Air-Trapping

Ive written about this before, but this is such an important topic; one that effects most chronic lungers and causes more suffering than any other respiratory symptom, that Ive decided to come out of blog retirement to write about it again.

Most of the information that Ive been able to find on the internet regarding air-trapping is way too technical for the average person to understand. Hopefully my explanations will make it a little less confusing. This post will also appear as a topic on my Asthma forum pages for those of you who would like to discuss the issue further.

In a nutshell the term “air-trapping” refers to air that, well … gets trapped in your lungs!
Basically what happens, is that a person with an obstructive lung disease (like asthma), inhales a volume of air, but cannot exhale it easily or completely. The resulting sensation is often perceived as a feeling of chest heaviness or breathlessness. This uncomfortable symptom can vary in intensity from mild to debilitating and usually lasts until the lungs decompress to their baseline state. In the most severe cases, as in severe emphysema, air- trapping tends to get progressively worse and the lungs never fully decompress.

The hallmark of Emphysema, COPD and Severe Asthma, air- trapping occurs when mucus and/or inflammation obstructs the inside of air passages preventing the inhaled air from being easily exhaled. The condition can also occur when the airways themselves loose their elasticity (their ability to recoil) and/ or through the loss of alveolar attachments that stint the alveoli open from the outside. This type of destruction of the airways is seen in both emphysema and in chronic severe asthma (the former usually caused by cigarette smoking).

To get a better understanding of how air becomes trapped in the lungs , it’s helpful to review what goes on during the normal breathing cycle. I think this animation by the folks at Interactive Medical does a superb job of depicting that.

The act of inspiration (the act of inhaling) is an active process. It requires the use of certain muscles (in this case the diaphragm) to make the process work. What happens, is that the diaphragm muscle(which is a dome shaped muscle in your abdomen), contracts and pulls down making room for the lungs to expand within the chest cavity. The expansion of the lungs creates a vacuum within them, allowing air to be drawn in. As the lungs fill with air, stretch receptors tell the brain when equilibrium has been reached and inspiration terminates.

Expiration is (or should be)totally passive. Under normal circumstance there are no muscles used during the act of expiration. The whole system works pretty much like an inflatable balloon. You have to “work” to blow up the balloon, but to deflate it, you just let it go and the air escapes by itself. Ah, but if you have swollen airways or thick mucus in them, or if your balloon is made out of cardboard or stiff plastic instead of rubber, it then becomes much harder for that balloon to deflate on it’s own. People who have obstructive lung diseases have to actually work harder to breath, because they have to literally “push” or force the air out of their lungs to make room for the next breath. This requires the use accessory muscles that you wouldn’t normally use to breath, and that extra muscle expends more energy, which makes you more tired and even more short of breath.

It’s important to note, that while air-trapping is abnormal, there is always a small amount of air that remains in the lungs after you exhale completely… even if have totally healthy lungs. This is known as residual volume. Without this residual air, your lungs would collapse into themselves and you would not be able to overcome the resistance required to re-inflate them.

With the exception of drugs like Tiotropium ( Spiriva) or the more radical treatments like LVS surgery or airway stints to treat the more severe forms of air trapping, there are really very few options out there. Certain breathing and relaxation techniques can help minimize the symptoms by basically tricking the brain and reducing the associated anxiety, but the best practice is to prevent the condition from occurring in the first place ,or if it does, by preventing it from getting worse.

This of course is an oversimplification of how and why air trapping occurs, there are different types of air trapping and many other factors involved, but hopefully my explanation gives you a better idea of what’s actually going when you hear the term…”air trapping”

OK, back to my retirement…

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19 Comments

  1. kerri says:

    I've seen that video before. The intense music in respiratory videos always cracks me up.

    I have this crazy feeling you're never gonna fully retire from anything. EVER. 😉 That last line made me smile.

    Now I'm off to imagine you sitting on a beach [read: play guitar]. That's what retired people do, right? Sit on the beach? [Yeah right.]

    • Air -trapping is one of those terms that people like to throw around, but not many understand. Yea, I like to use that video because it shows how the diaphragm works.

  2. Travis says:

    Excellent! Thanks for such an effective article on this unknown & misunderstood topic.

