In 2011 I attended an introductory talk on breathing pattern dysfunction, given by Gerry Gajadharsingh DO, founder of The Health Equation in London’s West End. We looked at breathing physiology and how poor breathing can contribute greatly to a variety of issues that we as Osteopaths see on a daily basis in our practice. This lecture sparked an interest in breathing physiology and the use of capnometry as a method of greatly enhancing patient management and care, so I booked to attend the Level I course on ‘Breathing, Breathing Therapy and Capnography in Clinical Practice: An Integrated Approach’. Below is an overview of what we covered, detailing how important breathing and capnometry is if we are to truly become the holistic practitioners we aspire to be as Osteopaths.

Capnometry is a method by which carbon dioxide (CO2) concentration in expired gases can be measured. The process is carried out using a device called a capnometer, and an additional (optional) device, a capnograph, which can plot the levels as a graph for visual aid. Capnometry is used during anaesthesia, intensive care and in lung function studies. As osteopaths, capnometry is of most use as a method of studying lung function and breathing behaviour. Breathing is a unique behaviour that has a major influence on all systems in the body, including body chemistry (pH).

Basic breathing physiology tells us that oxygen (O2) is delivered to where it is needed in the body, and CO2 is removed. O2 is required by the body to release energy in the process of respiration. Movement of blood in the circulatory system plays an important role, with gas exchange occurring at the pulmonary alveoli via passive diffusion between alveolar gas and blood in lung capillaries. When the gases are dissolved in the blood, the heart and circulatory system pump them around the body.

O2 is the essential component of all the breathing gases. Inhaled air is made up predominantly of nitrogen (78%), O2 (21%), argon (0.96%), CO2 (0.04%) and other components (helium, water and other gases). Gases exhaled are approximately 5% richer in CO2 and 5% poorer in O2. The exact amounts of O2 and CO2 exhaled vary, depending on fitness, energy expenditure and diet of the individual in question, and this is where capnometry comes in use.

Good breathing entails proper allocation of CO2 and exhaling too much CO2 can create serious health problems. CO2 regulates the pH level of extracellular body fluids (blood and cerebrospinal fluid), electrolyte balance (sodium and potassium), blood flow (to the brain, heart and body), kidney physiology (bicarbonate regeneration) and vasodilation (delivery of O2 and nitric oxide by haemoglobin). A deficiency in CO2 is known as hypocapnia, or overbreathing.

Overbreathing can have immediate and long-term effects, triggering or exacerbating a wide variety of physical and psychological complaints, such as shortness of breath, chest pain, heart palpitations, anxiety, stress, fatigue, dizziness, blurred vision, confusion, attention deficit, poor concentration, headache and muscle tension, all of which impact on health and performance. In predisposed individuals, overbreathing can trigger or exacerbate phobias (public speaking), migraine, hypertension, attention disorder, asthma, angina, cardiac arrest, panic attacks, hypoglycemia, ischaemia (brain cell death), depression, epilepsy, sleep disturbance, allergy, irritable bowel syndrome and chronic fatigue.

So how can these problems be overcome? Often we are told to “breathe deeply”. This is a concept that has been taught in yoga, meditation and biofeedback for many years, and often leads a person to a state of drowsiness, a state mistaken for a relaxed meditative state. The individual is actually becoming lethargic and inducing hypoxia, as too much air is being inhaled, and not enough exhaled. This can be demonstrated using capnometry. When CO2 levels are measured, a decrease in CO2 can be seen, meaning that the body is being shorted of O2. Shortage of CO2 in the body reduces cellular uptake of O2, leading to a reduction of O2 in the bloodstream travelling to the brain and muscles of the body. This induces a state of hypoxia, and can often be mistaken for this relaxed meditative state that yoga and meditation aim to achieve. Deep breathing feels ‘relaxed’ to many people, and this is for a number of reasons. Firstly, we expect it to help, due to being told it will if practiced in situations of stress, as it takes our awareness inwards and because deep breaths usually slow down breathing rates, calming the system. The latter is what we aim to achieve, however, the deep breath is actually reducing oxygen supply, so this is not the correct method.

Capnometry is one way that is scientifically accurate in measuring CO2 levels, which also measures heart rate variability (HRV) and can be used to help breathing retraining, capnotraining. HRV is the variance between our heart rate at rest and at exertion. When at rest, when we breathe in, heart rate increases, and when we breathe out, heart rate decreases. This variance is HRV. A low HRV is a predictor of all causes of death, and from a scale of 0 (dead) – 30 (elite athlete), the average person will range somewhere between 8 – 12. A low HRV will often combine with negative emotions and poor health, with the converse also holding true. The role good breathing physiology plays in maximising HRV is not to be underestimated.

This course demonstrated how to provide objective assessment, diagnosis and management of patients showing patterns of breathing dysfunction. It also helped me understand the factors that originate and sustain breathing dysfunction, as well as the ability to educate patients about breathing behaviour. The basics of capnography were explained along with the benefits of direct measurement of CO2 and the use of breathing retraining to reestablish the correct CO2 levels. After this first course, I was able to understand how CO2 feedback methods can be used for assessment and breathing retraining, and how capnography will be a valuable adjunct to my practice.

I have since attended the Level II course, and come away with the intention of introducing breathing assessment to my practice, and to educate patients about breath and its impact on physiology and health. If you would like any more information on this, please do not hesitate to contact me.

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