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Breath Cycles: Understanding Components of Breathlessness

Breath Cycles: Understanding Components of Breathlessness

Recently I came across a really interesting journal article on the breathless cycle and its role in chronic disease.1 A lot of the specifics referred to COPD however, I thought about the applicability to asthma.

What is breathlessness?

You can think of breathless as being short of breath. A need to breath or an uncomfortable awareness of the need to breathe.2 Some patients have described it as a feeling of air hunger, a need for air.2

Studies into the neurophysiology of breathlessness have identified that there may be a mismatch in the neural processing of the sensation of breathlessness.4 This can be thought of a disconnect between the thoughts and emotions that affect breathing and the chemoreceptors and metabolic receptors with information on actual ventilation needs.5

This leads to sensations of dyspnea, it is also thought, that the thought that avoiding the thought by decreasing activity can lead to deconditioning, which can make breathlessness worse.

My experience with breathlessness

This had me thinking about the dyspnea that I have experienced had me trying to understand those feeling. I am not sure that I have ever objectively measured lung function during these times. The study highlighted the idea of increased breathlessness in the absence of lung function decline. Hmm….. What does this all mean?  Enter the thoughts of the Breathing, Thinking, Functioning clinical model. This model looks at three domains, breathing, thinking and functioning.

The breathing domain looks at the role of dysfunctional breathing patterns (without underlying pathology) which may include a higher ratio of inspiratory to expiratory length, the absence of end-expiratory pause and frequent sighs or yawns.6-8 I never considered some of the manifestations as apical breathing.

The thinking element of breathlessness?

The thinking domain, I think this is the big one, it involves the anxiety and fear of breathing, which involves our perception of breathlessness. This can lead to a cycle of escalating panic and the anxiety increases respiration rates which increases the load on our muscle, making breathing harder.9-10

The function domain deals with the understanding that deconditioning increases the demands on the respiratory system, making breathing difficult.

This model was developed to be an educational tool for healthcare workers and to aid in the potential use on non-pharmacological techniques to interpret each cycle. Each of the domains is supported by research and evidence, it is also used in cognitive-behavioral therapy within psychological medicine.11 The model can also be used by patients to understand the cycles and implement self-management techniques and interventions.

Does anyone think of their breathlessness in these domains or talk themselves through periods of breathlessness? I would love to hear your thoughts.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. 1. Spathis, A., Booth, S., Moffat, C., Hurst, R., Ryan, R., Chin, C., & Burkin, J. (January 01, 2017). The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease. Npj Primary Care Respiratory Medicine, 27, 1.)
  2. Manning, H. & Schwartzstein, R. Pathophysiology of dyspnea. N. Engl. J. Med. 333, 1547–1553 (1995).
  3. Schwartzstein, R., Manning, H., Weiss, J. & Weinberger, S. Dyspnoea: a sensory experience. Lung 168, 185–199 (1990).
  4. Banzett, R., Mulnier, H., Murphy, K., Rosen, S., Wise, R. & Adams, L. Breathlessness in humans activates insular cortex. Neuroreport 11, 2117–2120 (2000).
  5. Sharma, P., Morris, N. & Adams, L. Effect of induced leg muscle fatigue on exertional dyspnea in healthy subjects. J. Appl. Physiol.118, 48–54 (2015).
  6. Gardner, W. The pathophysiology of hyperventilation disorders. Chest 109, 516–534 (1996).
  7. Chaitow L., Bardley D., Gilbert C. Multidisciplinary approaches to breathing pattern disorders. (Churchill Livingstone, London, 2002).
  8. Thomas, M., McKinley, R., Freeman, E. & Foy, C. Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. Br. Med. J. 2001, 1098–1100 (2001)
  9. Livermore, N., Butler, J., Sharpe, L., BcBain, R., Gandevia, S. & McKenzie, D. Panic attacks and perception of inspiratory resistive loads in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 178, 7–12 (2008).
  10. von Leupoldt, A., Sommer, T., Kegat, S., Baumann, H., Klose, H. D., Dahme, B. & Büchel, C. The unpleasantness of perceived dyspnea is processed in the anterior insula and amygdala. Am. J. Respir. Crit. Care Med. 177, 1026–1032 (2008).
  11. Moorey, S. The six cycles maintenance model: growing a ‘vicious flower’ for depression. Behav Cogn Psychol. 38, 173–184