DB Management

• Management of DB:

  • Explanation of mechanisms +++ e.g. stop using accessory muscles
  • Breathing retraining
  • diaphragmatic breathing control
  • management of speech
  • compensatory techniques (after sighing/yawning)
  • Acute symptom management
  • rescue techniques
  • Exercise
  • Relaxation techniques
• Aims of Breathing Retraining:

  • Restore and maintain normal diaphragmatic breathing pattern
  • Re-programme respiratory centre to trigger inspiration at a higher level of CO2
• Breathing Retraining:

  • Teach breathing control in crook lying first
  • Progress to side lying, sitting and standing
  • Awareness of faulty breathing pattern
  • Relaxation of the upper chest, shoulders and accessory muscles
  • Abdominal / lower chest breathing pattern (breathing control)
• Breathing Control:

  • Gentle relaxed breathing using the lower part of the chest
  • Tidal volume
  • Inspiration through nose
  • Focus on location rather than respiratory rate
  • Proprioceptive/visual feedback
  • Should feel uncomfortable
  • Breathing retraining CD
• Compensatory Breath Holds:

  • Short breath-holds
  • Use after sighing/yawning etc.
  • The breath hold should not be preceded by a deep inspiration
  • Breath hold allows CO2 to rise
  • Follow with normal breathing
• Rescue Techniques:

  • Techniques to use during an acute attack of symptoms
  • Rest positions e.g. forward lean sitting with arms supported
  • Breathing into hands cupped over nose and mouth
  • rebreathe CO2
  • caution with paper bag
  • can also use oxygen mask
  • Use of a fan on each side of face (trigeminal nerve outlet) helps reduce respiratory rate
• Dysfunctional Breathing and Speech:

  • Problems
  • Forgetting to pause for breath during speech
  • Speaking to the end of exhalation following by a gasping inhalation
  • Management strategies
  • Speak slowly
  • Regular pauses for breath
  • Low volume breaths
  • Reading aloud
• Exercise:

  • Exercise may help “normalise” breathing
  • Start with walking and stair climbing +/- oximetry
  • Education of expected changes
  • Increase in minute ventilation due to increased consumption
  • Loss of rest phase after exhalation
  • Upper chest involvement
  • Switching from nose to mouth breathing
  • Breathlessness not harmful
  • Breathing control on exertion