COPD-Associated Tachypnea

Tachypnea describes a rapid respiration rate. It commonly occurs in lung diseases such as chronic obstructive pulmonary disease (COPD). The normal respiratory rate for a healthy adult ranges from 12 to 18 breaths per minute. Tachypnea is when you take more than 20 breaths per minute.

With COPD, you may experience tachypnea when you exert yourself physically or if you develop an infection. Advanced COPD can be associated with frequent episodes of tachypnea, even without triggers. Typically, when you have COPD, you may feel a sense of discomfort during episodes of tachypnea.

This article discusses tachypnea in people with COPD and how the condition can be managed.

Symptoms of COPD-Associated Tachypnea

Tachypnea is common in all forms of COPD, including chronic bronchitis, emphysema, and bronchiectasis. COPD exacerbations are often characterized by tachypnea.

When you have tachypnea you can experience:

• Rapid breathing
• Shallow breaths
• Shortness of breath
• Inability to walk
• A feeling that you want to lean over, sit down, or lie down
• A sense that you are running out of oxygen
• A strong feeling of anxiety
• Nausea and/or vomiting

Associated Symptoms

Pulmonary infections often induce COPD exacerbations characterized by tachypnea, fevers, productive cough (coughing up phlegm), and fatigue. Sometimes, pleurisy (pain with breathing) can develop with tachypnea as well.

You may also use your accessory muscles to breathe when you have tachypnea. These include the muscles in your neck, abdomen, or the sides of your chest. If you are struggling to breathe, your body may inadvertently use these extra muscles to help expand your lungs.

Complications

Tachypnea can have some effects on the body. One of the most harmful effects is an acid-base imbalance. This can occur as your rapid breathing causes an alteration in the ratio of gases (carbon dioxide and bicarbonate) in the body.

What Causes Tachypnea in COPD?

There are a number of causes of tachypnea in COPD. You may experience rapid, shallow breathing when your breathing becomes impaired or when your body needs to compensate for a lack of oxygen; both of these are common issues with COPD.

Oxygen and Carbon Dioxide Levels

COPD can make you prone to alterations in oxygen and carbon dioxide levels in the blood and/or lungs.

When you have a low blood oxygen level (partial pressure of oxygen, pO2) your body may respond with rapid breathing as a way to obtain oxygen.

Carbon dioxide is a waste product of metabolism that needs to be eliminated during respiratory expiration. Hypercapnia (excess carbon dioxide in the blood) may also lead to tachypnea as your body attempts to rid itself of this gas.

Triggers

While lung disease itself makes you susceptible to tachypnea, certain triggers can exacerbate the situation:

• Physical exertion or exercise: Activity can trigger brief periods of rapid, shallow breathing, typically lasting for less than an hour.
• Lung infections: These are among the most common causes of episodic tachypnea in COPD. You may experience tachypnea for days or even weeks after an infection resolves.
• Anxiety: You may be anxious about being short of breath, which results in a self-perpetuating cycle of tachypnea and anxiety.
• Obstruction of your airways: This can occur due to lodged food particles, infections, or cancer. One or more obstructions can cause you to breathe rapidly.
• Heart disease and/or anemia (low red blood cell function): Either issue can cause persistent tachypnea due to low oxygen levels in the blood.
• Pulmonary embolus: A blood clot in a blood vessel in the lungs, this is a medical emergency that can suddenly cause rapid, shallow breathing and severe oxygen deficiency.
• Severe medical illness: Medical problems such as kidney failure or excessive vomiting can affect your blood electrolyte levels (including hydrogen, potassium, sodium, and calcium), causing alterations in your respiration.
• Brain injury: Your respiratory rate is controlled by the medulla oblongata (an area in your brain). Life-threatening brain damage due to a large stroke or head trauma can cause tachypnea.

Diagnosis

There are a number of tests that can be used to help your medical team understand why you are having bouts of tachypnea. Your COPD treatment can be adjusted to help prevent this problem from recurring.

In general, the diagnosis of tachypnea is based on how many breaths you take per minute.

During your medical examination, your medical team can observe you as you breathe and count the number of breaths you take. (If you are in the hospital or intensive care, your respiratory rate may be constantly monitored by a device.) You or your family can do this on your own as well if you feel tachypneic when you are not in a medical setting.

When discussing tachypnea with your medical team, it's important to describe your symptoms in as much detail as possible.

Diagnostic Tests

When you have COPD and tachypnea, your diagnosis will involve more factors than your respiratory rate. Your medical team will also work to diagnose the cause of your rapid breathing.

Tests that can help identify the cause of tachypnea include:

• Chest imaging: An X-ray or computerized tomography (CT) scan of your chest can help identify changes in your lung structure, such as those caused by an obstruction or an infection.
• Sputum sample: Sputum can be sent to a laboratory for a microbial culture, which can help identify the organism causing respiratory infection.
• Ventilation-perfusion (V/Q) scan: This is a special imaging test that can help in identifying a pulmonary embolus.
• Electroencephalogram (EKG) or echocardiography: These diagnostic tools may be needed to evaluate your heart function.

Since tachypnea can be associated with low oxygen and acid-base imbalance, additional tests may be done to specifically detect these harmful complications:

• Pulse oximeter: This is a non-invasive test that measures your blood oxygen level with a device that is placed on your finger.
• Venous blood tests: Blood tests can help identify anemia and electrolyte imbalances.
• Arterial blood gases (ABG): An arterial blood gas is collected from an artery, not a vein. This procedure is slightly more uncomfortable than a typical venous blood sample procedure. An ABG test measures your blood pH (a measure of your acid-base balance), oxygen, carbon dioxide, and bicarbonate levels.

Differential Diagnoses

Other breathing issues can be mistaken for tachypnea. Your healthcare provider will consider (and rule out) these before coming to a diagnosis of tachypnea:

• Dyspnea: With dyspnea (shortness of breath), your breathing rate may be rapid, slow, or normal, and your depth of breathing may be shallow, deep, or normal.
• Hyperpnea: Rapid and deep breathing that occurs during moderate exercise
• Hyperventilation: Rapid deep breathing that commonly occurs with anxiety or medical illnesses

How Tachypnea Is Treated

Treatment of tachypneic episodes in COPD is based on short-term management of urgent problems such as acid-base imbalance or oxygen insufficiency, as well as treatment of the cause or trigger of your tachypnea. You may need oxygen therapy if your blood oxygen concentration is low.

Immediate management may include inhalers, such as bronchodilators or epinephrine. These medications can rapidly open your airways, allowing oxygen to efficiently reach the alveoli.

If you are diagnosed with a pulmonary embolus, surgical or medical intervention may be required. When tachypnea in COPD is related to an infection, medications such as antibiotics may be needed to treat the infection.

For sustained relief, steroids can reduce airway inflammation in COPD, which helps open the airways for more efficient oxygen delivery with each breath. Treatment of underlying illnesses, such as heart disease or a brain injury, is also essential.

When tachypnea is caused by anxiety, strategies such as relaxation breathing, guided imagery, or meditation may help.

Summary

Tachypnea describes abnormally rapid breathing. It is common in all forms of chronic obstructive pulmonary disease. Tachypnea may cause you to have shallow breaths, shortness of breath, and discomfort during physical exertion.

Tachypnea can be treated with oxygen therapy, inhalers, or steroids. In some cases, surgery may be helpful.