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== Introduction ==
== Introduction ==
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'''Breathing Pattern Disorders''' (BPD) (or Dysfunctional Breathing) are abnormal respiratory patterns in relation to overbreathing which ranges from simple upper chest breathing to, at the extreme end of the scale, hyperventilation. Dysfunctional breathing (DB) is defined as chronic or recurrent changes in breathing pattern that cannot be attributed to a specific medical diagnosis, causing respiratory and non-respiratory complaints. <ref name="Lum">Lum L 1987 Hyperventilation syndromes in medicine and psychiatry: a review. J. R Soc Med. 80:229-231.</ref>This is not a disease process, simply alterations in breathing patterns that interfere with normal respiratory processes. They can however, co-exist with disease such as COPD or heart disease, and in some cases can mimic cardiac symptoms<ref name="Sueda">Sueda S et al. 2004 Clinical impact of selective spasm provocation tests Coron Artery Dis 15(8):491–497</ref><ref name="Ajani">Ajani A 2007 The mystery of coronary artery spasm Heart, Lung & Circulation 16:10–15</ref>.
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'''Breathing Pattern Disorders''' (BPD) (or Dysfunctional Breathing) are abnormal respiratory patterns in relation to overbreathing which ranges from simple upper chest breathing to, at the extreme end of the scale, hyperventilation. Dysfunctional breathing (DB) is defined as chronic or recurrent changes in breathing pattern that cannot be attributed to a specific medical diagnosis, causing respiratory and non-respiratory complaints. <ref name="Lum">Lum L 1987 Hyperventilation syndromes in medicine and psychiatry: a review. J. R Soc Med. 80:229-231.</ref>This is not a disease process, simply alterations in breathing patterns that interfere with normal respiratory processes. They can however, co-exist with disease such as COPD or heart disease, and in some cases can mimic cardiac symptoms<ref name="Sueda">Sueda S et al. 2004 Clinical impact of selective spasm provocation tests Coron Artery Dis 15(8):491–497</ref><ref name="Ajani">Ajani A 2007 The mystery of coronary artery spasm Heart, Lung &
amp;
amp; Circulation 16:10–15</ref>.
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BPDs are whole person problems, especially in long term conditions where dysfunctional breathing can destabilise mind and muscles, mood and metabolism<ref name="Peters">Peters, D. Foreword In: Recognizing and Treating Breathing Disorders. Chaitow, L., Bradley, D. and Gilbert, C. Elsevier, 2014</ref>. They can play a part in, for instance, premenstrual syndrome<ref name="Ott">Ott H et al 2006 Symptoms of premenstrual syndrome may be caused by hyperventilation Fertility and Sterility 86(4):1001.e17-1001.e19</ref>, chronic fatigue<ref name="Nixon">Nixon P, Andrews J. 1996 A study of anaerobic threshold in chronic fatigue syndrome (CFS). Biol Psychol. 43:264</ref>, pain, fibromyalgia<ref name="Naschitz">Naschitz J et al. 2006 Patterns of hypocapnia on tilt in patients with fibromyalgia, chronic fatigue syndrome, nonspecific dizziness, and neurally mediated syncope. Am J Med Sci. 331:295-303</ref> <ref name="Dunnett">Dunnett A et al. 2007 The diagnosis of fibromyalgia in women may be influenced by menstrual cycle phase. Journal of Bodywork and Movement Therapies 11:99-105</ref>and some aspects of anxiety and depression.<ref name="Lum">Lum L. Editorial: Hyperventilation and anxiety states. J R Soc Med. January 1984: 1-4</ref><ref name="Han">Han J et al 1996 Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders. J Psychosom Res. 41:481-493</ref>
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BPDs are whole person problems, especially in long term conditions where dysfunctional breathing can destabilise mind and muscles, mood and metabolism<ref name="Peters">Peters, D. Foreword In: Recognizing and Treating Breathing Disorders. Chaitow, L., Bradley, D. and Gilbert, C. Elsevier, 2014</ref>. They can play a part in, for instance, premenstrual syndrome<ref name="Ott">Ott H et al 2006 Symptoms of premenstrual syndrome may be caused by hyperventilation Fertility and Sterility 86(4):1001.e17-1001.e19</ref>, chronic fatigue<ref name="Nixon">Nixon P, Andrews J. 1996 A study of anaerobic threshold in chronic fatigue syndrome (CFS). Biol Psychol. 43:264</ref>,
neck, back and pelvic
pain
<ref name="Smith">Smith M Russell A Hodges, P 2006. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Australian Journal of Physiotherapy 21(52):11-16</ref><ref name="Haugstad">Haugstad G Haugstad T Kirste U 2006a Posture, movement patterns, and body awareness in women with chronic pelvic pain. J Psychosom Res. 61(5):637-644</ref>
, fibromyalgia<ref name="Naschitz">Naschitz J et al. 2006 Patterns of hypocapnia on tilt in patients with fibromyalgia, chronic fatigue syndrome, nonspecific dizziness, and neurally mediated syncope. Am J Med Sci. 331:295-303</ref> <ref name="Dunnett">Dunnett A et al. 2007 The diagnosis of fibromyalgia in women may be influenced by menstrual cycle phase. Journal of Bodywork and Movement Therapies 11:99-105</ref>and some aspects of anxiety and depression.<ref name="Lum">Lum L. Editorial: Hyperventilation and anxiety states. J R Soc Med. January 1984: 1-4</ref><ref name="Han">Han J et al 1996 Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders. J Psychosom Res. 41:481-493</ref>
== Clinically Relevant Anatomy ==
== Clinically Relevant Anatomy ==
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== Etiology<br> ==
== Etiology<br> ==
-
Breathing pattern disorders
involve being
in
a constant state of inhalation
.
