Tachypnoea- Breathing Abnormality

Shreejita Bhowmick, Techno India University

There are some instances when we feel breathlessness, a feeling of not getting enough air. Such instances might not necessarily indicate an underlying critical disease. Tachypnoea is such a condition that refers to abnormal, rapid but shallow breathing. It is often mistaken with conditions of hyperventilation, hypernoea (rapid but deep breathing), or dyspnoea (shortness of breath). But Tachypnoea can happen without any underlying disease.

Both Tachypnoea and Hyperventilation conditions are quite similar in respect to increased build-up of carbon dioxide in the lungs facilitating increased carbon dioxide in the blood as well. Hence, it is confused with hyperventilation. This increased presence of carbon dioxide in blood makes it more acidic and henceforth, our brain gets the alert to signal the respiratory system to increase the breathing pace to correct the imbalance and regulate the blood pH in the normal range.

The number of breaths per minute becomes more than 20 in tachypnoea conditions.

The normal respiration rate for an adult person at rest is 12 to 20 breaths/minute while in a child, the number of breaths per minute can be higher compared to that of an adult.

Cause of Tachypnoea-

Tachypnoea can be caused by some pathological problems such as:

• Sepsis
• Diabetic ketoacidosis – It occurs when our body doesn’t produce enough insulin leading to a build-up of acids like a ketone in our body. Diabetic ketoacidosis often leads to rapid breathing or tachypnoea condition.
• Other Metabolic acidosis like lactic acidosis

Respiratory issues like:

• Pneumonia
• Carbon monoxide poisoning
• Pulmonary embolism – Clotting of blood in the lungs can be observed. It might lead to tachypnoea conditions.
• Pleural effusion
• Pulmonary fibrosis
• Pneumothorax or collapsed lung
• Asthma – It is a chronic inflammatory condition of the lungs. It is often the cause of rapid and shallow breathing, especially after exercise, in presence of allergens or cold air.
• Chronic obstructive pulmonary disease (COPD) – Common lung disease including chronic bronchitis or emphysema. Bronchitis is related to inflammation of the airways while emphysema is related to the destruction of air sacs in the lungs. Both of them can lead to tachypnoea conditions.
• An imbalance between respiratory gases – Hypercapnia (increased level of carbon dioxide) or Hypoxemia (low level of oxygen)

There are also some medical conditions responsible for tachypnoea like:

• Allergic reactions
• Foreign body aspiration
• Fever

Cardiac issues might also lead to Tachypnoea:

• Heart failure

Central nervous system-related issues like brain abnormalities might also induce rapid breathing or tachypnoea condition

Medications like aspirin or any stimulants may cause tachypnoea. Even drugs like marijuana can induce rapid but shallow breathing rates.

Tachypnoea condition can be observed in patients with lung cancer. Any damage to the lungs can induce an imbalance in the exchange of respiratory gases. Even lung cancer surgery may decrease the ability to normal breathing hence leading to tachypnoea condition.

Chemotherapy-induced anemia can deteriorate tachypnoea condition as there is a decreased number of red blood cells to carry enough oxygen, hence leading to rapid abnormal breathing.

But interestingly, less critical issues like high-intensity workouts, anxiety, panic attacks, or even stress can be the reasons for Tachypnoea. Anxiety attacks or panic attacks might seem to be leading from mental disorders but they have a physical effect, often observed with shortness of breath and rapid breathing.

Tachypnoea is also seen in newborns, especially in preterm infants, right after delivery, indicating distress in their respiratory system which might happen because of retention of fluid in the lungs, neonatal pneumonia, respiratory distress syndrome, or meconium aspiration syndrome (MAS). 1 in 100 preterm infants can be seen with tachypnoea condition and the same can be present in 4 to 6 per 1000 term infants.

