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This is an example of a breathing pattern causing Air Trapping, which will in turn cause progressive Dynamic Hyperinflation after several breaths.

This is a rather unusual, but very instructive example, because the patient has only moderate airway obstructive disease, and her Respiratory Rate is slow, at about a normal 11 breaths per minute. This patient was a rather anxious lady, and at the time this record was obtained she was upset about her breathing comfort. Anxiety has been linked to not only rapid breathing, but also to Dynamic Hyperinflation. This is probably the main reason for this patient's breathing pattern.

Patients with severe COPD or Emphysema or Asthma, who are breathing more rapidly (frequently about 15 to 20 breaths per minute) are much more susceptible to developing Dynamic Hyperinflation. However, as anxiety also seems linked to triggering rapid breathing as well as Dynamic Hyperinflation, it is important for COPD patients to remain calm, and control their anxiety, and particularly if having breathing distress.

This upper record is one where the patient's computer screen was turned off, to obtain a record of the unprompted, natural breathing pattern.

Note that her inspired Tidal Volume breath is only about 425 cc, and that she does not properly exhale this breath back down to the normal resting (FRC) level. The amount of Air Trapping in this case is about 250 cc. Two or three more breaths of this type and she would certainly have significant Dynamic Hyperinflation. Note my hand written notation "You are not getting the breath out."




This bottom picture shows the Breathing Prescription prompting the patient. The time record shows it was obtained only 8 minutes later, and during that interval she did not take any medications.

Note that she follows the Breathing Prescription very well, and has easily increased her Tidal volume breath from 425 cc to about 1150 cc. And that she is now easily and fully exhaling back down to her starting level. Even with a much larger breath, she is no longer exhibiting any Air Trapping. Note the encouraging notations directly showing her with her own breathing record "You can breathe deeply" and "You can get the breath out." This Breathing Prescription has a slightly prolonged expiratory time with an Inspiration : Expiration Ratio of 1:1.7, to insure lung deflation.

This Breathing Prescription is essentially to PREVENT Dynamic Hyperinflation.

Using this patient example I have drawn some lines to indicate strategies to CORRECT Dynamic Hyperinflation.

The first technique is the most desirable one, the:

       Gradual Deflation Technique.

This is simply a natural prolongation of your usual expiration breathing pattern, which should always be relaxed, or at most, with very minimal effort, in order to minimize Dynamic Bronchial Compression.

This is demonstrated by the line extending to the right of the diagram. A 25% prolongation is about correct, as it will cause your lung volume to go below the beginning zero point, the so-called Functional Residual Capacity (FRC) by about 100 to 150cc.

Then, on Inspiration, the trick is not to breathe in more deeply than what your Breathing Prescription indicates. It is very tempting when you are short of breath to breathe in deeply, but if you do you will re-inflate your lung and have to start lung deflation all over again.

If you do this consistently, along with limiting your inspiration breath to about 70 to 80% of your usual inspiration volume, for about three to five breaths (no more than ten), you should be fully deflated. This is called the Inspiration Limitation Technique.

Only then, can you can start to take in some larger, and more satisfying breaths. And when you do, be sure that you are following your basic PREVENTION breathing prescription, by continuing to exhale all the way out, in order to not re-develop the Dynamic Hyperinflation problem. A recurrence of the Dynamic Hyperinflation situation is usually indicated by a sense of progressive tightness in your chest, and with further increased breathing difficulty.

The second deflation technique is a "Rescue Technique" for urgent lung deflation, the:

This is indicated by the second line below the diagram. Forced breathing should begin about two thirds to three quarters of the way through expiration, and at this juncture you should gently apply breathing force with your chest muscles, and also by tightening your upper abdomen. As noted in the previous module on Dynamic Bronchial Compression, this force must be gentle and carefully controlled. As noted in the diagram, this should abruptly force air out of your chest. Then, as before, be sure not to take in a deeper inspiration breath to re-inflate your lungs and have to start the deflation process all over again.

Unfortunately this technique has a penalty, and that penalty is the aggravation of Dynamic Bronchial Compression, which makes it harder to breathe out, and can make breathing very exhausting. When done, it should be done with the minimum force needed to do the job (Remember, like wringing water out of a wet towel). Save this technique for emergency use, such as acute dyspnea after a prolonged coughing attack, or just before you use your inhaler medications.

The final deflation technique is the:

As noted above, this technique can also be used in conjunction with the other deflation methods for rapid lung deflation. After exhaling, breathe in only about 70 to 80% of your usual inhalation breath, and then promptly perform the exhalation maneuver again. Do this generally no more than two or three times, as it can sometimes be rather uncomfortable to do.

We will next show you how to start your own program with the Breathing Trainer, and make adjustments to optimize your own personal breathing pattern.

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