Practical Tips on Managing Dysfunctional Breathing

Practical Tips on Managing Dysfunctional Breathing Community Outreach clinics Increased referral for Breathing Pattern Disorder
(BPD) Inspiratory Muscle Training (Relaxation Practitioner) REG (Respiratory Exercise Group) FIT (Following Intensive Therapy) Group
Recent Service Development
month Thetford Healthy Living Centre - Every Monday
morning Haverhill, Clements Surgery – Every Wednesday
afternoon Sudbury Health Centre – Every Thursday afternoon Botesdale Health Centre – 1st and 3rd Tuesday morning
Presenter
Breathing Pattern Disorder “around 10% of the population worldwide are
diagnosed with hyperventilion – far more have a subtle, yet clinically significant, breathing pattern disorder”.
Thomas,McKinley, Freeman, Foy, Price 2005
Presentation Notes
The diaphragm moves between 1cm at rest to 10cm during exercise. The intercostals use about 20% more energy than the diaphragm. During relaxed/ quiet breathing, the upper ribs should remain relaxed, and then while exercising, they then help to open the upper chest, almost like a reserve tank. Accessory muscles include the neck and shoulder muscles which lift the upper chest to increase the chest volume. They are active with RR >20bpm. The stomach muscles help with expiration during exercise. Inspiration should be split between the diaphragm and the external intercostals, 80/20, with the accessory muscles on standby by for exercise. Expiration is passive through elastic recoil - It is worth noting that many asthmastics have an element of forced end expiration I:E ratio of 1:2 Quiet breathing which is energy efficient, Regular breathing pattern, with RR 10-14. TV of around 500mls Diaphragm is also a core stabiliser for the trunk, and helps to support. Increases mechanical effeciency.
Presenter
“chronic or recurrent changes in breathing pattern that cannot be attributed to a specific medical diagnosis, causing respiratory and non-respiratory complaints”. (Lum 1987)
Hyperventilation, Dysfunctional Breathing, abnormal
breathing, breathing pattern disorder
Physiological Mechanical Psychological
Very evident in a variety of conditions, with or without lung disease
BTS/ACPRC Guidelines -2009 Breathing exercises, incorporating reducing RR and/or
tidal volume and relaxation training, should be offered to patients to help control the symptoms of asthma and improve quality of life (Grade A)
Breathing retraining incorporating reducing RR and/or tidal volume should be offered as a first-line treatment for hyperventilation syndrome, with or without concurrent asthma (Grade B)
• Behavioural programmes centred on breathing exercises and hyperventilation reduction techniques can improve asthma symptoms, quality of life and reduce bronchodilator requirement in adults with asthma.
• These techniques involve instruction by a trained therapist in exercises to reduce respiratory rate, minute volume and to promote nasal, diaphragmatic breathing. They can help patient’s experience of their condition and quality of life. They should ideally be provided as part of integrated medical care.
• Grade A Breathing exercise programmes (including physiotherapist-taught methods) can be offered to people with asthma as an adjuvant to pharmacological treatment to improve quality of life and reduce symptoms.
difficult asthma have identified high rates of dysfunctional breathing as an alternative or concomitant diagnosis to asthma causing symptoms. It remains unclear what is the best mechanism of identifying and managing this problem.
Dysfunctional breathing should be considered as part of a difficult asthma assessment.
Subjective and Objective history
Cardiovascular system
Increased blood pressure (Chaitow, 2006) Altered heart rhythm possibly including palpitations and tachycardia. Chest pain & angina Altered functioning of the venous system possibly including • Vasomotor instability (Unstable narrowing & widening of
the blood vessels ) • Raynaud’s phenomenon (Spasms of the small arteries of the
fingers, and sometimes the toes. It is usually brought on by exposure to cold or excitement. )
• Capillary vasoconstriction (face, arms, and hands) • Cold extremities
Respiratory system
Gastrointestinal system
Muscular system
Cramps Muscle pains (especially occipital, neck, shoulders, between scapulae) Muscle tremors, twitching, weakness, stiffness or tetany Myofascial trigger points (Chaitow, 2006) Overuse of the accessory muscles of breathing (Forman, 2007)
Nervous system Sympathetic arousal (Chaitow, 2006) Dizziness, instability, and sensation of faintness or giddiness Visual disturbances such as blurred or tunnel vision, intolerance of light Dilated pupils Headache (often migraine) Paresthesia – commonly of hands, feet or face sometimes scalp or whole body
Psychological effects
Tension and anxiety Depersonalisation, feeling “out of body”, hallucinations Panic disorders, phobias Fatigue and disturbed sleep Impaired mental function including concentration, memory and clarity of thought.
Cerebrovascular effects
Cerebrovascular constriction is a common response to breathing pattern disorder and can reduce oxygen available to the brain by about 1/2 Symptoms •Dizzinesss •Blurring of consciousness •Emotional instability
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1) I feel I cannot take a deep or satisfying breath
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1) My rib cage feels tight and can’t expand
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1) I feel breathless in association with other physical symptoms
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1) I feel that the air is stuffy, as if not enough air in the room
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1) My breath feels like it does not go in all the way
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1) My breath feels like it does not go out all the way
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1) I breath through my mouth at night while I sleep
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Presenter
Presenter
Inspiratory Muscle Training 2000 Caine, M.P and McConnell, A.K
Developed POWERbreathe POWERbreathe uses a technique commonly known as
resistance training, in much the same way as you might use weights to increase the strength of your arm muscles.
Dumbbell for the diaphragm
Training 30 breaths twice a day Aiming for repetition failure
If repetition failure reached, then quarter turn each day of the POWERbreathe to increase resistance
6 weeks Ensure good technique at rest and on movement
in performance Improved endurance Improved QOL questionnaires Improved performance for elite sports people Improved breathlessness scores
Patterns. 1:1 initially to ensure efficient breathing pattern Pilates style core strengthening exercises Functional based exercises – 2-3 levels POWERbreathe Nijmegan SEBQ End expiratory hold
McWilliams et al 2009
Outcome (Average)
6min walk – increase of 123m Incremental Shuttle – increase of 120m HAD – Anxiety 8.5>4.8 Depression 7.5>4.3 SF-36
Physical Functioning> 30% Physical Health> 16% Emotional stresses> 35% Energy/ Fatigue> 15% Emotional Well being> 7.7% Social Functioning> 16% Pain Levels> 8% General Health> 15%
Outcome
Possible symptoms of BPD
Possible symptoms of BPD
Possible symptoms of BPD