Breathing and the brain: How brain scanning could help treat chronic respiratory issues

Breathing is more tied up with our emotions than we might think – and understanding our brains better might hold the key to helping prevent asthma attacks and other chronic respiratory issues

It’s the climb: can simply thinking about walking up a set of stairs prompt breathlessness? (Rex)

Wallet, keys, mobile phone... these are the essential items most of us make sure we have before heading out for the day. But for those with chronic respiratory issues, it’s an inhaler that often tops the list – and when it’s accidentally left behind, it can spell disaster.

As a longtime asthma sufferer, I have always wondered why my worst asthma attacks seem to happen on days when I’ve noticed I’ve forgotten my inhaler at home. Is my brain playing tricks on me?

A new study from the University of Oxford shows that may actually be the case – and that how our brains learn to form connections based on past experiences could play a major role in how breathing issues manifest.

“Say you’ve just realised you’ve forgotten your inhaler at home while going out for the evening and you know that you’ve had trouble breathing at night in the past,” says Dr Kyle Pattinson, a neuroscience professor at the Nuffield Department of Clinical Neurosciences.

“Once you realise you’ve forgotten your inhaler, you might start to notice your breathing worsens and that’s triggered by panic.”

In short, simply worrying about having an asthma attack, Dr Pattinson says, could effectively cause a symptom like breathlessness to manifest.

“Clearly, the brain has a powerful influence on the way you perceive breathing,” he says.

​Our brains store a great deal of information about the world based on our past experiences. This helps us assess situations quickly and anticipate how our bodies might respond.

Experiencing repeated or particularly frightening symptoms of breathlessness can be enough, however, to forge a strong connection in the brain linking an activity that caused difficulty breathing with the symptom itself.

While these learned ideas, or “priors”, are meant to help us avoid threatening situations, they can also materially alter the way we perceive certain symptoms, like breathlessness.

Breathlessness is a symptom that affects people with a wide range of conditions, including respiratory, cardiovascular and neuromuscular diseases, as well as mental health issues, such as panic disorder.

While breathing issues have long been thought to be influenced by environmental factors and even psychological states, such as anxiety, the influence of our previous experiences and learned associations have only recently come into consideration as potential pieces of the puzzle. But regardless of whether breathlessness is caused by environmental factors or processes in the brain, the consequences can be equally serious and even deadly.

Asthma alone affects as many as 5.4 million people in the UK, or one in every 11 people, according to Asthma UK. The organisation estimates that as many as three people die every single day from an asthma attack, with 1,468 people dying in 2015 as a result of the condition.

Dr Pattinson says that by understanding the role ‘learned priors’ play in the development of breathing issues, we can create more carefully targeted and personalised treatments for people with chronic breathlessness.

Looking at patients with chronic obstructive pulmonary disease – a group of lung conditions, including bronchitis and emphysema, which make it difficult to breathe out air from the lungs due to a narrowing of the airway – Dr Pattinson’s team has found that connections formed in the brain around breathlessness can be seen through neural imaging.

Using functional magnetic resonance imaging (fMRI) to look at the more complex neural mechanisms involved in experiences of breathlessness, his team has found that specific parts of the brain linked to body symptom evaluation and emotion – namely the insula and anterior cingulate cortex – become active when breathing issues manifest. He says a more holistic treatment gaining traction in the medical world has been shown to promote positive changes in the brain that change the way it responds to learned priors.

Pulmonary rehabilitation is a programme involving exercise, education and support for people with chronic breathing problems. It has zero influence on physical lung function, focusing instead on helping people change the learned priors that can prompt – and worsen – symptoms associated with respiratory issues.

Looking at the fMRIs of those who have undergone pulmonary rehabilitation, Dr Pattinson says his team has been able to confirm that patients who have benefited from the programme experience positive changes in the parts of the brain associated with symptom evaluation and emotion.

The therapy programme helps those suffering from chronic breathlessness to manage their symptoms in a way similar to how cognitive behavioural therapy is used to create personalised coping strategies to change unhelpful thought patterns and behaviours.

Up until recently, Dr Pattinson says there has been a “one-size-fits-all” approach to treating breathing issues, which often overlooks the important role that psychological and neurological processes can play. He hopes his team’s research will demonstrate the need for more holistic treatments, such as pulmonary rehabilitation, that acknowledge the full complexity of chronic breathing problems.