Alright. I seem to have turned a few heads of late, so I guess it is time to take the dive:

"What's breathing got to do with it?"

A thread 🧵
There are three main functions of breathing:
🫁 delivery of oxygen to every cell
🫁 removal of carbon dioxide
🫁 maintain pH - homeostasis

Breathing must match metabolic demand in order to maintain homeostasis.
For example, if you breathe too big or too fast, you can blow off too much carbon dioxide, which will raise your pH. Or if you don't breathe enough, your carbon dioxide will rise and lower your pH. With either scenario, you will feel breathless.
In chronic hyperventilation (which I commonly see), homeostasis is disrupted. This can lead to reduced blood flow to the brain, heart, and muscles through vasoconstriction. https://www.nejm.org/doi/10.1056/NEJMra012457
Due to the Bohr effect, oxygen remains bound to red blood cells - a further reduction in tissue oxygenation.
With chronic hyperventilation, we see a reduction in lactic acid buffering: in order to stabilize pH (which becomes alkaline when we hyperventilate), the kidneys excrete bicarbonate.
Can this bicarbonate blow out affect our energy systems? 🧐 @sunsopeningband ??
In a chronic hyperventilated state, "air hunger" is common, as the body has re-set to a lower level of carbon dioxide. Meaning that an urge to breathe occurs sooner.

But it's not always about carbon dioxide.
So breathing is pretty important. And when there is a mismatch between breathing and metabolic demand, we can get a wide variety of symptoms. https://www.physio-pedia.com/Breathing_Pattern_Disorders
Breathing well is essential to maintaining homeostasis. It is complex and has implications on all body systems so should be considered in chronic disease. As health care professionals, we should at least consider it.
However - it is not the panacea. Be wary of those advocating that breathing a certain way will "cure" anything.

Our goal is to assist people into a better state of recovery, using breathing to restore homeostasis, and hopefully, improve function.
You can follow @BreathewellPT.
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