Choithram Institute of Health Sciences

PRESENTATION ON-

BREATHING PATTERNSBREATHING PATTERNS

Guided By- Submitted By- Dr. Kiran P. S. Aparna Bhagwat B.P.T. 3rd year

CONTENTS :

PHYSIOLOGY OF BREATHING INFLUENCING FACTORS PARAMETERS OF ASSESSMENT ABNORMAL BREATHING PATTERNS

PHYSIOLOGY OF BREATHING:• Breathing is a process by which Oxygen

is taken in and Carbon dioxide is given out of the body.

• It is the process of gas exchange that occurs in alveoli by passive diffusion of gases between the alveoli and blood.

• The normal rate of breathing is 12-20/min. (in adults) and 30-50/min. (in infants).

• The normal relaxed breathing is called as EUPNEA.

• There are two phases of breathing-1. Inspiration/Inhalation2. Expiration/Exhalation

1.INSPIRATION 2. EXPIRATION PHASE PHASE

INFLUENCING FACTORS:

1. AGE• New born- 30-50 breath/min• 3 years - 20-30 breath/min• 10 years – 16-22 breath/min• Adults - 12-20 breath/min 2. Body size and stature3. Exercise4. Body position

PARAMETERS OF ASSESING:

•Rate•Depth•Rhythm•Character

ABNORMAL BREATHING PATTERNS:

1. Apnea2. Tachypnea3. Bradypnea4. Hyperventilation5. Kussmaul breathing6. Cheyne-Stokes breathing7. Biot’s/Ataxic breathing8. Sighing breathing9. Obstructed breathing

APNEA : Suspension of breathing. No movement of muscles of

resp. and volume of lungs remains same.

No airflow into or out from the lungs.

Gaseous exchange & cellular resp. is not affected.

Apnea can be achieved _1. Voluntarily (breath holding)2. Mechanically-strangulation/

choking3. From neurological trauma

Prolonged apnea leads to severe lack of oxygen in circulation, b’coz under normal conditions body cannot store much oxygen.

A person cannot sustain voluntary apnea for more than 1-2 min. (This is much more decreased in smokers)

This is to maintain constant values of CO2 conc. & pH of blood.

Here CO2 is not removed out of lungs, it accumulates in blood, leading to stimulation of resp. centers in brain c stops apnea.

Apneic oxygenation Apnea test in determining

brain death: The 3 diagnostic criteria of brain death are as follows-

1. Coma2. Absence of pulse3. Apnea

TACHYPNEA :

o Increased rate of breathing , i.e. >20 breaths/min.

o Characterized by rapid, shallow breathing.

It is seen in following conditions-

1. Fever2. Pneumonia3. Compensatory resp.alkalosis4. Respiratory insufficiency5. Lesions to resp. centers in brain6. Salicylate poisoning7. Elevated diaphragm

Transient tachypnea of newborns

BRADYPNEA :

Decreased rate of breathing , i.e. <12 breaths/min.

Characterized by slow, shallow breathing.

The rate at c bradypnea is diagnosed depends on the age –

• 0-1 years - <30 breaths/min.• 1-3 years - <25 breaths/min.• 3-12 years - <20 breaths/min.• 12 & above - <12 breaths/min. It is see secondary to following

conditions-• Diabetic coma• Respiratory depression• Increased intra-cranial pressure

HYPERVENTILATION :

Characterized by rapid, deep breathing.

Caused by increased levels of CO2.

Other causes include –• Anxiety or pain• Excessive use of aspirin• Obstructive disorders- COPD,

asthma, & pulmonary embolism.

• Infections – pneumonia• Congestive heart failure• Diabetic ketoacidosis

Hyperventilation leads to following symptoms-

• Dizziness• Light headedness• Weakness• Shortness of breath• Muscle spasm in hands & feet. All these symptoms are the

result of increased CO2 in blood caused by over-breathing.

KUSSMAUL BREATHING :

Rapid, gasping & very deep type of labored breathing.

Commonly called as “air hunger”.

It is been named for - “Adolph Kussmaul”, a German doctor who first noted it among patients with advanced diabetes mellitus.

It is associated with severe metabolic acidosis, particularly diabetic ketoacidosis.

Mechanism of kussmaul breathing.

Kussmaul’s sign – increase in JVP during inspiration.

CHEYNE-STOKES BREATHING: Also called as “periodic

breathing”. This condition was named after

“John Cheyne & William Stokes”, the physicians who first described it in 19th century.

Characterized by alternate periods of tachypnea and apnea.

Occurs as a compensation for changing serum pO2 & pCO2, and classically seen in damage to pons where resp. centers are located.

Mechanism Conditions in c it is seen are-• Stroke• Traumatic brain injury• Brain tumors• Heart failure• Toxic metabolic

encephalopathy

BIOT’S BREATHING :

Also called as “cluster breathing" or “ataxic breathing”.

It is named for a French Physician “Camille Biot” who characterized it in 1876.

It is periodic in nature & is characterized by unpredictable irregularities in breathing that alternates with periods of apnea.

It is a group of quick, shallow inspirations followed by regular or irregular periods of apnea.

Causes include-• Lesion to brainstem (sp.

Medulla)• Cervical spine injury – leading

to resp.depression.

In ataxic breathing, there is complete irregularity of breathing, with irregular pauses & increasing periods of apnea.

As the breathing pattern deteriorates, it merges with the Agonal breathing.

AGONAL BREATHING :

shallow & very slow inspirations (about 3-4 breaths/min.) followed by irregular pauses of apnea.

Characterized by gasping, labored breathing, accompanied by strange vocalizations.

Causes include-• Cerebral ischemia• Severe hypoxia/anoxia• Cardiac arrest

SIGHING RESPIRATION :• Is is the breathing punctuated

by frequent sighs.• Alerts you for possibility of

hyperventilation syndrome.• Common cause of dyspnea &

dizziness.

OBSTRUCTED BREATHING :

Also called as “air trapping”. It is seen in obstructive

diseases of lungs.

Here, expiration is prolonged because of increased airway resistance.

As the respiratory rate increases patient lacks sufficient time for full expiration. Hence the chest over-expands i.e. air trapping occurs and the breathing becomes more shallow.

Revision of waveforms:

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