Recognizing and Treating Breathing Disorders

Christopher Gilbert, Leon Chaitow, Dinah Bradley

• Publisher: Churchill Livingstone
• Year: 2014
• eBook ISBN: 9780702054273
• Edition: 2
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

This authoritative, research-based book, written by a team of clinical experts, offers an introduction to the symptoms and causes of disordered breathing as well as the strategies and protocols that can be used to correct and restore normal breathing. Multidisciplinary Approaches to Breathing Pattern Disorders guides readers through a discussion of the current research that links disordered breathing patterns with perceived pain levels, fatigue, stress and anxiety. Basic mechanics, physiology, and biochemistry of normal breathing are outlined to lay a foundation for understanding causes and mechanics of disordered breathing. Self-help strategies with charts and workbook pages that may be photocopied as handouts are designed to help patients overcome specific breathing problems.

"...this second edition is particularly outstanding, providing a good basis of practical hands-on techniques, well supported by pictures and the website, and giving specific focus on sports, speech and chronic pain." Reviewed by Janet Rowley on behalf of the New Zealand Journal of Physiotherapy, January 2015

"..a fantastic resource which will help students, clinicians, and physiotherapists to carry out effective evaluation and treatment in an acute care setting." Reviewed by Poonam Mehta on behalf of the New Zealand Journal of Physiotherapy, January 2015

• Written by an international team of highly experienced clinicians in the field
• Addresses all the most effective aspects of therapy - physiotherapy, psychotherapy, osteopathy
• Includes an introduction to the understanding of the mechanics, physiology and biochemistry of normal breathing
• Includes self-help measures with charts and workbook material which may be photocopied for using with the patients

Chapter 1

What are breathing pattern disorders?

Leon Chaitow, Dinah Bradley and Chris Gilbert

Chapter contents

Historical background to the extreme of BPD/hyperventilation

Varieties of BPD and its symptoms

How common is HVS, and who is most affected?

BPD is not a disease

‘The Great Mimic’

Lum's perspective

Adaptation

How well is the individual adapting?

Has adaptation reached the point of exhaustion?

Biological rhythms as a guide

Evidence of functional change with treatment

Patient categorization

Homeostasis and heterostasis

Therapy as a stress factor

Conclusion

Where next?

References

The focus of this book is on normal versus abnormal respiratory patterns – referred to throughout the book as breathing pattern disorders (BPD) – and how best to restore normal function once an altered pattern has been established. This commonly requires the removal of causative factors, if identifiable, and, if possible, the rehabilitation of habitual, acquired dysfunctional breathing patterns. In order to achieve this most efficiently, some degree of structural mobilization to restore the machinery of breathing – the structural components – towards normality, is usually helpful.

If rehabilitation is attempted without taking account of etiological features, or of maintaining features – for example restricted rib articulations, shortened thoracic musculature, or psychosocial problems – results will be less than optimal.

An example of extreme breathing pattern alteration is hyperventilation. Acute, chronic, or acute on chronic hyperventilation, and its effects, occupy a major part of the book. It is also necessary to explore the widespread area of functional BPDs, in which normal patterning is clearly absent, even though symptomatic hyperventilation is not evident.

What is clearly evident is that hyperventilation syndromes/breathing pattern disorders (HVS/BPDs) are alive and thriving in the 21st century (Gardner 2004, Studer et al 2011). In the 5th century BC Hippocrates observed that breathing is the balancing force in maintaining mental and physical health: his words, ‘The brain exercises the greatest power in human-kind – but the air supplies sense to it,’ are as relevant today as they were 2500 years ago. More recently called ‘a diagnosis begging for recognition’ (Magarian 1982), these disorders are increasingly being recognized as major causes of ill health, though still remaining widely under-diagnosed and under-treated.

Historical background to the extreme of BPD/hyperventilation

The first description of hyperventilation in Western medical literature dates back to the American Civil War, when a surgeon published a paper entitled ‘On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences’ (Da Costa 1871). The series of 300 soldiers studied suffered breathlessness, dizziness, palpitations, chest pain, headache and disturbed sleep. The symptoms improved when the soldiers were removed from the front line, but their recovery was slow. Although Da Costa recognized the symptoms as functional in origin, he did not identify hyperventilation as the primary cause.

Physiologists Haldane & Poulton (1908) associated numbness, tingling, and dizziness with overbreathing. A year later, Vernon (1909) added an additional symptom, muscular hypertonicity. These symptoms occurred with respiratory alkalosis when patients were hyperventilating.

Kerr and colleagues (1937) introduced the term ‘hyperventilation syndrome’ (HVS) and pointed out the diversity and variability of symptoms in many systems of the body. Before these publications, a number of cardiologists following up Da Costa's syndrome had debated whether the heart was involved and coined phrases to fit in with their own views. Thomas Lewis (1940) used the terms ‘soldier’s heart’ and ‘effort syndrome’ in relation to British soldiers in and after the First World War, whereas US cardiologists were reluctant to label the symptoms as cardiac or related to effort. They preferred the term ‘neuro-circulatory asthenia’.

