Implications of mouth breathing on the pulmonary function and respiratory muscles
Implicações da respiração oral na função pulmonar e músculos respiratórios
Helenize Lopes Veron; Ana Gabrieli Antunes; Jovana de Moura Milanesi; Eliane Castilhos Rodrigues Corrêa
Abstract
The mouth breathing syndrome is characterized by a set of signs and symptoms, which may be present in subjects who replace an adequate and efficient nasal breathing mode by the mouth or mist breathing mode, for a period equal or superior of six months. The mouth or mist breathing mode may be associated to changes in the ventilatory function and mechanics. This review has the objective of investigating more deeply the consequences of the mouth breathing in the lung function and respiratory muscles, emphasizing the development of such changes since childhood to adult age. Eighteen articles were selected through data basis PubMed and Web of Science and they were grouped in the text, comprehending the follow topics: 1) Implications of mouth breathing on the lung function and 2) Implications of mouth breathing on the respiratory muscles. From the information derivate of the analyzed articles, it may realized that few studies reject or did not find some relation between pulmonary changes and mouth breathing. It was suggested that the muscular unbalance produced by these changes may contribute for the mechanic disadvantage of the diaphragm muscle and increase of accessory inspiratory muscles work. Nevertheless, studies with more selective method, including objective and reproducible evaluation of the respiratory muscles are still need.
Keywords
Resumo
A Síndrome do Respirador Oral é caracterizada por um conjunto de sinais e sintomas que podem estar presentes em indivíduos que substituem o modo adequado e eficiente da respiração nasal pelo modo respiratório oral ou misto, por um período igual ou superior a seis meses. O modo respiratório oral ou misto pode estar associado a mudanças na função e mecânica ventilatória. Esta revisão tem como objetivo investigar mais profundamente as consequências da respiração oral na função pulmonar e músculos respiratórios, ressaltando o desenvolvimento de tais alterações desde a infância até a idade adulta. Foram selecionados 18 artigos por meio das bases de dados Pubmed e Web of Science e foram agrupados no texto, compreendendo os seguintes tópicos: 1) Implicações da respiração oral sobre a função pulmonar e 2) Implicações da respiração oral sobre os músculos respiratórios. A partir das informações oriundas dos resultados dos artigos analisados, percebe-se que poucos estudos refutam ou não encontram alguma relação entre as alterações pulmonares e a respiração oral. Sugere-se que, o desequilíbrio muscular produzido por estas alterações pode contribuir para a desvantagem mecânica do músculo diafragma e aumento do trabalho dos músculos acessórios da inspiração. Entretanto, são necessários estudos com métodos mais criteriosos, incluindo avaliações objetivas e reprodutíveis dos músculos respiratórios.
Palavras-chave
Referências
1. Brant TCS, Parreira VF, Mancini MC, Becker HMG, Reis AFC, Brito RR. Breathing pattern and thoracoabdominal motion in mouth-breathing children. Rev Bras Fisioter. 2008;12(6):495-501.
2. Yi LC, Jardim JR, Inoue DP, Pignatari SSN. The relationship between excursion of the diaphragm and curvatures of the spinal column in mouth breathing children. J Pediatr. 2008;84(2):171-7.
3. Hartsook JT. Mouth breathing as a primary etiologic factor in the production of malocclusion. J Dent Child. 1946;13(4):91-4.
4. Barbiero EF, Vanderlei LCM, Nascimento PC, Costa MM, Neto AC. Influência do biofeedback respiratório associado ao padrão Quiet Breathing sobre a função pulmonar e hábitos de respiradores bucais funcionais. Rev Bras Fisioter. 2007;11(5):347-53.
5. Conti PBM, Sakano E, Ribeiro MAGO, Schivinski CIS, Ribeiro JD. Assessment of the body posture of mouth-breathing children and adolescents. J Pediatr. 2011;87(4):357-63.
6. Menezes VA, Tavares RLO, Granville-Garcia AF. Síndrome da respiração oral: alterações clínicas e comportamentais. Arq Odontol. 2009;45(3):160-5.
7. Abreu RR, Rocha RL, Lamounier JA, Guerra AFM. Etiology, clinical manifestations and concurrent findings in mouth-breathing children. J Pediatr. 2008;84(6):529-35.
8. Felcar JM, Bueno IR, Massan ACS, Torezan RP, Cardoso JR. Prevalence of mouth breathing in children from an elementary school. Ciênc Saúde Coletiva. 2010;15(2):437-44.
9. Menezes VA, Leal RB, Moura MM, Granville-Garcia AF. Influence of socio-economic and demographic factors in determining breathing patterns: a pilot study. Rev Bras Otorrinolaringol. 2007;73(6):826-34.
10. Cattoni DM, Fernandes FDM, Di Francesco RC, Latorre MRDO. Quantitative evaluation of the orofacial morphology: anthropometric measurements in healthy and mouth-breathing children. Int J Orofacial Myology. 2009;35:44-54.
11. Posnick JC, Agnihotri N. Consequences and management of nasal airway obstruction in the dentofacial deformity patient. Curr Opin Otolaryngol Head Neck Surg. 2010;18(4):323-31.
12. Menezes VA, Leal RB, Pessoa RS, Pontes RMES. Prevalência e fatores associados à respiração oral em escolares participantes do projeto Santo Amaro-Recife. Rev Bras Otorrinolaringol. 2006;72(3):394-9.
13. Falcão DA, Grinfeld S, Grinfeld A, Melo MVR. Oral breathers clinically diagnosed and by autodiagnosed. Body posture consequences. Int J Dent. 2003;2(2):250-6.
14. Motonaga SM, Berte LC, Anselmo-Lima WT. Respiração bucal: causas e alterações no sistema estomatognático. Rev Bras Otorrinolaringol. 2000;66(4):373-9.
