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Breathing pattern disorder (BPD) is a condition in which a person's breathing becomes irregular, shallow, or rapid, leading to a variety of symptoms. Also known as dysfunctional breathing or hyperventilation syndrome, BPD is not a disease process but an alteration in breathing patterns that interferes with normal respiratory processes. However, BPD can co-exist with diseases such as COPD or heart disease.

Causes of Breathing Pattern Disorders

BPD can be caused by various factors, including stress, anxiety, poor posture, or chronic respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). Breathing disorders such as sleep apnea or lung disease can also lead to BPD.

Types of Breathing Pattern Disorders

Breathing pattern disorders (BPDs) can be categorized into two types:

  1. Hyperventilation Syndrome

    • Characterized by rapid, shallow breathing that leads to the loss of carbon dioxide from the body, causing symptoms such as dizziness, tingling in the hands and feet, and muscle spasms. Hyperventilation syndrome can be triggered by anxiety, stress, or physical exertion.
  2. Disordered Breathing During Sleep

    • Caused by obstructive sleep apnea, a condition in which the airway becomes partially or completely blocked during sleep, leading to pauses in breathing that can last for several seconds. This can cause sleep disruptions, leading to symptoms such as fatigue, daytime sleepiness, and headaches.


  • Shortness of breath
  • Chest tightness or pain
  • Rapid or shallow breathing
  • Dizziness or light-headedness
  • Feeling like you can't catch your breath
  • Fatigue
  • Anxiety or panic attacks
  • Headaches

Physical Assessment

Assessment of Breathing Pattern

When assessing breathing patterns, it is important to understand what normal breathing looks like. The resting respiratory rate changes throughout the lifespan:

  • Babies breathe 35 - 58 times per minute
  • Toddlers 15-22 times per minute
  • Adolescents 12-16 times per minute
  • Adults adopt a respiratory rate of 10-14 breaths per minute when lungs stop growing (around age 22).

At rest, a typical pattern will involve the nose and abdomen. Exhalation should be slightly longer than inhalation, with an approximate ratio of 1:2 (inhalation to exhalation). There should be a slight pause at the end of the exhalation to maintain homeostasis and pH.

Important Assessment Tests

  1. Breath Holding

    • Ask the patient to exhale and then hold their breath. People can usually hold their breath for 25 to 30 seconds. If a patient holds less than 15 seconds, it may indicate low tolerance to carbon dioxide.
  2. Seated Lateral Expansion

    • Place hands on the lower thorax and monitor motion while breathing, looking for symmetrical lateral expansion.
  3. Sniff Test

    • Assesses bilateral diaphragm function. Useful for assessing upper or lower chest pattern dominance. The therapist places their hand three fingers below the patient's xiphoid process. The patient performs a quick sniff. The therapist should feel an outward movement of the abdominal wall, indicating both hemi-diaphragms are working. Upper chest breathers usually have no diaphragmatic excursion or may draw in their abdominal wall.

Assessment of Musculoskeletal System

  • Observe elevated and depressed ribs and clavicle with rib palpation techniques.
  • Check for muscle tone and length, especially in the psoas, quadratus lumborum, latissimus dorsi, upper trapezius, scalene, and sternocleidomastoid.
  • Assess for alterations in the mobility of the thoracic and rib articulations.

Physical Examination

Includes observation, palpation, and auscultation:

  1. Observation

    • Observe the patient's breathing pattern at rest, during activities, and in different positions. Look for signs of shallow, rapid, or uneven breathing, and any use of accessory muscles or other signs of respiratory distress.
  2. Palpation

    • Feel for any tension or tightness in the chest, back, or abdomen. This can help identify areas of restricted movement or muscle tension contributing to the breathing pattern disorder.
  3. Auscultation

    • Listen to the patient's breath sounds using a stethoscope. Identify any wheezing, crackling, or other abnormal sounds that may indicate a breathing problem.
  4. Spirometry

    • A non-invasive test measuring how much air a person can exhale and how quickly. Helps diagnose breathing pattern disorders like asthma or COPD.
  5. Other Tests

    • Depending on the suspected cause of the breathing pattern disorder, additional tests such as chest X-rays, CT scans, or allergy testing may be ordered.

Physiotherapy Management

Physiotherapy can play an important role in the management of BPD. Here are some common physiotherapy techniques that may be used:

  1. Diaphragmatic Breathing

    • Involves breathing deeply from the diaphragm, increasing the amount of air entering the lungs and improving oxygen exchange. Helpful for people who tend to breathe shallowly or use their chest muscles instead of their diaphragm.
  2. Pursed-Lip Breathing

    • Involves exhaling through pursed lips, reducing the work of breathing and preventing shortness of breath. Particularly helpful for people with COPD.
  3. Breathing Retraining

    • Teaches patients to recognize and correct their abnormal breathing patterns. Helpful for people who have developed habits of over-breathing or under-breathing, or who tend to breathe rapidly or shallowly.
  4. Postural Drainage and Chest Physiotherapy

    • Involves positioning the body in different ways to promote the drainage of mucus from the lungs and improve breathing. Helpful for people with conditions like cystic fibrosis or bronchiectasis.
  5. Exercise Training

    • Regular exercise can help improve lung function and increase overall fitness. A physiotherapist can help design a safe and effective exercise program for each individual.
  6. Relaxation Techniques

    • Stress and anxiety can worsen BPD symptoms, so relaxation techniques like deep breathing, meditation, or progressive muscle relaxation can help manage symptoms.


Breathing pattern disorders can significantly impact a person's quality of life, leading to symptoms like shortness of breath, chest tightness, and anxiety. Proper assessment and management, including physiotherapy techniques such as diaphragmatic breathing, pursed-lip breathing, and exercise training, can help alleviate symptoms and improve breathing patterns. Addressing BPD early is crucial to prevent long-term complications and improve overall health and well-being.

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