This systematic review and meta-analysis evaluated the association between asthma and mouth breathing. We performed a systematic search in the PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar and OpenThesis databases. Asthma is defined as a heterogeneous disease characterized by variable symptoms of wheezing, shortness of breath, chest oppression and/or cough, and limitation of expiratory airflow. Although several studies have examined the association between asthma and mouth breathing, there are no systematic reviews or meta-analyses that synthesize the available bodies of evidence. We used the odds ratio as a measure of the association between asthma and mouth breathing. Summary estimates were calculated using random-effects models, and the risk of bias was estimated using the Newcastle-Ottawa Scale for case-control studies and the National Institutes of Health tool for cross-sectional studies. Nine studies were included in the present systematic review. Data from 12,147 subjects were analyzed, of which 2083 were children and adolescents and 10,064 were adults. We found an association between mouth breathing and asthma in children and adolescents (OR 2.46, 95% CI 1.78–3.39) and in adults (OR 4.60, 95% CI 1.49–14.20). However, limitations were found in the methodological description of the included studies, as well as high heterogeneity among studies evaluating adult populations. This meta-analysis showed an association between mouth breathing and asthma in children, adolescents and adults, but the results should be interpreted with caution. Further studies with standardized criteria for the investigation of mouth breathing are needed.

Association Between Mouth Breathing and Asthma: a Systematic Review and Meta-analysis

Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.

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Breathing Re-Education and Phenotypes of Sleep Apnea: A Review.

BACKGROUND Empty nose syndrome (ENS) remains a controversial disease primarily associated with inferior turbinate tissue loss. Cotton placement into the inferior meatus often alleviates ENS symptoms within minutes, but the physiologic explanation for this phenomenon is unknown. Computational fluid dynamics (CFD) was employed to evaluate the mechanisms of altered nasal airflow conferred by cotton testing. METHODS Six ENS patients (12 sides) with pre-existing sinus computed tomography (CT) imaging were enrolled after marked symptomatic improvement (decrease in score on the Empty Nose Syndrome 6-Item Questionnaire [ENS6Q] of >7 points) with office-based cotton testing. The fashioned cotton plug was labeled in situ with iohexol contrast spray, and sinus CT was immediately obtained to detect cotton contouring in the inferior meatus. CT imaging from pre- and post-cotton placement was analyzed using comparative CFD techniques. RESULTS After cotton placement, significant symptomatic improvement and reduced ENS6Q scores (16.8 ± 4.1 to 3.1 ± 2.4; p < 0.001) were recorded. Using CFD, cotton placement produced an expected 21% increase in upper airway resistance (p < 0.05). However, a significant shift in the nasal airflow distribution was also detected, with a transition of airflow vectors away from a middle meatus jetstream (-41%; p < 0.002). CONCLUSION Objective CFD assessment confirmed that the cotton test not only increases nasal resistance, but also restores airflow distribution to the inferior meatus in symptomatic ENS patients. These results highlight the potential efficacy of cotton test in ENS patients and further bolster the utility of this tool in identifying appropriate candidates for the inferior meatus augmentation procedure.

The cotton test redistributes nasal airflow in patients with empty nose syndrome.

Objective: The present study aimed to compare the clinical characteristics of volunteers with temporomandibular dysfunction before and after performing exercises with those of volunteers who only followed self-care guidelines.Methods: A parallel randomized controlled trial was performed. Individuals included underwent the intervention twice a week for one month, while the control group only followed self-care guidelines.Results: Twenty-three volunteers participated; however, during the study, four dropped out. At the end of the study, the degree of depression decreased in the volunteers in the intervention group.Conclusion: The level of pain decreased, but the improvement was not statistically significant and, therefore, could not be attributed to the intervention. It can be concluded that the strategies used to reduce pain in this study were not sufficient for clinical improvement in volunteers with temporomandibular dysfunction.

Isotonic exercises and relaxing techniques in individuals with temporomandibular dysfunction.

BACKGROUND: We sought to evaluate the acute effects of different inspiratory loads using nasal and oral interfaces on the volumes of the chest wall and its compartments, breathing pattern, and respiratory muscle activation in children with mouth-breathing syndrome. METHODS: Children with mouth-breathing syndrome were randomized into 2 groups, one with an inspiratory load intensity 20% of maximum inspiratory pressure (n = 14), and the other with an inspiratory load intensity 40% of maximum inspiratory pressure (n = 15). The chest wall volumes and electromyography of sternocleidomastoid, rectus abdominis, scalene, and internal intercostal muscles were used to analyze respiration against the 2 load intensities and using 2 interfaces (ie, nasal and oral). RESULTS: A total of 72 children with mouth-breathing syndrome were recruited, and 29 were evaluated in this study. The use of inspiratory load promoted improvement in the components of the breathing pattern: breathing frequency (P = .039), inspiratory time (P = .03), and total respiratory time (P = .043); and increases in tidal volume (P CONCLUSIONS: The use of acute inspiratory loads improved the breathing pattern and increased lung volume and electrical activity of inspiratory muscles. This work brings new perspective to the investigation of using nasal interfaces during the application of inspiratory loads. The nasal interface was more effective compared to the oral interface commonly used in clinical practice.

http://rc.rcjournal.com/content/respcare/early/2020/04/07/respcare.06908.full-text.pdf

Effects of Inspiratory Load on Chest Wall Kinematics, Breathing Pattern, and Respiratory Muscle Activity of Mouth-Breathing Children.

