Glossopharyngeal Breathing

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 involves a series of gulps using the lips, tongue, pharynx, and larynx to pull air into the lungs when the normal inspiratory muscles are not functioning.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'.

Significance

GPB is useful in

• Patients with a reduced vital capacity owing to respiratory muscle paralysis.
• 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.
• 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.
• 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.
• 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.
• vital capacity could be increased from 60% to 81 % of its predicted value when using GPB.
• The use of GPB has been shown to be sufficient to maintain arterial blood gases within normal range

Techniques

one Glossopharygeal breathing stroke

Step 1	Air enters oral pharynx (concurrent events)
	Mouth opens; air enters as patient reaches out with lips rounded Pharynx is widened to allow more room for air to enter Floor of mouth, larynx, and tongue depress Tongue flattens and the tip touches posterior mandibular dentition Glottis is closed
Step 2	Air is trapped in oral pharynx
	Patient shapes lips as if to say “oop” but instead makes an “up” sound just before lips close Lips close and trap air in the pharynx while the glottis remains closed Cheeks compress
Step 3	Air enters lungs
	Lips remain closed Soft palate, floor of mouth, larynx, and dorsum of tonque elevate as the tonque sequentially rolls to propel air into the pharynx Pharynx constricts, glottis opens, and air passes into the larynx
Step 4	Air is trapped in the lungs
	Glottis immediately closes, trapping the air in the trachea and lungs as a result of prior steps Procedure is repeated 8–1 2 times 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. GPB is learnt easily by some patients, but

others need time and patience to acquire this skill and must be motivated to practise frequently during the learning period.

Indication

• GPB was first described as a trick movement seen in patients with poliomyelitis (Dail 1951).

• GPB is an effective maneuver to augment tidal volume in any patient who is unable to voluntarily alter tidal breathing.

• 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).

• GPB may prove useful in improving cough effectiveness in patients with tetraplegia or neuromuscular disorders, impaired tracheobronchial clearance

Contraindication

• GPB is contraindicated in patients with a tracheostomy when the cuff is inflated.

• GPB must be avoided in patients with airflow obstruction or pulmonary disease, due to the risk of air trapping.

• 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.