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Friday
Aug152014

Dysfunctional Breathing- What Is It, How Do You Measure It and Why Does it Matter

 We often see the term dysfunctional breathing (DB) used and many people are confused as to what this actually means. In some people’s minds the term is a proxy for hyperventilation or used to refer to patients who have unexplained breathing symptoms or to describe some types of breathing behavior.   

This term DB only started to appear in the scientific literature after the year 2000 as a result of  the huge furor in the 1990s over the validity of the “hyperventilation syndrome” as a diagnostic entity.   Briefly, the reason for the controversy was a series of research studies spanning about 10 years which showed that patients with all the symptoms of  hyperventilation syndrome often had normal CO2 and that experimental manipulation of CO2 levels did not reliably correlate with onset of symptoms.  As a Buteyko practitioner in the early 1990’s  who was also training practitioners all over the world I felt I needed to get to the bottom of this before I could go on teaching. I wanted to be sure that what I was teaching was true and accurate so I did a PhD on the subject.  

Dysfunctional Breathing is Multidimensional-

The model I came up with during my research is that DB is multi-dimensional and related to biochemical as well as biomechanical and psychophysiological functions.  An important concept to understand this multi-dimensional  model of DB  is that breathing has many functions beyond the regulation of blood gases. For example breathing has direct effects on the brain and nervous system, it influences how muscles are used for posture and movement, for speech and vocalisation, it has influences on the regulation of some key homeostatic functions in the circulatory system helping to match blood pressure to heart rate and regulate the autonomic nervous system and the homeostatic brain. Breathing is also an important tool for self regulation of mental and emotional states.     Breathing that is dysfunctional does not adequately or efficiently perform these and other functions so it promotes disease instead of health.

So how do we measure dysfunctional breathing?

Ideally measurement of dysfunctional breathing includes measurement of all the key dimension of breathing function at rest and under a range of challenges.  Ive developed a fairly simple and quick protocol that includes capnometry, breathing pattern assessment, a range of breath holding time measures and questionnaires. I also test the effect of breathing on the autonomic nervous system.   The breathing pattern assessment is done using a validated technique called the Manual Assessment of Respiratory Motion (MARM) which allows the therapist to quantify a range of components of breathing pattern.  The MARM includes a 5 step process that lets you see how breathing responds to posture and movement and breathing effort. It also gives an indication of the ways that breathing pattern is dysfunctional.  I use the Nijmegen Questionnaire but also developed and validated another questionnaire called the Self Evaluation of Breathing Questionnaire, which can give an indication of the origin of breathing symptoms and breathing dysfunction. For capnometry I do resting CO2 and also measure the response of ventilation to a range of mental and physical challenges. I do the classic Buteyko Control Pause but also use some other types of breath holding protocols as well, looking at the effect of varying lung volumes and response to the Hyperventilation challenge.  It sounds complex but the time taken to do all these measures is about 45 minutes.  

What does this mean practically?

A multidimensional model of dysfunctional breathing gives us a number of angles from which to approach evaluation and treatment. When we comprehensively evaluate different aspects of a patients breathing at the first visit it means we can more precisely adjust and individualize treatment to the patients needs. It also means that during the course of treatment we can tweak our instruction and use of techniques to optimise all aspects of breathing functionality.  

By seeing how measures change after and during treatment we start to get an insight into the “how and why” of how breath heals. It means we can slowly evolve a more complex understanding of how breathing retraining works, which patients it is best for

Futher testing this model and learning opportunities

Several groups of Osteopathy masters students at Southern Cross University have been testing various parts of this model as part of their masters research. Southern Cross are sponsoring me to teach this 2 day course for the research students and other interested health professionals.  Here is a link to info on the course

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