  3. Janet says:

    Hey guys- Great video– I have never seen it before. Part of my breathing problem is that my diaphragm appears to be partially or completely paralyzed. So, moving air is very difficult for me. I enjoyed the article, too, Stephen– I found it very informative. Thanks!

  4. Dezirae says:

    this article really helped me. my grandmother is currently in the hospital and she has air trapped in her lungs.. the doctor says that there is not much they can do. but after reading this article they have several things they can do to help her survive. this article was very easy to find and i appreciate you putting it into more of an understable language.

  5. tricia says:

    Stephen you have helped explain so many things to me..I really appreciate all you do for asthma and education…

  6. michelle says:

    Ive just recently admitted my 21yrs old son to hosp with this condition! 🙁 I hope he’s going to be alright! 🙁

  7. Steve says:

    I have been diagnosed as having air/gas trapping. Is this condition also associated with autonomic neuropathy. I have been diagnosed with autonomic neuropathy with reference to my bladder. The suspected cause is toxin exposure to Agent Orange. I also have peripheral neuropathy.

    • Hello, Gas trapping/ air trapping usually refers to the over-inflation of the alveoli ( the tiny air sacs in the lungs), which is commonly seen in chronic asthma, bronchitis and emphysema. To my knowledge it’s not associated with any type of neuropathy.

  8. Rhea says:

    Hi Stephen,

    Thank you so much for all the time & sharing that you’ve put into this site & blog. I’m a young doctor – had a first hospitalisation with asthma this month – I’ve found reading through your blogposts really helpful to understand a bit more – and relief in discovering that so many elements of the experience are common and we’re not alone!
    Thanks for the info on air trapping. Is there anywhere you’d recommend for reading more on different types of air trapping and which meds are good for which symptoms?
    (I’m wondering from your self observations post if air-trapping might have been one of my main features…. I haven’t had a wheeze since childhood, maintain my Sats, and barely drop my peak flow – but get chest tightness, feeling like I’m breathing in against a Pilates/physio band which someone’s wrapped around my chest, dry cough triggered by chest tightness (and almost earned myself a tube from tiring), and breathlessness on moving/speaking. Currently trying to work out with the docs/nurses what signs they need to look for when monitoring me, and which medications will work best.
    Thanks again for all your help! You’re a real trooper & I know you’re helping so many people 🙂
    Best of luck in your own recovery from your last bout!

  9. Kathryn says:

    I would like information on how to prevent air trapping from getting worse. My doctor told me I had it, but dismissed it as not important and said nothing about preventing it from getting worse. Both my parents had serious lung disease.

  10. Lisa says:

    When I was in college 25 years ago, I played NCAA soccer. After a game, I was dying of thirst so I guzzled a bunch of water and then I heard out coach say “that game sucked so everyone is doing suicide sprints until they puke. I did the sprints and that night I had a bunch of air trapped in my lungs; so I think. It was so painful that I missed school for 5 days straight and I could not get out of bed. Here was the really strange part, when I would turn from side to side, the huge air bubble in my lung would move up or down in the lung depending on which side i turned onto. I felt like someone was stabbing me and I basically had to lay in one position for 5 days straight cuz the pain was so bad when I would turn over that I would almost pass out. I was so scared that I did not know what to do so I just laid in bed for 5 days straight, did not eat anything, and only got up to pee. I had no roommate cuz I was a senior. I did not want to go to the hospital cuz I was in a different State from where I normally lived and I had no idea where the hospital was located, plus my college was a very, very small private religious college where they did not believe in doctors. Im really surprised I did not die. I have no clue what the hell was going on with me. For 5 days I tried to burp out the air. It finally dissipated after the 5 days and the stabbing pain subsided. Was that air trapping?

  11. Edward Markham says:

    Hi, I have very severe Emphysema and am waiting to be referred for either NR Valves to be fitted or else LVRS. After my last Lung Function Test my Consultant said that I have 2 litres of Air trapped in my lungs !. What is the significance of this amount of trapped air ?.

    • Thats a lot trapped air. Air trapping results in the inability to empty your lungs during exhalation, making it difficult to get rid of CO2 and to take a full breath in. Over inflated lungs can also compress the blood vessels that supply the lungs ( pulmonary hypertension) ,which causes the heart to work harder to pump blood through the lungs.

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