These arguments were largely settled when Soley & Shock (1938) found that all the manifestations of ‘soldier’s heart’ and ‘effort syndrome’ could be induced by hyperventilation and consequent respiratory alkalosis. Since then, many names have been given to this complex set of symptoms – changing with the fads of the time. ‘Designer jeans syndrome’ (Perera 1988) was popular in the 1970s, and the current so-called Gulf and Balkan War syndromes include many of the same signs and symptoms. Broadly speaking, HVS/BPD was accepted as being of psychiatric origin in the USA and readily diagnosed, whereas in the UK physicians were reluctant to recognize it. A number of factors may have been operating. Most of the reports were in psychological and psychiatric literature, unnoticed by general practitioners and physicians. Influential UK cardiologist Paul Wood (1941) had reviewed Da Costa's syndrome and firmly placed it in the hands of the psychiatrists. Sadly there was little dialogue between the two specialties.

More recently, chest physician Lum (1977), writing from the Addenbrooke and Papworth hospitals in Cambridge, England, with physiotherapists Innocenti (1987) and Cluff (1984), who developed assessment and treatment programmes, has done much to enlighten the medical practitioners in the UK and re-ignite scientific interest and research into the condition. Since that time there has been a flowering of literature on the subject as more sophisticated and accessible research equipment has become available.

Despite such progress, there are still considerable numbers of cardiologists, general and specialist physicians, or general practitioners who are reluctant to diagnose or seek treatment for their patients with hyperventilation (Hornsveld & Garsson 1997). Endless, increasingly sophisticated tests are carried out. Alternatively, patients are referred to further specialists for symptoms related to other fields, or they are told ‘nothing is wrong’ with them. If hyperventilation as a causative factor is not considered and tested for, investigations may be protracted, diagnosis avoided, and the patient and the patient's file relegated to the ‘too hard’ basket. This puts patients at great risk of invalidism or of being labelled as malingerers. Medical historians have suggested, for example, that the chronic invalidism of Florence Nightingale and Charles Darwin in the 19th century was more likely chronic hyperventilation, rather than heart disease resulting from infections picked up in the Crimea and the Andes respectively, as was previously believed (Timmons & Ley 1994).

Varieties of BPD and its symptoms

There are a variety of symptoms, the most extreme of which is hyperventilation syndrome, which is defined as breathing in excess of metabolic requirements, reducing carbon dioxide (CO₂) concentrations of the blood to below normal. This alters the body's pH, increasing alkalinity, and so triggering a variety of adaptive changes that produce symptoms – described in more detail below....

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Contributors
• Foreword
• Preface
• Acknowledgments
• Disclaimer
• The Website
• Chapter 1: What are breathing pattern disorders?
• Chapter 2.1: Dynamic Neuromuscular Stabilization: developmental kinesiology: breathing stereotypes and postural-locomotion function
• Chapter 2.2: The structure and function of breathing
• Chapter 2.3: Nasal influences on breathing
• Chapter 3: Patterns of breathing dysfunction in hyperventilation and breathing pattern disorders
• Chapter 4: Biochemical aspects of breathing
• Chapter 5: Interaction of psychological and emotional variables with breathing dysfunction
• Chapter 6.1: Dynamic Neuromuscular Stabilization: assessment methods
• Chapter 6.2: Osteopathic assessment of structural changes related to BPD
• Chapter 6.3: Physiotherapy assessment approaches
• Chapter 6.4: Psychological assessment of breathing problems
• Chapter 6.5: Questionnaires and manual methods for assessing breathing dysfunction
• Chapter 6.6: Capnography assessment
• Chapter 7.1a: Indirect approaches to breathing regulation
• Chapter 7.1b: Dynamic Neuromuscular Stabilization: treatment methods
• Chapter 7.2: Osteopathic treatment of thoracic and respiratory dysfunction
• Chapter 7.3: Physiotherapy in rehabilitation of breathing pattern disorders
• Chapter 7.4: Psychological training and treatment of breathing problems
• Chapter 7.5: Speech and singing
• Chapter 7.6: Breathing pattern disorders and the athlete
• Chapter 7.7: Capnography in treatment of BPD
• Chapter 8.1: Breathing patterns in longstanding pain disorders: a somatocognitive approach to evaluation and therapy
• Chapter 8.2: Buteyko breathing method
• Chapter 8.3: Feldenkrais® and breathing
• Chapter 8.4: Pilates in the rehabilitation of breathing disorders
• Chapter 8.5: Tai chi, Qigong and breathing
• Chapter 8.6: A review of the use of yoga in breathing disorders
• Chapter 9: Self-help approaches
• Glossary/Acronyms/Abbreviations
• Index