This leads
to hypocapnia
- the
deficiency of carbon dioxide in the blood
due to
hyperventilation
- leading to
respiratory alkalosis, and eventually hypoxia or the reduction of oxygen to tissue.<ref name="Biff">Biff F. Palmer 2012 Evaluation and Treatment of Respiratory Alkalosis Am J Kidney Dis. 60(5):834-838.</ref> <ref name="Jensen">Jensen F 2004 Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport Acta Physiologica Scandinavica 182(3):215-227</ref>
This is commonly seen in chest breathers, that essentially never fully exhale in order to utilise full lung capacity.
+
Breathing pattern disorders
occur when ventilation exceeds metabolic demands, resulting
in
symptom-producing hemodynamic and chemical changes
.
Habitual failure to fully exhale - involving an upper chest breathing pattern -
may lead
to hypocapnia
. This involves a
deficiency of carbon dioxide in the blood
resulting from a breathing pattern disorder, the extreme of which involves
hyperventilation
. The result is
respiratory alkalosis, and eventually hypoxia
,
or the reduction of oxygen
delivery
to tissue.<ref name="Biff">Biff F. Palmer 2012 Evaluation and Treatment of Respiratory Alkalosis Am J Kidney Dis. 60(5):834-838.</ref> <ref name="Jensen">Jensen F 2004 Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport Acta Physiologica Scandinavica 182(3):215-227</ref>
-
As well as having a marked effect on the biochemistry of the body BPD can influence emotions, circulation, digestive function as well as musculoskeletal structures involved in the respiratory process. Essentially a sympathetic state and a subtle, yet fairly constant state of fight-or-flight becomes prevalent. This can lead to changes in anxiety, blood pH, muscle tone, pain threshold, and many central and peripheral nervous system symptoms. So, despite not being a disease, BPDs are capable of producing symptoms that mimic pathological processes. For example, overuse of accessory breathing muscles can lead to neck and shoulder pain/dysfunction. Some even mimic cardiac and gastrointestinal problems.
+
As well as having a marked effect on the biochemistry of the body BPD can influence emotions
<ref name="van Dixhoorn">van Dixhoorn J 2007. Whole-Body breathing: a systems perspective on respiratory retraining. In: Lehrer P et al . (Eds.) Principles and practice of stress management. Guilford Press. NY pp. 291–332</ref>
, circulation, digestive function as well as musculoskeletal structures involved in the respiratory process. Essentially a sympathetic state and a subtle, yet fairly constant state of fight-or-flight becomes prevalent. This can lead to changes in anxiety, blood pH, muscle tone, pain threshold, and many central and peripheral nervous system symptoms. So, despite not being a disease, BPDs are capable of producing symptoms that mimic pathological processes. For example, overuse of accessory breathing muscles can lead to neck and shoulder pain/dysfunction. Some even mimic cardiac and gastrointestinal problems.
This diagram (from <ref name="Chaitow">Chaitow, L., Bradley, D. and Gilbert, C. [http://bit.ly/1fe2oIE Recognizing and Treating Breathing Disorders]. Elsevier, 2014</ref>) shows the stress-anxiety-breathing flow chart demonstrating multiple possible effects and influences of breathing pattern disorders.
This diagram (from <ref name="Chaitow">Chaitow, L., Bradley, D. and Gilbert, C. [http://bit.ly/1fe2oIE Recognizing and Treating Breathing Disorders]. Elsevier, 2014</ref>) shows the stress-anxiety-breathing flow chart demonstrating multiple possible effects and influences of breathing pattern disorders.