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Inhale, exhale

Hear what your breathing pattern says about your health.

By Ivan Olegario, M.D.

AUGUST 2013 

The Law of Threes states that if you’re in a harsh environment, you could live around three weeks without food, around three days without water, around three hours without shelter, but only three minutes without breathing.

Inspiration + expiration = respiration

Breathing and your lungs are extremely vital to living. All of your blood flows through the lungs, so they are completely in tune with the state of health of your entire body.

We take for granted the 12 to 20 breaths we take per minute, an automatic function controlled by the unconscious part of your brain called the brain stem. Your rate of breathing changes throughout the day, depending on the amount of oxygen and carbon dioxide in your blood, the demand of your body for these gases, and the blood’s acidity.

In normal, gentle inhalation, your diaphragm contracts, acting as bellows to enlarge the chest cavity and suck in air through the nose, to the windpipe, down to the lungs. Your intercostal muscles—the muscles in between the ribs—also assist by widening the chest wall slightly. Normal exhalation simply involves the relaxation of these muscles. All these happen unconsciously.

But with deep breathing, several other muscles attached to your rib cage, including your chest muscles and your back muscles, also activate to move the rib cage more forcibly. Even exhalation requires some muscle power. These are also activated by your brain stem, but you can also consciously take deep breaths, like when you’re doing yoga or blowing out a birthday candle.

Rhythmic gentle and deep breathing occur in a healthy person. But these patterns can change during illness. What can these changes say about your health?

Gasping for air

A sensation of difficulty when breathing, or a sensation of gasping for air, is a common reaction during heavy exertion. But if you find yourself gasping for air while at rest, it could be a sign of serious disease, and shouldn’t be ignored. The most common causes are asthma, pneumonia and other lung diseases, heart disease, and anemia. Sometimes, it may be due to psychological causes such as anxiety, although this diagnosis is best left to the doctor.

If you experience shortness of breath at rest, or persistence of this symptom after resting from exertion, get help and go to the emergency room immediately.

Over 20 breaths per minute?

Rapid breathing is often closely related to shortness of breath. This is technically defined as more than 20 breaths per minute. Rapid breathing is a normal reaction of the body during times of exertion, anxiety or pain. All the diseases that cause shortness of breathing can also cause rapid breathing. It also occurs when the acidity of the blood increases, such as in the case of poorly controlled diabetes, alcoholism, cancer, liver failure, heart failure, seizures, kidney disease, severe dehydration and some cases of poisoning. Rapid breathing at rest can be a sign of failing health, so you should see a doctor as soon as possible.


A person snores when the tissues of the mouth and throat—usually the uvula and soft palate—vibrate while sleeping. The most common causes are: jaw malposition; fat in and around the throat; obstruction of the nasal passageways; intake of alcohol and muscle relaxants; and sleeping on one’s back, with the tongue dropping to the back of the mouth.

Snoring may also be the first sign of obstructive sleep apnea (OSA). Here, patients stop breathing for about 20 to 40 seconds during sleep because of obstruction of the air passages. Patients with OSA also have disturbed sleep, leading to sleepiness throughout the day. They may also have morning headaches, poor concentration, and irritability, anxiety and depression. OSA and the lack of oxygen it causes also strain the heart. People with OSA are at risk of developing heart disease, high blood pressure, stroke, diabetes, depression and obesity.

Most people find that snoring can be relieved by sleeping on one’s side, or at an elevation of 30 degrees or higher. You may sleep on a recliner, an adjustable bed, or a bed wedge placed under the mattress to achieve this angle.
If snoring isn’t relieved by changing your sleeping position, or you have other OSA symptoms, see an ENT specialist or a sleep specialist for proper treatment.

Involuntary whistles and wheezing

Most healthy people generally breathe quietly; all you can hear is the gentle flow of air moving in and out of the nostrils. Whistling, wheezing, rasping, gasping or crackling sounds are all signs of disease in the respiratory tract. Wheezing can be a sign of asthma. Wheezing, rasping or gasping sounds point to obstruction of the air passages. Crackles can mean fluid in the lungs, as in pneumonia or heart failure. All of these diseases warrant the care of a physician, which shouldn’t be delayed.

Have you heard of orthopnea? Or did you know that mouth breathing is unnatural and dangerous? Find out more about these abnormal breathing patterns in the August issue of
HealthToday, from bookstores or newsstands.

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