15. Bicalho GP, Motta AR, Vicente LCC. Evaluation of Swallowing in Mouth Breathing Children. Rev CEFAC. 2006;8(1):50-5.
16. Cattoni DM, Fernandes FDM, Di Francesco RC, Latorre MRDO. Características do sistema estomatognático de crianças respiradoras orais: enfoque antroposcópico. Pró-Fono R Atual Cient. 2007;19(4):347-51.
17. Menezes VA, Barbosa AMF, Souza RMS, Freire CVC, Granville-Garcia AF. Ocorrência de rinite, respiração oral e alterações orofaciais em adolescentes asmáticos. Rev CEFAC. 2013;15(3):663-71.
18. Costa Jr EC, Sabino HAC, Miura CS, Azevedo CB, Menezes UP, Valera FCP et al. Atopia e hipertrofia adenoamigdaliana em pacientes respiradores bucais em um centro de referência. Braz J Otorhinolaryngol. 2013;79(6):663-7.
19. Banzatto MGP, Grumach AS, Mello JF, Francesco RCD. Adenotonsillectomy improves the strength of respiratory muscles in children with upper airway obstruction. Int J Pediatr Otorhinolaryngol. 2010;74(8):860-3.
20. Belli JFC, Chaves TC, Oliveira AS, Grossi DB. Analysis of body posture in children with mild to moderate asthma. Euro J Pediatr. 2009;68(10):1207-16.
21. Corrêa ECR, Bérzin F. Mouth Breathing Syndrome: cervical muscles recruitment during nasal inspiration before and after respiratory and postural exercises on swiss ball. Int J Pediatr Otorhinolaryngol. 2008;72(9):1335-43.
22. Milanesi JM, Borin G, Correa ECR, Silva AMT, Bortoluzzi DC, Souza JÁ. Impact of the mouth breathing occurred during childhood in the adult age: biophotogrammetric postural analysis. Int J Pediatr Otorhinolaryngol. 2011;75(8):999-1004.
23. Trevisan ME, Boufleur J, Soares JC, Haygert CJP, Ries LGK, Correa ECR. Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: a cross-sectional study. J Electromyogr Kinesiol. 2015;25(3):463-8.
24. West JB. Fisiologia respiratória. 8ª ed. Porto Alegre: Artmed; 2010.
25. Pires MG, Di Francesco RC, Junior JFM, Grumach AS. Alterações Torácicas Secundárias ao Aumento de Volume de Tonsilas Palatinas e Faríngeas. Arq Int Otorrinolaringol. 2007;11(2):99-105.
26. Chaves TC, Silva TSA, Monteiro SAC, Watanabe PCA, Oliveira AS, Grossi DB. Craniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing. Int J Pediatr Otorhinolaryngol. 2010;74(9):1021-7.
27. Duggan CJ, Watson RA, Pride NB. Postural Changes in Nasal and Pulmonary Resistance in Subjects with Asthma. J Asthma. 2004;41(7):695-701.
28. Hallani M, Wheatley JR, Amis TC. Enforced mouth breathing decreases lung function in mild asthmatics. Respirol. 2008;13:553-8.
29. Barbiero EF, Vanderlei LCM, Neto AC, Nascimento PC. Influence of respiratory biofeedback associated to re-expansive ventilation patterns in individuals with functional mouth breathing. Int J Pediatr Otorhinolaryngol. 2008;72:1683-91.
30. Silveira W, Mello FCQ, Guimarães FS, Menezes SLS. Postural alterations and pulmonary function of mouth-breathing children. Braz J Otorhinolaryngol. 2010;76(6):683-6.
31. Campanha SMA, Fontes MJF, Camargos PAM, Freire LMS. The impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents. J Pediatr. 2010;86(3):203-8.
32. Ferreira FS, Weber P, Correa ECR, Milanesi JM, Borin GS, Dias MF. Efeito da fisioterapia sobre os parâmetros ventilatórios e a dinâmica tóraco-abdominal de crianças respiradoras bucais. Fisioter Pesq. 2012;19(1):8-13.
33. Milanesi JM, Weber P, Berwig LC, Ritzel RA, Silva AMT, Correa ECR. Childhood mouth-breathing consequences at adult age: entilator function and quality of life. Fisioter Mov. 2014;27(2):211-8.
34. Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012;32(2):E51–E70.
35. Chaves TC, Grossi DB, Oliveira AS, Bertolli F, Holtz A, Costa D. Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children. J Clin Pediatr Dent. 2005;29(4):287-92.
36. Baltar JÁ, Santos MSB, Silva HJ. Does asthma promote changes in static posture? – Systematic review. Rev Port Pneumol. 2010;16(3):471-6.
37. Okuro RT, Morcillo AM, Ribeiro MAGO, Sakano E, Conti PBM, Ribeiro JD. Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children. J Bras Pneumol. 2011;37(4):471-9.
38. Cunha RA, Cunha DA, Assis RB, Bezerra LA, Silva HJ. Evaluation of Respiratory Muscle Strength in Mouth Breathers: Clinical Evidences. Int Arch Otorhinolaryngol. 2014;18(3):289-93.
39. Breslin EH, Garoutte BC, Kohlman-Carrieri V, Celli BR. Correlations between dyspnea, diaphragm and sternomastoid recruitment during inspiratory resistance breathing in normal subjects. Chest. 1990;98(2):298-302.
40. Gutiérrez MF, Valenzuela S, Miralles R, Portus C, Santander H, Fuentes AD et al. Does breathing type influence electromyographic activity of obligatory and accessory respiratory muscles? J Oral Rehabil. 2014;42(11):801-8.
Submetido em:
24/07/2015
Aceito em:
10/11/2015
Facebook
Twitter
LinkedIn
Mendeley
Email