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Chapter 4
Respiratory Care

 

Breathing is the voluntary and involuntary movement of air, in and out, either your nose or your mouth. The two purposes of breathing are:

  • To get oxygen (O2) to your tissues for survival, and
  • To remove the waste product of the cells, carbon dioxide (CO2).
 

The exchange of gases is the job of your lungs. In the lungs, oxygen (O2) tubes come down from your windpipe and branch from your neck down into your chest like a tree growing upside down. (See figure 4.1.)

These tubes keep branching until they are very tiny. At the very end of the smallest branch are air sacs that look like little clusters of balloons. These balloons are located next to the blood vessels in the walls of your lungs. Because of the way your lungs are built, when you inhale, air is sucked into the balloons to fully inflate them. The oxygen is then passed to red blood cells in the blood vessels to be carried to the rest of the body by way of your heart. The carbon dioxide (CO2) waste in your blood is passed into your lungs so that when you breathe out, you get rid of it. See the chapter on the Circulatory System for more information.

Breathing out generally takes no effort or energy. Breathing in does require energy. The faster you breathe, the more energy it takes. Breathing in requires many different muscles. (See table 4.A.)

FIGURE 4.1.
The Respiratory System

FIGURE 4.1. The Respiratory System

 

TABLE 4.A. Some of the Muscles Used in Breathing

RESPIRATORY MUSCLES FUNCTION SPINAL CORD INJURY LEVEL AND ITS EFFECT ON BREATHING
Diaphragm The main muscle of breathing. It is found just underneath your lungs. An injury above C5 may require the use of a breathing machine for a while or permanently, because the diaphragm and most other muscles may not work.*
Intercostals These muscles run in between your ribs. They are used in coughing and deep-breathing. An injury above T1 will reduce the strength of these muscles, but diaphragm and neck muscles can assist breathing.
Abdominals These muscles help you in coughing. They run between your ribs and your hips. An injury above T12 will reduce the strength of these muscles, but intercostals, diaphragm, and neck muscles can assist.
*If you use a breathing machine, you will get special training in its use.

 
KEEPING YOUR LUNGS HEALTHY

  1. Stop smoking. Smoking increases your secretions and likelihood of getting infections. It prevents the lung’s natural action to get rid of pollutants.
  2. Do breathing exercises on a regular basis if you have a cervical or high-thoracic level of injury. If you have an incentive spirometer, use it at least two or three times a day. If you don’t have one, take as deep a breath in as you can two or three times a day. Hold it for a count of three, then push all the air out. Do that 5 to 10 times each session.
    You may also learn something called "frog breathing" to help you increase the amount of air in your lungs. It is a type of breathing exercise that you can learn with practice. This is taught by speech therapists to patients who need this type of exercise.
  3. Try to stay away from known pollutants, such as smoke, dusts, and dangerous chemicals.
  4. If you get a cold or sore throat, do more breathing exercises. If you have a cold, perform quad coughing two to three times a day. This should help prevent the build up of secretions and the risk of a pneumonia (new-MOAN-yah). Take it seriously. If a cold or sore throat does not go away in a week to 10 days, contact your SCI clinic or your doctor for further instructions.
  5. The use of an abdominal binder can increase respiratory capacity by substituting for a paralyzed abdominal wall.

 
RESPIRATORY PROBLEMS

Respiratory problems can be caused by many things, but by far the most common problem is an infection, such as pneumonia. Other problems can cause you to feel the same way.

You may experience any or all of the following symptoms of infection:

  1. Increased shortness of breath.
  2. Rapid breathing.
  3. Increased congestion or secretions from your lungs.
  4. Lower reading of air flow through your incentive spirometer.
  5. Early morning headache, fever, or unusual drowsiness.

 
Treating Respiratory Problems

  1. Increase the number of times you do your breathing exercises. Do them every two hours.
  2. Quad coughing can be done to increase the effectiveness of your cough. This is done by having someone else push over your abdomen at the same time you cough. NOTE: Do not attempt this if it has never been demonstrated to you. Self-assisted coughing can be done by bracing your arms, leaning forward, and putting pressure on the abdomen.
  3. Change your position more frequently by moving from sitting to lying and by turning from side to side. This will change the areas of your lungs that get air and will help you keep all areas of your lungs working.
  4. Do postural drainage after your breathing exercises, whenever time and place allow, but only if you have been taught how to do it properly. Putting your head and chest down allows secretions to drain by gravity toward the upper lung. They can then be coughed up more easily.
  5. Chest percussion can also be done while you are lying head down. Get someone to clap their hands on your chest. This also aids in removal of secretions. You must be taught how to do this properly.
  6. Consider taking a warm (not hot!) bath or shower. This warms and humidifies the air with steam. Steam can help liquefy secretions so that they become easier to cough up. Do this once or twice a day, then cough.
  7. Increase fluids to thin your secretions, which will make it easier to cough these secretions up.

If your symptoms do not go away in 5 to 10 days and your treatments don’t seem to help, call the SCI clinic.

If your symptoms are getting worse or if you have a fever, call your SCI clinic or local doctor.

Some respiratory infections may need antibiotics to kill bacteria or medications to help you breathe better and easier. Those decisions may require that the SCI clinic staff see you. Serious breathing problems may need to be treated in the hospital. Fever, chills, and cough that is associated with shortness of breath should be evaluated by SCI clinic staff.

 
Sleep Apnea

What is sleep apnea?

People with sleep apnea stop breathing for at least 10 seconds at a time while they are sleeping. These short stops in breathing can happen up to 400 times every night. The periods of not breathing can make you wake up from deep sleep. If you’re waking up so often all night long, you aren’t getting enough rest from your sleep.

How do you know if you have sleep apnea?

  • Your doctor can diagnose sleep apnea.
  • The person you sleep with or your caretaker may notice heavy snoring or long pauses in your breathing during sleep.
  • You may notice daytime sleepiness (falling asleep at work, while driving, or when talking) and irritability or fatigue.
  • You may also notice that you have morning headaches, forgetfulness, mood changes, and a decreased interest in sex.

There are steps that may help people with sleep apnea to sleep better.
  • Stop all use of alcohol or sleep medicines.
  • If you are overweight, lose weight.
  • Sleep on your side instead of on your back.

If you still have problems, you can wear a special mask over your nose and mouth while you are sleeping. The flow of the air from the machine will keep your airway open by adding pressure to the air you breathe. In a very few cases, surgery is necessary to remove tonsils or extra tissue in the throat.

You may request a sleep apnea consultation from your physician.

 
SCI Self-Care Guide Main Page
Chapter 1     SCI Anatomy & Physiology
Chapter 2     Skin Care
Chapter 3     Circulatory System
Chapter 4     red dotRespiratory Carered dot
Chapter 5     Range of Motion
Chapter 6     Bladder Management
Chapter 7     Bowel Management
Chapter 8     Nutrition
Chapter 9     Medications
Chapter 10   Nerves, Muscles, and Bones
Chapter 11   Autonomic Dysreflexia
Chapter 12   Pressure Sores
Chapter 13   Psychosocial Adjustment
Chapter 14   Sexual Health & Rehabilitation 		Chapter 15   Community Resources
Chapter 16   Vocational Rehabilitation
Chapter 17   Recreation
Chapter 18   Driver’s Training
Chapter 19   Attendant Management
Chapter 20   Home Modifications
Chapter 21   Approaching Discharge
Chapter 22   Pain after Spinal Cord Injury
Chapter 23   Substance Abuse and SCI
Chapter 24   Exercise
Chapter 25   Alternative Medicine
Chapter 26   Equipment
Chapter 27   Staying Healthy
Glossary

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