Glossopharyngeal Breathing

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed and Kim Jackson

Introduction

Glossopharyngeal breathing (GBP), also known as “frog breathing, is a positive pressure breathing method using muscles of mouth and pharynx to push volume of air (gulps) into the lungs. It is a trick movement that was first described by Dail (1951) when patients with poliomyelitis were observed to be gulping air into their lungs. It was this gulping action that gave the technique the name 'frog breathing'.[1]

Significance

GPB is useful in

  • Patients with a reduced vital capacity owing to respiratory muscle paralysis.[1]
  • Paralysed patients dependent on a mechanical ventilator may be able to use GPB continuously, other than during sleep, to substitute the mechanical ventilation.[1]
  • The most common use of GPB is in patients who are able to breathe spontaneously but whose power to cough and clear secretions is inadequate. The technique may enable these patients to shout to attract attention and it may help to maintain or improve lung and chest wall compliance.[1]
  • Patients with high-level quadriplegia are often instructed in glossopharyngeal breathing (GPB), in which the patient swallows air into the lungs in order to increase vital capacity.[2]
  • GPB is used to augment cough effectiveness, provide internal mobilization of the chest wall, and improve quality of life by allowing periods of ventilator or phrenic nerve stimulator independence and more effective phonation.[2]
  • GPB shows that vital capacity could be increased from 60% to 81 % of its predicted value when using GPB.[3]
  • The use of GPB has been shown to be sufficient to maintain arterial blood gases within normal range[3]

Techniques

  1. Mouth opens oral pharynx filled with air
  2. Mouth closes air trapped in the oral pharynx
  3. Mouth remain closed and forces the air back to the open glottis and then into the lungs
  4. Glotis closed and air is trapped in the lungs

GPB should be practised slowly at first and then gradually speeded up until the movement flows. A leak of air may occur through the nose and, until it is prevented by the soft palate, a nose dip may be required. GPB is learnt easily by some patients, but others need time and patience to acquire this skill and must be motivated to practise frequently during the learning period.[1]

The next stage is to take a maximum breath in and, while holding this breath, to add several glossopharyngeal gulps, to augment the vital capacity. When correct, the patient will feel his chest filling with air, and the physiotherapist can test the 'GPB vital capacity' by putting a mouthpiece attached to the expiratory limb of a Wright's respirometer in the patient's mouth before he exhales. The respirometer can be used to measure the volume per gulp; the patient will require less effort and reach his maximum capacity more quickly if he develops a bigger volume per gulp.[1]

Indication

  • GPB was first described as a trick movement seen in patients with poliomyelitis (Dail 1951).[1]
  • GPB is an effective maneuver to augment tidal volume in any patient who is unable to voluntarily alter tidal breathing.[3]
  • Dail & Affeldt (1955) taught GPB to 100 patients with poliomyelitis. They found that 69 patients used this technique to assist normal breathing and 31 to assist speech and coughing. 42 patients found that GPB allowed them to discontinue respiratory support (mechanical ventilation, NIPPV).[3]
  • GPB may prove useful in improving cough effectiveness in patients with tetraplegia or neuromuscular disorders, impaired tracheobronchial clearance[3]

Contraindication

  • GPB is contraindicated in patients with a tracheostomy when the cuff is inflated.[3]
  • GPB must be avoided in patients with airflow obstruction or pulmonary disease, due to the risk of air trapping.[3]
  • GPB should not be attempted in patients with neuromuscular disorders affecting swallowing and in patients with a progressive disorder, intermittent positive pressure breathing (IPPB) may be more appropriate than GPB.[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition. Churchill Livingstone. 1998
  2. 2.0 2.1 Joanne Watchie. Cardiovascular and pulmonary physical therapy. 2nd edition. Saunders. 2010
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd. 2002
  4. JPursed CANVent Ottawa. Glossopharyngeal Breathing. Available from: https://youtu.be/9OswSaTG71I
  5. CANVent Ottawa. Glossopharyngeal Breathing Teaching Session with Greg. Available from: https://youtu.be/0ZgfZ01uLDQ