What Is Tachypnea

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Your breathing rate, a fundamental component of vital signs assessed during a medical examination, is indicative of your overall health. During a check-up, your doctor will monitor your respiration rate. The normal rate varies with age, and for most adults at rest, it falls within the range of 12 to 20 breaths per minute.

You can easily determine your own breathing rate by counting the number of breaths you take in a minute. Alternatively, you can count the breaths you take in 15 seconds and then multiply that number by 4.

Tachypnea, characterized by fast paced breathing, is a medical term denoting an elevated respiratory rate. For the typical adult, a regular breathing pace ranges from 12 to 20 breaths per minute. In children, the resting respiratory rate can be higher compared to that of adults.

This prevalent condition arises when your breathing rate exceeds the necessary pace, resulting in an excessive elimination of carbon dioxide. This disrupts the delicate gas balance in your blood.

Hyperventilation can stem from various factors, such as physical exertion, heightened anxiety, or asthma. It may induce sensations of dizziness, weakness, or confusion.

Understanding tachypnea

Explanation of breathing rate

Breathing is a fundamental process necessary for the proper functioning of all levels of biological organization, ranging from individual cells to whole organisms. Oxygen, which is distributed locally through circulation at the tissue level, plays a critical role as a mediator for energy release within the mitochondrial internal membrane. Within the mitochondria, nutrients that have been digested undergo metabolic reactions, ultimately reaching the electron transport chain, where they release high-energy compounds like ATP. A significant byproduct of this energy production is carbon dioxide, which is carried in the venous blood back to the lungs. Carbon dioxide then diffuses across alveolar walls and is released into the exhaled air.1

Normal breathing rate in adults and children

The respiratory rate, defined as the number of breaths taken per minute, is meticulously regulated to ensure that cells produce the optimal amount of energy for their needs. This regulation is orchestrated by a complex nervous system involving various nerve tissues, which finely tune the inflow of oxygen and outflow of carbon dioxide. This regulation is essential, especially in circumstances that may alter the partial pressures of gases in the blood.1

Differentiating normal breathing from tachypnea

Respiration is a highly intricate process that involves a range of structures, including the brain, brainstem, respiratory muscles, lungs, airways, and blood vessels. These structures play integral roles both structurally and functionally, and they contribute significantly to the regulation of respiration.

The typical respiratory rate varies based on age, with a resting adult usually having a range of 12 to 20 respirations per minute. However, in the elderly population, an individual with a rate exceeding 28 respirations per minute is considered tachypneic. Children generally have a higher respiratory rate than adults. For instance, in the first two years of life, the median respiratory rate decreases from 44 respirations per minute at birth to 26 respirations per minute by the second year.1,2

Respiratory rate, alongside blood pressure, temperature, and pulse rate, is a vital sign routinely monitored in clinical settings.

Changes in the normal respiratory rate often indicate underlying pathological conditions. These conditions disrupt the feedback mechanisms related to respiratory regulation, leading to adjustments in respiratory rate or volume, reflecting the state of the disease.1

Causes of tachypnea

Tachypnea isn't always linked to a pathological origin. For instance, physical exertion can induce tachypnea. There are various pathological factors that can also lead to tachypnea, including:

  • Sepsis: A severe immune response to an infection.
  • Diabetic Ketoacidosis: A serious complication of diabetes characterized by high levels of ketones and acidosis.

Respiratory conditions:

  • Pneumonia: Inflammation of the lungs often caused by an infection.
  • Carbon Monoxide Poisoning: Inhalation of toxic carbon monoxide gas.
  • Pulmonary Embolism: Blockage in the pulmonary artery, usually due to a blood clot.
  • Pleural Effusion: Accumulation of fluid between the lungs and chest cavity.
  • Asthma: A chronic respiratory condition causing inflammation and narrowing of the airways.
  • Chronic Obstructive Pulmonary Disease (COPD): A group of progressive lung diseases that impede airflow.

Other medical conditions:

  • Allergic Reactions
  • Anxiety 
  • Foreign Body Aspiration: Inhalation of foreign objects into the respiratory tract.

These factors can disrupt the normal respiratory rate, resulting in tachypnea. Accurate identification of the cause is crucial for appropriate treatment and management.3, 4

Symptoms and effects of tachypnea

Patients might express concerns about experiencing breathlessness, often mentioning their inability to take in sufficient air. During a physical examination, indicators such as bluish discoloration in the fingers or lips, and the use of additional muscles or chest engagement for breathing may be observed. Conversely, some patients may not exhibit apparent symptoms.

