Breathing dysfunction in bronchiectasis
A good breathing pattern, which uses the diaphragm and external intercostal muscles to breathe in and elastic recoil to breathe out, enables the body to function efficiently with minimal oxygen consumption. However, breathing dysfunction, characterised by excessive recruitment of accessory muscles of respiration at rest, may increase oxygen consumption by up to thirty percent (Berne & Levy 1998).
Two common breathing pattern disorders are hyperventilation and upper chest breathing, both of which utilise the accessory muscles of respiration. These breathing disorders can result from a chronic respiratory condition, such as asthma, chronic obstructive pulmonary disease (COPD), or a suppurative lung disease. In asthma, it is well demonstrated that hyperventilation is a trigger for some individuals (Hough 2001).
In people with COPD or a suppurative lung disease, the removal of sputum is reliant on annular and slug flow along the bronchi, assisted by functioning cilia. These mechanisms are dependent on airflow from an efficient breathing pattern. An upper chest breathing pattern is a common presentation for patients with excess sputum. This may be due to a chronic cough, which engages the accessory muscles of respiration and reinforces a poor breathing pattern, or to patients adapting their breathing pattern so that the cycle of inspiration and expiration occurs above their sputum to prevent a cough. This disordered breathing pattern inhibits airway clearance therapies, and increase the risk of lower respiratory exacerbations.
A poor breathing pattern generally results from repetition and muscle memory and is a common scenario for people with chronic respiratory conditions. Efficient breathing patterns which enhance the use of the diaphragm and external intercostal muscles improve quality of life for people with chronic respiratory conditions (Burgess et al 2011). However, instruction in these techniques requires tuition from a health profession with expertise in breathing disorders and home training.
At present, little research is available to support breathing re-training for people with bronchiectasis but clinically it is recognised as an important addition to a comprehensive management plan for this group of patients.
An example of a physiotherapist teaching an appropriate breathing pattern to a patient can be seen in this video – Optimising Breathing Patterns in Chronic Respiratory disease