The Importance of Breathing

The Importance of Breathing

While the title may seem patronising,  a large number of patients I've treated have presented with an incorrect upper (or accessory respiratory muscle) breathing pattern.
The upper breathing pattern is often associated with patients who suffer with respiratory diseases such as asthma, or chronic obstructive pulmonary disease and hyperventilation through panic or anxiety attacks.

Asthma or panic disorder?

In January 2017 a Canadian study of physician diagnosed asthmatics excluded 33% of its "asthmatic" participants due to misdiagnosis from a lack of testing, mainly spirometry.
The common presentation of asthma is a chronic airway inflammation that results in respiratory symptoms of wheeze, dyspnoea, chest tightness, or cough that vary over time and in intensity, together with variable expiratory airflow limitation.

As a result of the limited breathing ability, patients with moderate or severe asthma tend to display an upper breathing pattern where accessory respiratory muscles, such as the sternocleidomastoid, scalenes and pectorals are used to assist the air intake.

Hyperventilation is commonly associated with anxiety. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger and display rapid shallow breathing (hyperventilation) in the upper region of the thorax, similar to that of an asthma attack (NIMH 2016). Panic disorder (PD) is the most common anxiety disorder, which is characterized by recurrent and unexpected panic attacks (Zou et al 2016). Often patients are unable to discuss potential triggers of the attacks, also known as alexithymia, and it is considered that PD may be associated with severe psychological trauma, most likely during childhood.

PD and asthma share a number of similarities and in some studies show connections between asthma and anxiety (Giacco et al, 2010). Though PD and panic attacks do not share the same wheezing and cough symptoms between attacks as that of moderate to severe asthma.

Stress and sympathetic dominance.

Stress as previously mentioned has become a common disorder in modern life and many function with high stress levels, chronic stress and in some cases PTSD without being fully aware of the implications. Stress is a fight or flight reaction, meaning one of the sympathetic nervous system (SNS). Next time you are able to undertake physical activity, be it running, climbing up a ridiculously long flight of stairs or whatever other cardio you have to endure; try and breathe down towards your tummy - you'll find it quite difficult to do so! This is a stress or sympathetic breathing pattern and causes you to enlist your accessory breathing muscles to expand and contract the thorax leaving the diaphragm redundant.

Sympathetic dominance (SD) is a recognised pattern in which a person overuses their SNS or in simple terms, the person is pushing himself or herself, or worrying too much (Wilson, 2016). Usually, when a person exhausts their SNS response the autonomic nervous system flips over to the parasympathetic (rest and digest) nervous system (PNS) functions however in those stuck in SD they eliminate more potassium and sodium through sweat and urine than they should causing nutritional deficiencies and of decrease action potential on a physiological level.
One of the key symptoms of SD is anxiety and as a result of this SD can result in breathing patterns akin to those previously mentioned, with the added delights of fatigue and restlessness.


The diaphragm's role in movement.

Behold! A shiny anatomical diagram of the diaphragm! This muscular partition separates the respiratory and cardiac organs of the thorax with the digestive organs of the abdomen, but in order to maintain their relationship and mutual support there are a number of openings, known as hiatus or hiatuses. The three most obvious of these are the caval opening (at vertebral level T8 allowing the inferior vena cava to pass up from the abdomen to the thorax), the oesophageal hiatus (at vertebral level T10 and containing the oesophagus) and of course the aortic hiatus (at T12 and containing the aorta).

Movement is life, if you stop moving your body things begin to go awry. For example, unused muscles begin to atrophy and weaken, in some cases muscle wasting occurs (Pietrangelo, 2016). The same is applicable within the body. If the digestive system stops moving the food around (like gastroparesis or achalasia) death can occur. Similar for the movement of blood, as we more commonly experience with thromboses.

As vital passages for both blood and digestion pass through the diaphragm, the movement of this muscle is able to assist their function with a pumping action for each breath. But it doesn't stop there!!

Further to aiding venous return, arterial massage and peristalsis, use of the diaphragm also assists by massaging the digestive organs of the abdomen by contraction and relaxation, improving the oxygen intake through inspiration, improving lymphatic drainage and encouraging the activation of the PNS, thus reducing the stress or SNS symptoms the patient is enduring. Hence why deep breaths are encouraged when having dealing with a panic attack or incredibly upsetting event.


As a therapist, almost all of my patients are advised of breathing exercises, mostly with core muscle involvement to assist in stabilising the back. I actively encourage (nag, for want of a better word) my patients to do focused exercises such as transverse abdominus (TVA) activation.
This not only gets their core working but helps with stress levels and of course the beloved and often neglected act of sleeping.
Both yoga and pilates instructors utilise breathing techniques during their classes to encourage the correct use of the diaphragm.
By using your diaphragm correctly, other functions in the body are supported and in turn the well-being of both body and mind are improved.

If more people took notice of their breathing at least once a day, I am almost certain that a multitude of ails would be less common, especially those relative to chronic stress disorders.


Del Giacco, S., Cappai, A., Gambula, L., Cabras, S., Perra, S., Manconi, P., Carpiniello, B. and Pinna, F. (2016). The asthma-anxiety connection. Respiratory Medicine, 120, pp.44-53. (2016). [online] Available at:
Pietrangelo, A. (2016). Muscle wasting: Causes, Symptoms and Diagnosis. [online] Available at: [Accessed 7 Jun. 2019].
Zou, Z., Huang, Y., Wang, J., He, Y., Min, W., Chen, X., Wang, J. and Zhou, B. (2016). Association of childhood trauma and panic symptom severity in panic disorder: Exploring the mediating role of alexithymia. Journal of Affective Disorders, 206, pp.133-139.