A patient who is healthy and at rest should have a respiratory rate and rhythm that is not labored with passive exhalation.

This is known as normal breathing.

However, some patients may show signs of an abnormal breathing pattern, which can occur due to a variety of neurological and cardiopulmonary conditions.

In this article, we will explain the common types of abnormal respiratory patterns, what they indicate, and how they can be treated.

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What is a Respiratory Pattern?

A patient’s respiratory pattern refers to the rate, depth, and rhythm at which they are breathing.

In a healthy patient at rest, the respiratory rate should be 12-20 breaths per minute, with passive exhalation and a normal rhythm.

Again, this is known as eupnea (i.e., normal breathing).

Types of Abnormal Respiratory Patterns

When a patient’s breathing deviates from normal, it is considered to be an abnormal respiratory pattern. There are several different types, including the following:

  1. Tachypnea
  2. Bradypnea
  3. Apnea
  4. Cheyne-Stokes breathing
  5. Kussmaul breathing
  6. Biot’s breathing
  7. Hyperpnea
  8. Hypopnea
  9. Orthopnea
  10. Apneustic breathing
  11. Agonal breathing
  12. Ataxic breathing
  13. Paradoxical breathing

Each abnormal respiratory pattern has different characteristics that must be recognized by doctors, nurses, and respiratory therapists.

This helps with the diagnosis and treatment of the patient’s underlying condition.

Tachypnea

Tachypnea is an abnormal breathing pattern characterized by rapid breathing. It is defined as a respiratory rate that is greater than 20 breaths per minute.

Tachypnea does not have a single specific cause, but it is often seen in patients who are struggling to breathe, such as those with heart failure, COPD, or pneumonia.

Some other common causes of tachypnea include:

  • Sepsis
  • Hypoxemia
  • Diabetic ketoacidosis
  • Carbon monoxide poisoning
  • Pulmonary embolism
  • Asthma
  • Pleural effusion

Tachypnea is treated based on the underlying cause. For example, if hypoxemia is present, the patient may benefit from receiving supplemental oxygen.

Bradypnea

Bradypnea is the opposite of tachypnea and is defined as a respiratory rate of fewer than 12 breaths per minute.

As with tachypnea, bradypnea does not have a single specific cause, but it is often seen in patients who are sedated or have a central nervous system disorder.

Some other common causes of bradypnea include:

  • Drug overdose
  • Hypothyroidism
  • Brain injury

Bradypnea is treated based on the underlying cause. For example, if the patient is breathing slower than normal due to a drug overdose, naloxone (Narcan®) may be indicated to reverse the effects of the drug.

Apnea

Apnea is a term that refers to the absence of spontaneous breathing. Therefore, the breathing pattern for apnea appears as a flat line because the patient is not performing inhalation or exhalation.

This means that there is no effort or movement of the inspiratory muscles, and the volume of the lungs does not change.

Apnea can cause severe complications throughout the body because, without breathing, the tissues and organs are unable to obtain the oxygen that is required for survival.

Some of the common causes of apnea include:

  • Cardiac arrest
  • Severe brain trauma
  • Neuromuscular disorders
  • Central nervous system disorders
  • Narcotic overdose

Apnea can also occur voluntarily by breath-holding, and it can be mechanically induced by choking or strangulation.

The treatment for apnea often involves intubation and mechanical ventilation.

Cheyne-Stokes Breathing

Cheyne-Stokes breathing is an abnormal respiratory pattern that is characterized by periods of shallow and deep breathing, separated by brief periods of apnea.

This breathing pattern is often seen in patients who are in a comatose state and is caused by a lack of oxygen to the brain. Some other causes include:

  • Increased intracranial pressure
  • Traumatic brain injury
  • Stroke
  • Heart failure
  • Hyponatremia
  • Brain tumor

The treatment for Cheyne-Stokes breathing involves reversing the underlying cause. In some cases, noninvasive ventilation (NIV) is indicated (e.g., CPAP).

Kussmaul Breathing

Kussmaul breathing is an abnormal respiratory pattern that is characterized by deep and rapid breathing. This is often seen in patients with metabolic acidosis.

The treatment for Kussmaul breathing involves treating the underlying cause of the patient’s acid-base imbalance.

Biot’s Breathing

Biot’s breathing is a chaotic respiratory pattern that is characterized by irregular periods of deep, shallow, fast, and slow breathing. This pattern eventually turns into agonal breathing, which then leads to apnea.

