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Control of Breathing

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

Breathing is usually automatic, controlled subconsciously by the respiratory center at the base of the brain. Breathing continues during sleep and usually even when a person is unconscious. People can also control their breathing when they wish, for example during speech, singing, or voluntary breath holding. Sensory organs in the brain and in the aorta and carotid arteries monitor the blood and sense oxygen and carbon dioxide levels. Normally, an increased concentration of carbon dioxide is the strongest stimulus to breathe more deeply and more frequently. Conversely, when the carbon dioxide concentration in the blood is low, the brain decreases the frequency and depth of breaths. During breathing at rest, the average adult inhales and exhales about 15 times a minute.

Diaphragm’s Role in Breathing

When the diaphragm contracts and moves lower, the chest cavity enlarges, reducing the pressure inside the lungs. To equalize the pressure, air enters the lungs. When the diaphragm relaxes and moves back up, the elasticity of the lungs and chest wall pushes air out of the lungs.

The lungs have no skeletal muscles of their own. The work of breathing is done by the diaphragm, the muscles between the ribs (intercostal muscles), the muscles in the neck, and the abdominal muscles. The diaphragm, a dome-shaped sheet of muscle that separates the chest cavity from the abdomen, is the most important muscle used for breathing in (called inhalation or inspiration). The diaphragm is attached to the base of the sternum, the lower parts of the rib cage, and the spine. As the diaphragm contracts, it increases the length and diameter of the chest cavity and thus expands the lungs. The intercostal muscles help move the rib cage and thus assist in breathing. The muscles used in breathing can contract only if the nerves connecting them to the brain are intact. In some neck and back injuries, the spinal cord can be severed, which breaks the nervous system connection between the brain and the muscles, and the person will die unless artificially ventilated.

The process of breathing out (called exhalation or expiration) is usually passive when a person is not exercising. The elasticity of the lungs and chest wall, which are actively stretched during inhalation, causes them to return to their resting shape and to expel air out of the lungs when inspiratory muscles are relaxed. Therefore, when a person is at rest, no effort is needed to breathe out. During vigorous exercise, however, a number of muscles participate in exhalation. The abdominal muscles are the most important of these. Abdominal muscles contract, raise abdominal pressure, and push a relaxed diaphragm against the lungs, causing air to be pushed out.

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