The mouth breathing syndrome is characterized by a set of signs and symptoms, which may be present in subjects who replace the adequate and efficient nasal breathing mode by mouth or mixed breathing mode for more than six months. Mouth or mixed breathing mode may be associated to changes in the ventilatory function and mechanics. This review aims to further investigate the consequences of mouth breathing on the pulmonary function and respiratory muscles, emphasizing the development of such changes from childhood to adulthood. Eighteen articles were selected through PubMed and Web of Science databases and they were grouped in the text, covering the following topics:1) Implications of mouth breathing on the pulmonary function and 2)Implications of mouth breathing on the respiratory muscles. Based on the information from the articles analyzed, it can be noticed that a few studies rejected or did not find any relationship between pulmonary changes and mouth breathing. It is suggested that the muscular imbalance produced by these changes may contribute for the mechanical disadvantage of the diaphragm muscle and the increase of accessory inspiratory muscles work. Nevertheless, studies with more judicious methods, including objective and reproducible evaluation of the respiratory muscles are still needed.

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Implications of mouth breathing on the pulmonary function and respiratory muscles

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 brea thing. 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.

Implications of mouth breathing on the pulmonary function and respiratory muscles Implicações da respiração oral na função pulmonar e músculos respiratórios

BACKGROUND AND OBJECTIVES: Physical therapy contributes to mitigate temporomandibular disorder symptoms because, in addition to stimulating proprioception and the production of joint synovial fluid, it improves adhered muscle fibers elasticity. This study aimed at evaluating the stability of therapeutic results in a follow-up period post- physical therapy in temporomandibular disorder patients. METHODS: Participated in the study 25 individuals of both genders, with temporomandibular disorder diagnosis. After a multimodal physical therapy program during 10 weeks, which included self-care guidance and home exercises, participants were re-evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders and algometry. Results obtained immediately after treatment were compared to results of the evaluation carried out after two months of follow-up. RESULTS: From 25 participants, with mean age of 31.6 years, 76% had no temporomandibular disorder diagnosis immediately after treatment and from these, 68% have maintained this result in the two-month follow-up period. With regard to joint noises, 60% of participants have remained with no noises and pressure pain threshold values had no statistically significant differences between evaluations. CONCLUSION: Multimodal physical therapy intervention, combined with self-care guidance and home exercises has produced, in this study, positive and long-lasting effects on temporomandibular disorder symptoms, maintaining results for two months after treatment completion.

Stability of physical therapy effects on temporomandibular disorder* Estabilidade dos efeitos da fisioterapia na disfunção temporomandibular

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Stability of physical therapy effects on temporomandibular disorder

Introduction: The relationship established between TMJ (Temporomandibular Joint), cranium and cervical spine requires the synchrony of these structures for the proper performance of stomatognathic functions and muscle balance in this region. Objective: Evaluate the craniocervical posture and the electrical activity of masticatory and cervical muscles in sitting and standing positions in patients with TMD, correlating these variables. Method: The participants were 21 women, with mean age 28 ± 5.33 years and severe TMD. The participants were evaluated by electromyography of the masseter, anterior temporal and sternocleidomastoid (SCM) and upper trapezius muscles, bilaterally, in standing and sitting position. The body posture was evaluated by biophotogrammetry, with analysis of the Head Horizontal Alignment (HHA) and Acromion Horizontal Alignment (AHA) in frontal view and the Head Vertical Alignment (HVA) and Head Horizontal Alignment related to seventh cervical vertebra (HHAc7) in lateral view. Results: The electrical activity of masticatory muscles during resting did not differ between the different evaluated positions. During maximum intercuspation, the electrical activity was significantly lower in the left masseter (p=0.016), higher in the left anterior temporal muscle (p=0.046) and higher in the right (p=0.005) and left (p=0.015) upper trapezius muscles, in standing position when compared to sitting position. The photogrammetric values found were within the normal range. There was a significant and moderate negative correlation between the left SCM muscle and the right (r=0.386) and left (r=0.428) HHAc7 angle. Conclusions: Muscular electrical activity was modified with the change between sitting and standing positions, with an increase in cervical muscle recruitment and asynchrony of the masticatory muscles. Thus, it can be inferred that there is a postural destabilization with possible head anteriorization during maximum intercuspation, reinforcing the relation of synergy between the masticatory and cervical muscles.

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Ana Gabrieli Ferreira Antunes

Papers

Implications of mouth breathing on the pulmonary function and respiratory muscles

Implications of mouth breathing on the pulmonary function and respiratory muscles Implicações da respiração oral na função pulmonar e músculos respiratórios

Stability of physical therapy effects on temporomandibular disorder* Estabilidade dos efeitos da fisioterapia na disfunção temporomandibular

Stability of physical therapy effects on temporomandibular disorder

Biofotogrametric and electromyographic analysis in different position in women with temporomandibular disorder.