Biot’s breathing is often seen in patients with an acute neurological disease that results in damage to the medulla or pons in the brain.

This can occur due to a stroke, trauma, or severe intracranial hypertension.

Hyperpnea

Hyperpnea is an abnormal breathing pattern characterized by an increased depth of breathing with or without an increase in rate. Therefore, the blood gas values of a patient with hyperpnea are normal.

The most common causes of hyperpnea include:

  • Exercise
  • High altitude
  • Anemia
  • Asthma
  • Acute lung injury
  • COPD

Treatment for hyperpnea is usually not necessary; however, in some cases, such as with high altitude sickness, supplemental oxygen may be indicated.

Hypopnea

Hypopnea is an abnormal respiratory pattern characterized by a decrease in depth of breathing with or without a decrease in rate. This can result in hypoxemia and an increase in PaCO2.

This breathing pattern is often associated with obstructive sleep apnea and is caused by a partial obstruction of the upper airway.

Hypopnea is often treated with continuous positive airway pressure (CPAP), which is a device that uses positive pressure to help prevent the obstruction.

Orthopnea

Orthopnea is an abnormal respiratory pattern characterized by shortness of breath while lying flat. This is often seen in patients with congestive heart failure (CHF) and is caused by the accumulation of fluid in the lungs.

The treatment for orthopnea is aimed at treating the underlying cause. This may involve diuretics, supplemental oxygen, and/or changes in position.

Patients may experience relief by sitting up or propping themselves up on pillows.

Apneustic Breathing

Apneustic breathing is an abnormal respiratory pattern characterized by a deep and gasping inspiration with a pause at full inspiration, followed by a brief, partial expiration.

This pattern is often seen in patients who’ve experienced severe brain damage to the upper medulla or pons caused by a stroke or trauma. It is also seen in patients with a hypoglycemic coma or those with profound hypoxemia.

Apneustic breathing is caused by basilar artery occlusion and usually has a poor prognosis.

Agonal Breathing

Agonal breathing is an abnormal respiratory pattern characterized by intermittent gasping and labored breathing.

It is caused by a preterminal brainstem reflex and eventually progresses to complete apnea. This breathing pattern often occurs during the final breaths before death.

Some of the most common causes of agonal breathing include:

  • Cerebral ischemia
  • Extreme hypoxemia
  • Anoxia

Agonal breathing may also occur during cardiac arrest or cardiogenic shock, where labored respirations may persist after the cessation of the patient’s heartbeat.

This type of respiration occurs in approximately 40% of cardiac arrest cases that take place outside of the hospital setting. Treatment is focused on resuscitation and support.

Ataxic Breathing

Ataxic breathing is an abnormal respiratory pattern characterized by irregular respirations with abnormal pauses and periods of apnea.

This means that the patient will have a variable respiratory rate, breathing cycle, and inconsistent tidal volumes with both small and large breaths. The periods of apnea occur abruptly and sporadically throughout the breathing cycle.

This breathing pattern often occurs when there is damage to the medullary respiratory center in the brain, which is caused by:

  • Head trauma
  • Traumatic brain injury
  • Brain tumor
  • Increased intracranial pressure

This pattern is generally a sign that a patient is in critical condition with a poor prognosis. Therefore, treatment is focused on supporting the patient and managing any underlying causes.

Paradoxical Breathing

Paradoxical breathing is an abnormal respiratory pattern characterized by an inward movement of the chest wall during inhalation followed by an outward movement during exhalation.

This breathing pattern is associated with a decreased pressure gradient that fails to stimulate normal breathing and can result in respiratory failure.

It can result from diaphragmatic fatigue or paralysis; however, it’s most commonly associated with trauma or an injury to the chest wall.

For example, a flail chest is a traumatic injury where a portion of the rib cage is fractured and becomes detached. When this occurs, the flail section moves in the opposite direction, which is known as a paradoxical movement.

This abnormal pattern may also occur in infants and children as a sign of respiratory distress.

Other Irregular Breathing Patterns

Earlier, we mentioned some of the most common abnormal patterns of respiration. Here are a few more irregular breathing patterns that medical professionals should be familiar with:

  1. Shallow breathing
  2. Dyspnea
  3. Hyperventilation
  4. Hypoventilation
  5. Sighing
  6. Air trapping
  7. Obstructive breathing
  8. Asthmatic breathing
  9. Central neurogenic hyperventilation
  10. Paroxysmal nocturnal dyspnea
  11. Postictal breathing
  12. Pursed-lip breathing
  13. Diaphragmatic breathing
  14. Platypnea
  15. Mouth breathing

Each type has different characteristics and may result in different signs and symptoms. The appropriate treatment method may also vary for each irregular pattern.

