Signal failure? Thinking outside the lung

Physiotherapist and Bradcliff practitioner Pip Windsor writes:

How can a symptom of chronic over-breathing be a feeling of lack of air? How can the answer to the feeling of air ‘hunger’ be to breathe less? Our body will usually give some useful signals to keep us safe. Thirst – drink. Hunger – eat. So what causes us to breathe more than is appropriate for our body’s metabolic requirements? Can we put it all down to the cliché of a Stone Age body in the space age, where our anatomical and physiological make-up hasn’t adapted to life in the fast lane? I find this idea useful when explaining breathing disorders to patients. We are designed to move; our fight/flight freeze reaction is still going strong, but used inappropriately and lasting too long. ‘All revved up with no place to go’ is another apt expression for the Meatloaf generation!

I have been fascinated by disordered breathing patterns for the last twenty years and am still delighted and amazed at the changes that people make, simply by correcting the way they breathe, and a little frustrated still at the lack of recognition and lack of early intervention. Clearly the symptoms experienced are wide-ranging and often require investigating by a cardiologist, respiratory physician, ENT or neurologist depending on which dominate. Once any serious pathology is rejected, far from putting minds at rest, the symptoms are now present with no explanation: chest pain, shortness of breath, poor focus/concentration, feelings of losing control, lack of air, dizziness, constant fatigue and poor sleep.

An estimated 10% of people admitting to ED and 10%  of those presenting to their GP have dysfunctional breathing patterns as an underlying cause for symptoms. These figures were from a study done in the USA, from which we can probably draw comparisons with Australia and the UK.  A study in the UK suggests this figure is higher.[1] The figure for those with asthma is about 33%. So what happens to these people who think they’re going crazy? They are usually given the diagnosis of anxiety. Of course they are anxious…

Some people will clearly benefit from counselling or psychological assessment but this will only help partially if the actual movement patterns and physiology of breathing are not addressed. I liken it to the experience of chronic pain. We now understand that for many reasons, including bio-psychosocial factors, people develop maladaptive or unhelpful movement habits, driven by fear of further hurt or damage which can cause pain to persist. Breathing is a movement. Unhelpful or maladaptive movement habits can develop which cause symptoms and a vicious cycle develops with worry about the symptoms causing further disruptions to breathing. The answer is reassurance, explanation and gradual resetting to normal – to go against our body screaming at us to breathe more, and breathe less!

Nose, diaphragm, gentle, silent when at rest. This is tapping in to our parasympathetic nervous system. Rest, digest, repair.

Upper chest mouth-breathing signals to our brain that we are in emergency. ACTION! Useful during exercise or true emergency situations, stressful on the musculoskeletal system and depleting of carbon dioxide if we are not! The body’s vital systems do not take kindly to the wrong fuel mix! We will hopefully get better at recognising the importance of breathing beyond just the state of the lung. The effects start early in childhood and address every aspect of life. For example, the growing mouth-breathing child will have abnormal craniofacial growth, leading to overcrowding top teeth, narrow jaw, and compromised airways. Mouth-breathing, due to sheer volume of air, can lead to chronic hyperventilation and compromised cerebral blood flow. Think of the effects on learning! Similarly, an elite athlete breathes vast amounts of air through necessity, but no attention has been given to the importance of coming back to baseline calm, appropriate volumes and relaxed muscles following training sessions. Rest, recovery and repair are compromised and so performance suffers.

Having asthma is frightening and flare-ups are common in times of emotional and physical stress. Breathing more than the body requires, and using mouth/upper chest is wasteful in terms of energy and can provoke bronchospasm through loss of carbon dioxide. The anticipation of exercise in someone who has this as a trigger will start the over-breathing process and tendency to flare up even before exercise begins. A person with COPD has irreversible lung disease, but will have symptoms disproportionate to their lung function if they have developed dysfunctional or unhelpful breathing habits. This will lead to decreased confidence, increased shortness of breath, avoidance of activity, loss of exercise tolerance, weakness of respiratory muscles, increased work of breathing … the list is endless. Tune in, breathe out!

[1] Thomas M. et al., 2005. The prevalence of dysfunctional breathing in adults in the community with and without asthma. Primary Care Resp Journal, 14: 78-82.

The image shows lungwort growing in the garden of Dr. Gene Feder, who also supplied the photograph.

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