving cough effectiveness in patients with tetraplegia or neuromuscular disorders, impaired tracheobronchial clearance[3]
Contraindication[edit | edit source]
- GPB is contraindicated in patients with a tracheostomy when the cuff is inflated.[3]
- GPB must be avoided in patients with airflow obstruction or pulmonary disease, due to the risk of air trapping.[3]
- GPB should not be attempted in patients with neuromuscular disorders affecting swallowing, and, in patients with a progressive disorder, intermittent positive pressure breathing ( I P P B ) may be more appropriate than GPB.[1]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition. Churchill Livingstone. 1998
- ↑ 2.0 2.1 Joanne Watchie. Cardiovascular and pulmonary physical therapy. 2nd edition. Saunders. 2010
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd. 2002
