Breathing

The process of external respiration (breathing) consists of two stages, namely inspiration, inhaling (breathing in) air in order to extract the oxygen from the air, and expiration, exhaling (breathing out) in order to expel carbon dioxide. Oxygen is required by the body to release energy at cell level so that the individual can participate in activities. The release of such energy through metabolism produces carbon dioxide as a waste product that must be expelled from the body. The presence of carbon dioxide in the blood plays a key role in maintaining respiratory function and in maintaining homeostasis by regulating the pH of the blood (acid–base balance). A pH value between 7.35 and 7.45 is essential for normal body functioning.

Breathing is essential to life. The ability to undertake a swift assessment of the client’s ability to breathe and instigate removal of an obstruction and/or rescue breathing if needed is therefore crucial (see ‘Maintenance of an airway’ and ‘Artificial respiration’). A full assessment of the person’s ability to breathe should be undertaken once adequate respiratory function has been restored.

There are several important structural differences between adults and children that influence respiration, including the shape of the chest at birth, shape and angle of the ribs and elastic properties of the lung tissue. The nasal passages and trachea of infants and young children are narrower and can therefore be more easily obstructed. They also have less alveolar surface area for gaseous exchange. These latter points are extremely important when attempting to remove an obstruction or provide effective rescue breathing. It is, therefore, crucial to be familiar with the different techniques for these client groups.

Factors that may affect breathing may be:

• physical, arising from alteration in the structure, function or processes of the respiratory and associated systems

• psychological, such as anxiety and stress

• sociocultural, for example smoking

• environmental, including pollution and allergies

• politico-economic, for example lack of finances for heating.

The remainder of this chapter gives the common terminology associated with the activity of breathing, points to consider when assessing an individual’s breathing, how to monitor respiratory rate and peak flow, airway maintenance, monitoring of expectorant, obtaining specimens and disposing of sputum, administration of oxygen, and rescue breathing. The chapter concludes with references and further reading.