Shallow Breathing

Shallow breathing is a type of abnormal respiration in which the patient takes shallow, quick breaths.

This type of breathing can result in hypoventilation and lead to hypercapnia, which is an accumulation of carbon dioxide in the blood.

Some of the most common causes of shallow breathing include:

  • Anxiety disorders
  • Panic attacks
  • Asthma
  • Pneumonia
  • Shock
  • Pulmonary edema

Treatment for shallow breathing depends on the underlying cause. For example, if the patient has asthma, the treatment may involve inhaled bronchodilators to help open up the airways.

Dyspnea

Dyspnea is a breathing pattern characterized by shortness of breath and difficulty breathing as perceived by the patient.

It is a symptom of many different conditions and can range from mild discomfort to a life-threatening emergency.

The most common causes of dyspnea include:

  • Asthma
  • COPD
  • Emphysema
  • Pneumonia
  • Pulmonary embolism
  • Bronchitis
  • Congestive heart failure
  • Pulmonary edema
  • Pneumothorax
  • Carbon monoxide poisoning
  • Pleural effusion

Treatment for dyspnea depends on the underlying cause. If it is accompanied by hypoxemia, supplemental oxygen therapy would be indicated.

Intubation and mechanical ventilation may be necessary if it progresses to respiratory failure.

Hyperventilation

Hyperventilation is a type of abnormal respiration characterized by an increase in the rate and depth of breathing. This results in a decrease in the levels of carbon dioxide in the blood, which results in respiratory alkalosis.

Some of the most common causes of hyperventilation include:

  • Anxiety disorders
  • Panic attacks
  • Severe pain
  • Lung infections
  • COPD
  • Asthma
  • Myocardial infarction
  • Diabetic ketoacidosis
  • Head injuries
  • Hyperventilation syndrome

The treatment for hyperventilation depends on the underlying cause. In some cases, such as during a panic attack, simply slowing down the breathing can help to ease the symptoms.

In other cases, such as with COPD or asthma, the use of oxygen or bronchodilators may be necessary.

Hypoventilation

Hypoventilation is a type of respiratory depression characterized by a decrease in the rate and depth of breathing. This results in an increase in the levels of carbon dioxide in the blood, which results in respiratory acidosis.

Some of the most common causes of hypoventilation include:

  • Stroke
  • Brainstem injury
  • Drug overdose
  • Hypocapnia
  • Obesity hypoventilation syndrome
  • Neuromuscular diseases
  • Chest wall deformities
  • Obstructive sleep apnea

The treatment for hypoventilation depends on the underlying cause. In some cases, supplemental oxygen may be all that is needed. In other cases, mechanical ventilation may be required.

Sighing

Sighing is a breathing pattern characterized by an involuntary inspiration that is deeper and longer than a normal tidal volume breath.

Sighing plays an important role in preventing atelectasis because the inhalation of a larger breath helps open the alveoli, preventing a collapse.

While this is a normal part of respiration, excessive sighing can be a sign of an underlying respiratory condition.

It can also occur as a response to an emotional trigger, such as anxiety.

Air trapping

Air trapping is an abnormal respiratory pattern in which air gets trapped in the lungs, and it becomes difficult to exhale.

This can result in hyperinflation of the lungs, which often leads to respiratory distress. Air trapping is often seen in obstructive lung diseases, such as:

  • Asthma
  • COPD
  • Chronic bronchitis
  • Emphysema
  • Bronchiolitis obliterans syndrome

Air trapping is not considered to be a disease but rather a symptom of an underlying condition. Therefore, the treatment for air trapping depends on the underlying cause.

Obstructive Breathing

An obstructive breathing pattern is characterized by prolonged expiration due to narrowed airways and increased airway resistance.

The most common causes of an obstructive breathing pattern include:

  • Asthma
  • COPD
  • Chronic bronchitis
  • Emphysema

Similar to air trapping, the treatment for obstructive breathing depends on the underlying cause. In most cases, the use of bronchodilators can help to ease the symptoms.

In severe cases, intubation and mechanical ventilation may be necessary.

Asthmatic Breathing

Asthmatic breathing is a respiratory pattern caused by narrowing of the airways due to inflammation. This can lead to wheezing, chest tightness, and shortness of breath.