Symptoms of Tachypnoea-

• Shortness of breath
• Feeling of not getting enough air; consequently, increased breathing pace
• A sensation of pain in the chest
• Having blue-ish tinted fingers and lips

In case of infants suffering tachypnoea condition:

• The blue color in the perioral area
• Signs of difficulty breathing
• Retraction of the chest while breathing
• Rhythmic forward and backward movement of the head (head bobbing)
• Flared nostrils

Patients can also show Tachypnoea without any definite symptoms.

Diagnosis of Tachypnoea-

Evaluation of Tachypnoea is based on oximetry, arterial blood gases, chest X-ray, chest-CT, pulmonary function test, glucose, electrolytes, hemoglobin, EKG, VQ scan, brain MRI, toxicology screen.

Arterial blood gases will evaluate the oxygen and carbon dioxide content which will further help in pH and metabolic abnormality determination. One can further identify any pathological issues like diabetic ketoacidosis, lactic acidosis, and hepatic encephalopathy if acidosis is indicated from the pH range.

A chest X-ray might reveal any pulmonary disorders like pneumonia, cystic fibrosis, pneumothorax while more lung pathological details can be determined from a chest – CT.

Obstructive lung diseases, like COPD or asthma, can be detected through pulmonary function tests and a VQ scan can be helpful to determine a potential pulmonary embolism.

Tachypnoea can occur due to cardiac abnormalities as well. Hence, an EKG might help determine any abnormal heart rate or evidence of heart attack.

Other than these usuals, if a person is anemic or suffering from any infection, Tachypnoea can occur. Hence, a complete blood count can detect any signs of anemia or infections.

A toxicology screening can help to determine the cause of Tachypnoea if it is occurring due to intake of any drugs.

Treatment for Tachypnoea-

Treatment of Tachypnoea is done based on its underlying cause.

• Inhalation medicines like inhalers, albuterol, are used to dilate and expand alveoli in obstructive lung diseases like asthma and COPD. 
• Antibiotics are used if it is the case of bacterial pneumonia.

In infants, care is taken in the neonatal intensive care unit (NICU), treated with extra oxygen. Transient tachypnoea in newborns can also be treated by the administration of corticosteroids. Corticosteroids might compensate for the impaired hormonal changes which occur when infants are delivered late preterm, or at term but before the onset of spontaneous labor (elective cesarean section). It might improve the clearance of liquid from the lungs, thus reducing the effort required to breathe and improving respiratory distress. Transient tachypnoea in infants should be monitored closely as children and newborns are unable to convey their symptoms properly. 

One should remember Tachypnoea can also occur due to less critical and non-pathogenic causes like high-intensity exercise, stress, or even panic attacks. So, medical assistance should be taken accordingly since during panic attacks or anxiety states tachypnoea conditions can lead to hypocapnia which means reduced carbon dioxide content in blood, decreasing respiratory drive.

Diagnosis of Tachypnoea can be done efficiently when the patient has a good understanding of their condition. Hence, patient education regarding the underlying causes of Tachypnoea is quite important.

One should keep in mind that severity might vary and it is a good decision to seek medical guidance when in confusion. 

Also read: Pigments of Tomatoes reveal linkage to taste and aroma

Sources:

1. Park, S. B., & Khattar, D. (2021). Tachypnea. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK541062/
2. Long, S. S., Edwards, K. M., & Mertsola, J. (2018). Bordetella pertussis (Pertussis) and other Bordetella Species. Principles and Practice of Pediatric Infectious Diseases. https://doi.org/10.1016/C2013-0-19020-4
3. Chowdhury, N., Giles, B. L., & Dell, S. D. (2019). Full-term neonatal respiratory distress and chronic lung disease. Pediatric Annals, 48(4). https://doi.org/10.3928/19382359-20190328-01
4. Reuter, S., Moser, C., & Baack, M. (2014). Respiratory distress in the newborn. Pediatrics in Review, 35(10), 417–429. https://doi.org/10.1542/pir.35-10-417
5. Bruschettini, M., Moresco, L., Calevo, M. G., & Romantsik, O. (2020). Postnatal corticosteroids for transient tachypnoea of the newborn. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD013222.pub2

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