Identification and management of dysfunctional breathing in primary care
Dysfunctional breathing can lead to a range of symptoms that can be confused with neurological, respiratory and cardiac disease. Heather Henry and Charlotte Wells give an overview of the signs, symptoms, diagnosis and treatment of this condition
General practice nurses (GPNs) are often on the front-line of respiratory assessment. Dysfunctional breathing (often termed breathing pattern disorder) is a term that relates to changes in breathing patterns. Since dysfunctional breathing can be confused with neurological, respiratory and cardiac disease, this article will help GPNs to understand the signs, symptoms, diagnosis and treatment.
Dysfunctional breathing (often termed breathing pattern disorder) is a term that relates to changes in breathing patterns. These are caused by a dysregulation in the feedback loop between the brain and various receptors in the body, changing breathing from an efficient to a less efficient pattern. Dysfunctional breathing can be seen when someone uses the wrong muscles to breathe, uses the upper chest rather than the diaphragm (apical breathing), or breathes through their mouth rather than their nose. Breathing often loses its regular rhythm and may become variable in rate, flow and volume. It reflects a change in the mechanics of breathing and can occur alongside or without a specific lung condition. This change can feel sudden or can build up over time and there are many causes. Depending on the cause, treatment usually consists of a course of breathing pattern retraining from a physiotherapist or in combination with psychologists.
The ‘breathing drive’ is responsive to the body's requirements detected by feedforward and feedback loops from the brain and receptors in the respiratory system, with underlying ‘background’ control from the brain stem and autonomic nervous system. Central and peripheral chemoreceptors, as well as mechanoreceptors in the lungs, convey sensory and neural input to the brain to help modulate respiratory drive (Brinkman et al, 2021):
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