In newborns, tachypnea can stem from excess fluid in the lungs during the initial 24 hours after birth. Infants may display signs like a bluish hue around the mouth, grunting, apparent breathing difficulties, chest retractions during breathing, head bobbing, and/or flaring of the nostrils.4

Diagnosis and evaluation

The assessment and origins of tachypnea hinge on the patient's overall health condition. Healthcare professionals can utilize various diagnostics such as oximetry, arterial blood gas analysis, chest X-rays, chest CT scans, pulmonary function tests, glucose levels, electrolyte levels, haemoglobin tests, EKGs, VQ scans, brain MRI scans, and toxicology screenings.

Arterial blood gas analysis offers insights into oxygen and carbon dioxide levels, aiding in the assessment of pH and metabolic irregularities. If the pH indicates acidosis, potential culprits could include diabetic ketoacidosis, lactic acidosis, or hepatic encephalopathy. Additionally, blood sugar levels, if assessed, can confirm or rule out diabetic ketoacidosis.

Chest X-rays can reveal any pulmonary factors contributing to tachypnea, such as pneumothorax, cystic fibrosis, or pneumonia. A more detailed evaluation through a chest CT scan can shed light on other lung pathologies or potential malignancies. Pulmonary function tests are instrumental in identifying causes linked to obstructive lung diseases like COPD or asthma. VQ scans come into play when symptoms and signs suggest a potential pulmonary embolus. Should tachypnea be connected to cardiac abnormalities, an EKG will manifest evidence of a heart attack or abnormal heart rhythms.

A thorough blood count and metabolic panel can provide clues about anaemia or infections, both potential contributors to tachypnea. Employing a toxicology screen can help determine if any medications, whether prescribed or over-the-counter, might be linked to the rapid breathing.4

Management and treatment

The approach to treating tachypnea varies based on the root cause.

In the case of infants displaying transient tachypnea of the newborn, administering additional oxygen is a common treatment. In some instances, a stint in the neonatal intensive care unit may also be necessary.

For individuals experiencing tachypnea as a result of asthma or COPD, inhalation therapy can be used to widen and enhance alveolar function in obstructive lung diseases. In scenarios where tachypnea stems from pneumonia, antibiotics are recommended for bacterial pneumonia, while viral pneumonia can be managed supportively without antibiotics.4

Complications of tachypnea

Although tachypnea can be a normal response to physical exertion, it's crucial for clinicians to recognize potential pathological origins, considering the associated complications that could escalate and impact both the patient's physical condition and the efficacy of their care.

Tachypnea often manifests as a symptom in cases of sepsis or acidosis, like diabetic ketoacidosis or metabolic acidosis. Patients grappling with lung-related issues such as pneumonia, pleural effusion, pulmonary embolism, COPD, asthma, or allergic reactions may also exhibit tachypnea. Additionally, congestive heart failure is another potential source of tachypnea, and if not effectively managed, it can deteriorate into worsened heart failure.

Furthermore, anxiety disorders and hyperventilation during panic attacks can induce tachypnea, leading to hypocapnia characterized by reduced carbon dioxide levels, ultimately affecting the respiratory drive. Healthcare providers need to be vigilant about distinguishing between normal and pathological tachypnea to ensure appropriate care and management for their patients.4

Summary

Tachypnea, characterized by rapid and shallow breathing, can create a sensation of inadequate air intake. This symptom is prevalent across all age groups and can manifest in both newborns and individuals with respiratory ailments. Addressing the root cause is vital to alleviate this symptom and ensure improved respiratory function.

References

  1. Chourpiliadis C, Bhardwaj A. Physiology, respiratory rate. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537306/
  2. Fleming S, Thompson M, Stevens R, Heneghan C, Plüddemann A, Maconochie I, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet. 2011 Mar 19;377(9770):1011–8. 
  3. Park SB, Khattar D. Tachypnea. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541062/
  4. Takayama A, Takeshima T, Nakashima Y, Yoshida T, Nagamine T, Kotani K. A comparison of methods to count breathing frequency. Respir Care. 2019 May;64(5):555–63. 

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Ion Gabriel Moisescu

MBBS, Carol Davila University of Medicine and Pharmacy

Ion is a trainee General Practitioner living in London. He has several years of experience working as a registered physician with the British Health Services, in a variety of settings within acute and general internal medicine. He has a strong passion for sports medicine and promotes leading a health conscious and active lifestyle.

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