Breathlessness – How to breathe correctly (Part 1)

Breathlessness, or dyspnoea, refers to the sensation of having difficulty breathing or feeling short of breath. While feeling breathless from time to time is a natural human response, breathlessness that occurs at rest or while carrying out daily tasks, such as reaching down to a low cupboard, requires expert assessment and treatment.

Dr Jonathan Pitts Crick is a highly renowned consultant cardiologist who specialises in breathlessness. In the first of a three-part series of articles on breathlessness, Dr Pitts Crick provides a comprehensive insight into the factors that can stimulate breathlessness.

What can affect breathlessness?

The general perception is that you breathe because you need oxygen, and therefore, not getting enough oxygen can make you breathless. However, this is completely wrong, because most people who are breathless have a normal level of oxygen in their blood. The lack of oxygen is not the cause for their breathlessness, and thus, breathing more will not help.

When it comes to breathlessness, the main issue is that the respiratory centre (which is the part of the brain that controls breathing) can easily get it wrong. The respiratory centre is located in the medulla oblongata (which is one of the oldest parts of the brain), and evolved in very early amphibians when it was necessary to breathe air. However, the breathing centre has not developed much since that time, and remains “badly designed” as a system to control breathing. Although it works well enough in young and fit people, it becomes progressively less effective in older people.

Now, most control systems (such as a thermostat on a radiator) work in two directions. This ensures that the radiator will shut down when the temperature gets too hot, and that the radiator will open up to try and maintain the temperature if it gets too cold.

Most processes in the body have a similar control system (called a feedback system) that works in two directions. But the respiratory centre is unusual, because it is missing half of this feedback system. This means that if you are not breathing enough, as detected by an increase in carbon dioxide in your blood, the system will stimulate your breathing. However, if you breathe too much, the system will do nothing to slow your breathing down. It only slows down over time when all the causes of stimulation have stopped. Thus, there is a natural tendency for any change in your body to increase your need to breathe, but nothing besides the lack of stimulants, that makes you reduce your breathing again.

The breathing centre is stimulated by many factors. The principal of these agents is carbon dioxide, which is produced when muscles “burn” the sugar or fatty acids by combining them with oxygen to release the energy to work. This stimulates breathing if levels of carbon dioxide in the blood build up. This occurs because carbon dioxide is acidic when in solution – and the respiratory centre is sensitive to acid in the blood. As soon as your blood becomes even slightly acidic, your brain immediately thinks, “I have to breathe more, because I am piling up carbon dioxide” and so, you start breathing more.

Yet, carbon dioxide is not the only agent, because almost all stimuli to the nervous system will make you breathless. For example, if you jump in the cold sea during spring, you will still be very breathless (gasping for breathing), but the cold will not indicate that you need more oxygen. Rather, it will only be a stimulus to your nervous system. Almost all stimuli in the body can do it, including anxiety messages from other parts of your brain, which can make us breathe more based on the potential need for “fight or flight”.

A strong input to the respiratory centre are also the nerves in the chest. As you try and take a deep breath, your movement stimulates those nerves, which signal to the respiratory centre that “it is a bit tight down here.” The respiratory centre will then respond saying that “we will try breathing more, because it might help”, and as it stretches the lungs, this will stimulate the nerves even more. In turn, this will stimulate the respiratory centre, and the whole process will become a “vicious circle” of constant stimulants. The more you breathe, the more you will feel breathless.

Given that there is nothing stopping you from breathing too much, people wind up breathing more and more to the point of becoming breathless – having been triggered only by an initial need for breath. This can be a very debilitating symptom to have, and the main reason that stops people from doing things. For example, if you think about what is stopping you from walking up a hill, the most common reason is not that your legs are tired, but that you get breathless, which is completely unnecessary because the lungs (unless someone has a very severe lung disease) are perfectly able to supply the oxygen you need to walk up a hill. Here, it is only that the brain gets the wrong idea and thinks that it is the lack of oxygen that is the problem. For this reason, it is very important to recognise that breathlessness is not always a sign of lung or heart disease, but rather, a sign that the brain’s breathing centre has “got the wrong end of the stick”. This is the key to the whole treatment of breathlessness.

Head on over to the second part of this series of articles on breathlessness to find out about the actions that you should take if you feel breathlessness.

If you are worried about breathlessness and wish to seek expert assessment and treatment for it, do not hesitate to book a consultation with Dr Jonathan Pitts Crick via his Top Doctors profile today.