Biot’s Breathing: Meaning, symptoms, related conditions, prognosis, Ayurveda understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Biot’s Breathing is one among the abnormal patterns of breathing. Camille Biot, a French physician had characterized and described this pattern of breathing in 1876 and is hence named after him. It is characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea.

Other names –

Cluster Respiration
Biot’s Respiration

It is characterized by –

Variable tidal volume (tidal volume is the amount of air that moves in or out of the lungs with each respiratory cycle)
Random apneas (apnea is when someone stops breathing for a short time while asleep, it is a serious sleep disorder in which breathing repeatedly stops and starts)
No regularity in breathing

Table of Contents

Causes of Biot’s Breathing

Below mentioned are the main causes of Biot’s Breathing –

Trauma and subsequent damage to the medulla oblongata and pons
Stroke
Use of opioid
Herniation of uncas or tentorium leading to increased intracranial pressure
Meningitis

Differential diagnosis

Biot’s Breathing v/s Ataxic Respiration – Biot’s breathing has more regular and similar sized inspirations. On the other hand Ataxic Respiration is marked by presence of completely irregular breaths and pauses. As the breathing pattern deteriorates in Biot’s respiration, it merges with ataxic respirations and becomes similar to it.

Biot’s Breathing v/s Cheyne Stokes Respirations – Cheyne-Stokes respirations are cyclic type of breathing in response to buildup of carbon dioxide in the system (hypercapnia). It is marked by crescendo (smooth increase in rate and depth of respirations) followed by a decrescendo effect (gradual decrease in the rate and depth of respirations) ending with a short period of apnea which usually lasts from 15-60 seconds. After this, the cycle repeats itself. On the other hand Biot’s breathing is characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea. Any condition which slows down the blood flow to the brain stem causes Cheyne Stokes respirations whereas Biot’s respiration is caused by different causes mentioned above.

Biot’s Breathing v/s Kussmaul Respiration (hyperpnea) – Kussmaul respirations are deep, rapid respirations which occurs when the body tries compensates for severe metabolic acidosis or following strenuous exercise. They are marked by an increased rate, very large tidal volume and no expiratory pause. There is no stopping between inhaling and exhaling. This condition is typically seen in the diabetic patients having ketoacidosis. This shall be differentially diagnosed with Biot’s breathing.

Prognosis of Biot’s Respiration

Biot’s Respiration / Breathing usually carry a poor prognosis, more so if it is caused by damage to the medulla due to trauma or stroke or by pressure on the medulla due to herniation of uncus or tentorium.

Ayurveda Understanding

Ayurveda has explained ‘abnormal breathing patterns’ in the context of ‘Shwasa’. The term shwasa here pertains to ‘shwasa krichrata’ i.e. ‘difficulty in breathing’. Five kinds of shwasa have been enumerated in Ayurveda. Among these a condition named ‘Maha Shwasa’ and its symptoms closely resemble with those explained in the context of ‘Biot’s breathing’.