The most common causes of asthma respirations include the following triggers:

  • Allergens
  • Exercise
  • Cold air
  • Respiratory infections
  • Certain medications

When a trigger occurs, the airways become inflamed and narrowed, making it difficult to breathe. The treatment for asthma respirations depends on the severity of the symptoms.

In mild cases, the use of bronchodilators can help to ease the symptoms. In severe cases, ventilatory support may be indicated.

Central Neurogenic Hyperventilation

Central neurogenic hyperventilation is an abnormal breathing pattern characterized by deep, rapid breaths at a respiratory rate of at least 25 breaths/min.

This results in a decrease in the levels of carbon dioxide in arterial blood, which results in respiratory alkalosis.

The most common causes of central neurogenic hyperventilation include:

  • Brain stem lesions
  • Severe brain hypoxia
  • Head trauma
  • Lack of cerebral perfusion
  • Ischemia
  • Narcotic suppression

There is no set treatment for central neurogenic hyperventilation. However, the focus should be on reversing the underlying cause.

Patients with this breathing pattern may require mechanical ventilatory support in order to treat or prevent respiratory failure.

Paroxysmal Nocturnal Dyspnea

Paroxysmal nocturnal dyspnea (PND) is an abnormal breathing pattern characterized by severe episodes of shortness of breath that occur while the patient is sleeping.

This breathing pattern often occurs as a symptom of congestive heart failure (CHF), and it can also be caused by other conditions that lead to fluid retention.

Similar to orthopnea, patients with PND can find relief by sitting upright, as symptoms are often worse when lying down.

The treatment for PND depends on the underlying cause. In most cases, diuretics can help to reduce the amount of fluid retention and ease the symptoms.

Beta blockers and ACE inhibitors may also be indicated in patients who are experiencing PND due to CHF.

Postictal Breathing

Postictal breathing is an abnormal respiratory pattern that can occur after a seizure. This breathing pattern is often described as being stertorous, meaning that respirations are noisy and labored.

The postictal breathing pattern may sound similar to the snoring or gurgling that occurs during deep sleep.

Pursed-Lip Breathing

Pursed-lip breathing is a breathing pattern that is often performed to ease shortness of breath. This technique involves exhaling through pursed lips, which creates resistance and helps decrease the rate breathing.

Pursed-lip breathing can help to improve ventilation and gas exchange, as well as reduce the work of breathing.

It’s a common breathing pattern in patients with COPD, as it can ease symptoms of dyspnea by prolonging the expiratory portion.

Diaphragmatic Breathing

Diaphragmatic breathing, also known as “belly breathing” or “abdominal breathing,” is a breathing pattern that is helpful in taking deep breaths.

This technique involves contracting the diaphragm, expanding the stomach, and performing deep inhalations.

This results in a decreased respiratory rate, which increases the amount of blood that is available for perfusion and gas exchange.

Platypnea

Platypnea is an abnormal breathing pattern in which the patient experiences shortness of breath when sitting or standing upright.

Therefore, symptoms can be eased by having the patient lie down, as they tend to breathe better in this position. The causes of platypnea include:

  • Intracardiac shunts
  • Lung parenchymal diseases
  • Hepato-pulmonary syndrome
  • Parkinson’s disease

Platypnea is not a disease but rather a symptom of an underlying condition. Treatment should be focused on reversing the underlying cause.

However, patients experiencing this breathing pattern usually benefit from supplemental oxygen.

Mouth Breathing

Mouth breathing is a common respiratory pattern, especially in children. This technique is often used when the nose is obstructed, making it difficult to breathe through the nose.

Mouth breathing can also occur as a result of problems with the autonomic nervous system, such as cerebral palsy. In some cases, mouth breathing can lead to sleep apnea.

While mouth breathing is not necessarily an abnormal breathing pattern, it can be problematic if it progresses to other respiratory problems.

Treatment for mouth breathing usually involves addressing the underlying cause, such as nasal obstruction.

Newborn Breathing Patterns

The first few days after birth, it is common for newborns to have irregular breathing patterns. This is due to the fact that they are adjusting to breathing outside of the womb.

Most newborns will establish a regular breathing pattern within a few days. However, some may experience apnea spells, which are periods where they stop breathing for 10 seconds or more.

It is also important to remember that newborns breathe faster than adults. They typically take 40-60 breaths per minute, while adults average about 12-20 breaths per minute.

