Do patients with chronic obstructive pulmonary disease (COPD) exhibit slow breathing rates?

From the Guidelines

Patients with obstructive lung diseases typically breathe more slowly, not faster, as a physiological adaptation to compensate for airflow limitation and air trapping. In conditions like chronic obstructive pulmonary disease (COPD), airflow limitation occurs primarily during exhalation, making it difficult to fully empty the lungs, as highlighted in the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1. This leads to air trapping and hyperinflation, prompting patients to adopt a breathing pattern characterized by prolonged expiration and a reduced respiratory rate. They may breathe at rates of 12-16 breaths per minute or even lower during stable periods, compared to the normal rate of 12-20 breaths per minute.

The management of COPD, as outlined in the guideline, includes confirming COPD diagnosis with postbronchodilator spirometry, evaluation and ongoing monitoring of dyspnea/symptom burden and risk of exacerbations, and use of both pharmacologic and nonpharmacologic interventions to alleviate dyspnea/symptoms, improve health status, prevent acute exacerbations of COPD (AECOPD), and reduce mortality 1. The approach to management is integrated and comprehensive, including self-management education that covers optimizing inhaler device technique, breathing and cough techniques, and promoting physical activity and other healthy habits.

Key points to consider in the management and breathing patterns of patients with obstructive lung diseases include:

• The importance of slow, controlled breathing as a beneficial adaptation that reduces the work of breathing and helps prevent further air trapping.
• The role of breathing retraining techniques in pulmonary rehabilitation programs for these patients.
• The use of inhaled maintenance/preventative pharmacotherapies such as long-acting muscarinic antagonists (LAMA) and/or long-acting β2-agonists (LABA) with or without inhaled corticosteroids (ICS), as recommended in the guideline 1.
• The consideration of patient values and preferences in managing COPD, with exacerbation and hospitalization being outcomes that patients rate as most important, according to a recent systematic review 1.

Overall, the slower breathing pattern observed in patients with obstructive lung diseases during stable periods is a physiological response aimed at reducing symptoms and improving quality of life, and it is supported by the most recent and highest quality evidence, such as the 2023 Canadian Thoracic Society guideline 1.

From the Research

Breathing Patterns in Obstructive Lung Diseases

• Patients with obstructive lung diseases, such as chronic obstructive pulmonary disease (COPD), often experience expiratory flow limitation due to progressive airflow obstruction 2.
• This can lead to dynamic hyperinflation, where the lungs are not fully emptied at the end of expiration, resulting in increased alveolar pressure and auto-positive end-expiratory pressure (PEEP) 2.

Ventilatory Strategies

• Ventilatory strategies, such as noninvasive ventilation and pressure support ventilation, can help address acute respiratory failure in COPD patients 2.
• Invasive mechanical ventilation may also be necessary in some cases, with settings adjusted to minimize hyperinflation and provide reasonable gas exchange 2.

Bronchodilatory Effects

• Bronchodilators, such as formoterol and salmeterol, can provide significant and sustained bronchodilatory effects for up to 12 hours following a single dose 3.
• The onset of effect can vary between bronchodilators, with formoterol having a faster onset of action compared to salmeterol 4.
• Budesonide/formoterol has been shown to have a fast onset of bronchodilatory effect, similar to salbutamol, and superior to salmeterol/fluticasone in patients with COPD and reversible airway obstruction 4.

Breathing Rate

• While the provided evidence does not directly address whether patients with obstructive lung diseases breathe slowly, it suggests that these patients may experience breathing difficulties and require ventilatory support to manage their condition 2.
• The use of bronchodilators and other medications can help improve lung function and control symptoms, but may not necessarily affect breathing rate 5, 6, 3.