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When patients understand the underlying reasons why they have problems, and what they must do to correct these problems, they then become informed partners in their health care. Knowledgeable patients generally do much better than uninformed patients. For this reason it is important you have some understanding of breathing control, before we teach you how to alter your breathing patterns.
Breathing control is regulated by many sensors in the body that feed information into the Respiratory Center in the brain, which in turn sends out feedback regulatory signals to the diaphragm and rib muscles to tell them how to move to make a Breathing Pattern, in order for you to breathe in and out.
The system is very complex, with mechanical sensors in the lung and chest wall that sense pressure and tissue stretch, and the volume position of the lung. There are also chemical sensors in the central blood vessels and within the brain that sense Oxygen and Carbon Dioxide levels in the blood. The Respiratory Center must make a constant and delicate balance of breathing, to be certain enough Oxygen in breathed into the body, and that the waste Carbon Dioxide from body metabolism is removed. This system is very dynamically active, and constantly changing, to adapt to changing metabolic needs, such as when you go from a resting to exercise condition.
The respiratory regulatory system is unique among all the major body systems, because it has given you the ability to voluntarily control your breathing patterns. Higher centers in the brain can easily override the normal automatic feedback regulatory system of the Respiratory Center. Think of this as a manual override button, which allows you to take larger or smaller breaths, or vary your breathing rate and pattern in subtle ways. This ability to voluntarily control your breathing, and to train your breathing into a new pattern, is the marvelous tool that you can use to correct your abnormal COPD Breathing Pattern, and thereby minimize your breathing distress.
There is however a downside to this ability to voluntarily alter your breathing pattern. As noted in the discussion on the Rescue Breathing Pattern, this psychologically driven rapid and forceful breathing pattern can have serious consequences. This is particularly true in the COPD patient who is in danger of promoting Dynamic Hyperinflation and making their breathing distress much worse.
The person with COPD typically breathes at a relatively rapid rate and with a small breath volume, and usually with a relatively short expiration time. This is due to abnormal mechanical factors within your lungs and chest wall. The lungs are frequently stretched-out near their elastic limit and therefore more effort has to be expended to make the lungs move. The chest wall and chest muscles of breathing are also stretched-out near their elastic limit, and furthermore are involved in the stiffening problem related to the Barrel Chest deformity, thus making the chest wall even harder to move.
The result is a small breath volume (called the Tidal Volume), because taking in a larger breath is just too hard to do, and would require too much so-called Work of Breathing. Shortness of breath (Dyspnea) is related to a number of factors, but is most closely related to the Work of Breathing. And because of these smaller breaths, in order to provide enough air, the respiratory rate of breathing must speed up, hence the COPD breathing pattern of rapid and shallow breathing.
Unfortunately however, using smaller breaths to breathe more easily has a serious downside. Not all of the air you breathe in actually does you any good. Only the air that reaches the alveoli (the air sacks) can participate in the Gas Exchange of Oxygen and Carbon Dioxide with the blood. This air, at the beginning of the breath, that penetrates down deepest to the alveoli is called the Alveolar Ventilation. The air at the end of a breath in does not penetrate the lungs deep enough to reach the alveoli and participate in Gas Exchange, and appropriately is called Dead Space Ventilation. The smaller your breath, the smaller will be your relative Alveolar Ventilation that is actually doing you some good by permitting gas exchange of Oxygen and Carbon Dioxide.
Yes indeed, smaller breaths are easier to do, but they carry this serious breathing penalty of having relatively more of your breath as unused Dead Space Ventilation. Being able to take a larger breath with relative ease is crucial to optimizing your breathing. You now know why we have spent so much time discussing the chest wall, and the mobilization and strengthening of the chest wall, in order that you may take in a larger breath of air, and doing it more efficiently and easily.
This also introduces you to a more complex and comprehensive concept of balancing, and trading-off various parts of your breathing, in order to best optimize your breathing pattern within the constraints imposed by the disordered mechanics of the COPD and Emphysema lung. Later you will learn more about other apparent contradictions that may be used in a balanced manner to optimize your breathing, and how the Breathing Trainer may help you in fine tuning these balancing factors to advantage.
But first you must understand the concept of lung overinflation, and in particular the all-important concept of Dynamic Hyperinflation, as this is substantially responsible for increased breathing distress, literally having been tricked into this situation by an abnormal breathing pattern. This will be discussed in the next module.