Types of Abnormal Newborn Respiratory Patterns

If a newborn is in respiratory distress, they may experience one or more of the following irregular breathing patterns:

  • Tachypnea – breathing rate of more than 60 breaths per minute
  • Bradypnea – breathing rate of fewer than 40 breaths per minute
  • Apnea – period without breathing of 10 seconds or longer
  • Retractions – infant’s chest pulls in with each breath
  • Grunting – sound an infant makes with each breath
  • Nasal flaring – widening of the nostrils with each breath

The treatment for irregular breathing patterns in newborns will depend on the underlying cause. If the cause is unknown, the infant may be observed for a period of time to see if the breathing pattern improves on its own.

In some cases, supplemental oxygen may be necessary. If the infant is having difficulty maintaining adequate oxygen levels, they may need to be intubated and placed on a mechanical ventilator.

FAQ

What is Eupnea?

Eupnea is defined as normal breathing. This refers to a normal respiratory pattern characterized by regular, rhythmic breathing at a rate of 12-20 breaths/min.

If a patient has an underlying condition, it can affect their ability to breathe and result in an abnormal respiratory pattern.

What are the Abnormal Breathing Patterns While Sleeping?

There are several types of abnormal breathing patterns that can occur while sleeping, including:

  • Hypopnea
  • Orthopnea
  • Hypoventilation
  • Paroxysmal nocturnal dyspnea
  • Sleep apnea

Each type occurs as a symptom of an underlying condition. Therefore, the treatment will vary depending on the specific cause.

What Breathing Pattern is Most Indicative of Increased Intracranial Pressure?

A patient with increased intracranial pressure (ICP) may show a respiratory pattern with an irregular rate and volume of breathing with intermittent periods of apnea.

This is known as Cheyne-Stokes breathing and often occurs due to a lack of oxygen reaching the brain.

Biot’s and ataxic breathing are similar respiratory patterns that may also occur as a result of increased intracranial pressure.

What Breathing Pattern Occurs at the End of Life?

The respiratory pattern that often occurs at the end of life is known as agonal breathing. This is characterized by irregular, gasping breaths that become less frequent over time.

As the patient’s body begins to shut down, this breathing pattern transitions into apnea during the final moments of life.

What Breathing Patterns Occur After a Stroke?

There are several types of abnormal breathing patterns that can occur due to a stroke, including:

  • Cheyne-Stokes breathing
  • Biot’s breathing
  • Apneustic breathing
  • Hypoventilation
  • Ataxic breathing

The specific type of breathing pattern may depend on the location and severity of the stroke. Treatment will be based on the underlying cause.

What Breathing Pattern Occurs After a Seizure?

After a seizure, the patient may experience postictal breathing, which is characterized by loud and labored breathing.

A period of apnea may also occur, which is a short amount of time without breathing that usually lasts for 10-15 seconds.

In some cases, the patient may also experience other irregular breathing patterns, such as tachypnea or bradypnea. Treatment will be based on the underlying cause of the seizure.

What is Lateral Costal Breathing?

Lateral costal breathing is a type of shallow breathing that requires the use of the intercostal muscles. This muscle group is located between the ribs and helps to lift the chest during inhalation.

This type of breathing is characterized by lateral movement of the ribcage from one side to the other during inhalation. It helps increase ventilation to the lower lobes and aids in diaphragmatic breathing.

How to Assess a Patient’s Breathing Pattern?

There are several ways to assess a patient’s breathing pattern, including:

  • Observation
  • Auscultation
  • Pulse oximetry
  • Capnometry

Observation involves looking for signs of an abnormal respiratory rate, depth, or breathing effort. Auscultation is the process of using a stethoscope to listen for abnormal breath sounds, such as wheezing or crackles.

Pulse oximetry refers to the measurement of the oxygen saturation in arterial blood. Finally, capnometry is used to measure the carbon dioxide levels in the patient’s exhaled breath.

Final Thoughts

Breathing is a vital function that helps to bring oxygen into the lungs while removing carbon dioxide from the body. Normal breathing involves a normal respiratory rate and rhythm with passive exhalation.

However, there are a variety of abnormal respiratory patterns that can develop due to various underlying conditions.

Respiratory therapists and medical professionals must be able to identify the type and different causes of an abnormal breathing pattern so that the appropriate treatment can be initiated.

The treatment will vary for each type of abnormal respiratory pattern depending on the underlying cause.

We have a similar guide on the different types of breath sounds that can be heard during auscultation. I think you’ll find it to be helpful. Thanks for reading, and, as always, breathe easy, my friend.

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

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Medical Disclaimer: The information provided by Respiratory Therapy Zone is for educational and informational purposes only. It should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition.