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Bradypnoea: Causes, Symptoms and Treatment

Bradypnoea refers to an abnormally slow breathing rate of fewer than 12 breaths per minute in adults. It can indicate serious underlying conditions and requires prompt medical evaluation.

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Things worth knowing about "Bradypnoea"

Bradypnoea refers to an abnormally slow breathing rate of fewer than 12 breaths per minute in adults. It can indicate serious underlying conditions and requires prompt medical evaluation.

What is Bradypnoea?

Bradypnoea (also spelled bradypnea) is defined as an abnormally slow respiratory rate of fewer than 12 breaths per minute in adults. The term derives from the Greek words bradys (slow) and pnoe (breathing). While the normal resting respiratory rate in adults ranges from 12 to 20 breaths per minute, bradypnoea represents a significant reduction in breathing frequency. This can lead to inadequate oxygen supply to the body and elevated carbon dioxide levels in the blood, and is often a sign of a serious medical condition.

Causes

Bradypnoea can result from a wide range of conditions and factors:

Medications and substances: Opioids (e.g., morphine), sedatives, sleeping pills, and alcohol can suppress the respiratory center in the brain, leading to slowed breathing.
Neurological conditions: Damage to the respiratory center in the brainstem due to stroke, head trauma, or increased intracranial pressure can reduce the breathing rate.
Metabolic disorders: Severely low blood sugar (hypoglycaemia) or profound hypothermia (low body temperature) can impair breathing regulation.
Sleep apnoea: Obstructive sleep apnoea can be associated with prolonged breathing pauses or slowed respiration.
Severe infections: Certain systemic infections or sepsis can affect the respiratory center in the brain.
Heart conditions: Severe heart failure or cardiac arrhythmias can indirectly influence breathing patterns.

Symptoms

Bradypnoea is itself a clinical sign that may occur alongside other symptoms:

Drowsiness or lethargy
Confusion or disorientation
Cyanosis (bluish discolouration of the lips or fingernails due to lack of oxygen)
Shortness of breath or the sensation of not getting enough air
Headaches (caused by elevated carbon dioxide levels in the blood)
In severe cases: loss of consciousness or cardiorespiratory arrest

Diagnosis

Bradypnoea is initially identified by measuring the respiratory rate clinically. Further diagnostic investigations are aimed at finding the underlying cause:

Pulse oximetry: Measurement of blood oxygen saturation to detect hypoxia (oxygen deficiency).
Arterial blood gas analysis (ABG): Assessment of oxygen and carbon dioxide levels as well as blood pH.
Blood tests: Blood glucose, electrolytes, kidney function markers, and inflammatory markers.
ECG: Evaluation of cardiac function.
Imaging: CT or MRI of the brain when neurological causes are suspected.
Medication history: Review of all medications taken, especially opioids or sedatives.

Treatment

Treatment is directed at the underlying cause of bradypnoea:

Opioid antagonists: In cases of opioid-induced bradypnoea, naloxone (Narcan) can be administered to reverse the respiratory-depressant effects of opioids.
Oxygen therapy: Supplemental oxygen is provided via a mask or nasal cannula when oxygen levels are insufficient.
Ventilatory support: In cases of severe bradypnoea or respiratory failure, non-invasive ventilation (e.g., CPAP) or mechanical ventilation may be required.
Treatment of the underlying condition: Managing the root cause, such as treating sepsis, stroke, or hypothermia.
Monitoring: Continuous monitoring of respiratory rate, oxygen saturation, and vital signs in a clinical setting.

When to Seek Medical Help

A breathing rate below 12 breaths per minute is always a serious warning sign. Emergency services (such as 911 or 112) should be called immediately if a person is breathing fewer than 12 times per minute, is unconscious, shows bluish discolouration of the lips or fingernails, or is unresponsive. A sudden decrease in breathing rate following the use of medications or substances also requires immediate medical attention.

References

Longo, D.L. et al. - Harrison's Principles of Internal Medicine. 21st Edition. McGraw-Hill, New York, 2022.
World Health Organization (WHO) - Emergency Triage Assessment and Treatment (ETAT). WHO Press, Geneva, 2016.
Lumb, A.B. - Nunn's Applied Respiratory Physiology. 9th Edition. Elsevier, Edinburgh, 2021.

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