Paradoxical Breathing

Without breathing there is no life. However, most of us don’t pay attention to it until a breathing problem rises which prevents us from leading a normal life, sometimes even threatening our own life.
One of the breathing problems, which could be even life threatening is paradoxical breathing.

What is Paradoxical breathing?
Normally, breathing is characterized by the intake of air, which help the oxygen get into our lungs and from there into our bloodstream, traveling afterwards all over our body, and followed by the expiration of the air from the lungs, which will get the carbon dioxide out of our lungs. During breathing the chest wall expands with inspiration, and gets back to its place while expiration. This process goes on and on during our life.

However, in cases with paradoxical breathing, the chest wall, instead of moving outwards, moves inwards during the intake of the air into the lungs. The abnormal chest movement results in breathing problems, because the lungs are not able to function correctly and there will be also a lack of oxygen, very important for the wellbeing of our body. The levels of oxygen in the blood will drop, while the levels of carbon dioxide in the blood will be increased.

What causes Paradoxical breathing?
Various medical conditions that affect the chest wall, the abdomen and the respiratory system may cause paradoxical breathing. Some of the most common causes of paradoxical breathing include:

Flail chest – is characterized by a separation of a part of the rib cage from the rest of the chest wall, mostly due to trauma. The severity of the condition varies from the severity of the damage caused to the chest wall. It is believed that three or more ribs should be broken and detached in order to have flail chest. However, some others believe that only two broken ribs are sufficient to cause flail chest. The detached part of the rib cage will move on the opposite direction from the other part of the rib cage wile breathing. Eventually breathing problems, will lead to paradoxical breathing. Flail chest can be also very painful.

Pneumothorax – is characterized by the presence of air in the pleural area which surrounds the lungs. Pneumothorax could be caused by various reasons like: lung injury, asthma, cystic fibrosis, tuberculosis, air travel, scuba diving, pulmonary edema, emphysema, fractured rib, punctured lung, lung infections, etc. The signs and symptoms of pneumothorax include: collapsed lung, dry and barking cough, sudden shortness of breath, sudden pain on one side of the lung, difficulty breathing and eventually even paradoxical breathing. There are also different types of pneumothorax, and tension pneumothorax is the most dangerous one.

Obstructive mechanics – is characterized by a mechanic obstruction of the airways, which will impair the normal flow of the air from and out of the lungs, impairing also the gas exchange of the oxygen and carbon dioxide. During mechanic obstruction of the airways, the chest wall will move inwards, instead of outwards. This is very common during sleep apnea or in cases when a foreign object blocks the airway.

Mechanical disruption of the chest wall – which is commonly seen in car accidents. In this case the ribs are usually separated from the rest of the rib cage due to the trauma. The injured ribs will no longer expand during inspiration, but instead they will move on their own, mostly inwards, impairing the breathing. The more ribs get injured during trauma, the more breathing problems a person will have.

Nerve problems – diaphragm plays a great role in the breathing process together with the muscles between the ribs and the rib cage as a whole. The phrenic nerve is the one that controls the movements of the diaphragm during breathing. If for any reason this nerve will get damaged, the breathing process will be impaired. The diaphragm will not be able to function as it should. The diaphragm paralysis is more common in cases with spinal cord injuries, lung cancer, multiple sclerosis, muscular dystrophy, etc.

How to deal with Paradoxical breathing?
As mentioned before there are different causes of paradoxical breathing, which usually require the right diagnosis and medical treatment. In many cases paradoxical breathing can be life threatening. Immediate medical help is necessary in any cases of trauma to the chest flail chest or tension pneumothorax as they can be life – threatening conditions. Heimlich maneuver should be performed in cases when a foreign object is obstructing the airways. As soon as you notice any breathing problems, you should consult your health care provider.


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