Ive written about this before, but this is such an important an misunderstood topic; one that effects most chronic lungers and causes more suffering than any other respiratory symptom, that Ive decided to write a little bit more about it.

Most of the information that Ive been able to find on the internet regarding air-trapping is way too technical for the average non-medical person to understand. Hopefully my explanations will make it a little less confusing.

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 chronic 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, especially when exhaling. 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 some forms of 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 tiny airways loose their elasticity (their ability to stretch and 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 actually 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. In the absence of lung disease 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 ( your diaphragm contracts which causes air to be sucked into your lungs), 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, or if your balloon is more like a stiff paper bag, it then becomes much harder for that balloon to deflate on it’s own. People who have obstructive lung diseases and develop air trapping have to actually work harder to breath, because they have to literally “push” or force the air out of their lungs with accessory muscles that you wouldn’t normal use to make room for the next breath. So why do you feel anxious when you actually have too much air in your lungs? Well , because the breathlessness you experience feels out of proportion to the perceived degree of effort exerted. Even subtle changes in the amount of effort required to expel air out of clogged airways, can make you “feel” like you suffocating.

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 anticholenergic drugs like Tiotropium (Spiriva) or invasive and surgical interventions like LVR 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 occur, 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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33 thoughts on “Air-Trapping

  1. 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.]

  2. 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!

  3. 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.

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

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

  6. 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.

    1. 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.

  7. 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!

  8. 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.

  9. 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?

  10. 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 ?.

    1. 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.

      1. Wow, scary! My PFT showed 2.71 liters of stale air and my CO2 was something like 89. I was athletic and sang in a glee club in HS, so I always had large lung capacity ( about 6 liters); so about half of my air is trapped. I have been switched from Flovent to Advair, to Breo, now to Symbicort. It seems after a certain amount of time the medicine works, then they get bad again, even more pronounced actually. I personally have found using iprotropium has been my best result, but my doctors always want to put me on some sort of steroid inhalers. Eventually, each kind ends up giving me an adverse reaction. Is Spiriva related to iprotropium, and does it contain steroids! I really want to get my doctors to change the medicine to a non-steroid if possible. – Thank you

        1. Hello, Spiriva is a long acting anticholinergic drug similar to ipratropium. It does NOT contain a steroid. If you switch to Spiriva, try to get the respimat inhaler. It tends to work better than the traditional Spriva inhaler.
          I hope it works for you.

          1. Stephen don’t know if you can help I’ve got really bad wind I’m on omeprazole I have difficulty breathing nothing is easing it can you suggest anything

            1. In my post Im talking about air that gets trapped in lungs. Are you referring to gastrointestinal air ( gas)? Ive had issues with abdominal bloating . After switching to a more gluten free diet, the problem went away.

  11. As I mentioned in an earlier post, I get severe Air-Trapping, usually after excercise but not continually, it appears for several weeks and then for no apparent reason disappears for several weeks and then the cycle starts again . What I have found that helps to “Burp” it out is Pursed Lipped breathing whilst leaning forward from the hips and holding onto the back of the sofa whilst exhaling for as long as possible each time . Also if this doesn’t shift it all then leaning back in the chair 20 degrees or so past vertical and exhaling hard also helps and try to make the Burp as loud as possible as this seems to get more out each time . I hope this helps as it usually gives me relief each time .

    1. Hello,

      No, air trapping and lung collapse are two different things. Confusing I know. Air-trapping occurs when air gets trapped in the smaller airways, usually as a because of inflammation or mucus plugs, and sometimes because collapse of the airway itself. Air gets into the airways, but cant get completely out. As a result, the lungs become become hyperinflated and actually get bigger as air trapping increases.

      A total or partial lung collapse occurs when air or blood gets into the plural space ( the space between the lining of the lung and the chest wall.) We call this a pneumo or hemothorax. When air gets into this space, it breaks the vacuum or liquid seal that normally exists there, and which keeps the lung “pulled” open. In order to re-inflate the collapsed lung, the air or blood has to be drawn out with a chest tube ( a drain attached to a vacuum).

      Hope this helps

  12. Hi, thank you for this article. I have severe COPD and at times when I have over exerted, my chest feels like there is a clamp holding it from either expanding or contracting. At that point my oxygen level is 95% but I just can’t breathe. Is it possible that I have air trapped as in this article? This is not an everyday occurrence but when it happens it is very scary.

    1. Hello and thanks for writing. Yes, if you have COPD or severe asthma you could definitely be experiencing air trapping, especially if your O2 sats are normal during these bouts. Unfortunately, other than taking the standard neb treatments, there’s not a lot that can be done until the lungs decompress. There are certain breathing exercises which can help. They all work by having the person slowly and forcefully expelling the air from your lungs using your abdominal muscles to push the air out through pursed pips. If you haven’t already, you might want to check out a pulmonary rehab class or better breathers club.

      Take care

  13. My daughter is at present in ICU for her chronic asthma. I just found out about the air trapping this morning. The doctor called it a different name, not pneumothorax but something else. So, is it common to feel the air trap through the skin? With my daughter we left our town in the ambulance being transported to ICU in a children’s hospital. She started feeling the rice crispy sensation on her skin after they put a by-pap machine on her. Is that normal.

    1. Sorry to hear about your daughter. What you’re describing is a pneumothorax. Air trapping ( aka dynamic hyperflation) is a totally different thing. A pneumothorax can happen when the lungs gets a small tear in them , either from coughing hard or being put on a ventilator. The feel of rice crispies under the skin that you are referring to is called “crepitus” . This occurs when there is an air leak in the upper lobes of the lungs . You usually feel it in the breast or neck area. If its small it will heal on its own. I hope your daughter’s condition improves quickly.

  14. Hi, what I still don’t understand is if, say, a mucus plug prevents air from getting out, why doesn’t that same mucus plug prevent air from getting in? In other words, why do folks with COPD have more difficulty with expiration than with inspiration? Thanks, Tim

  15. Hi Stephen- I really appreciated this information. I was diagnosed with Asthma as an adult and have taken various meds for it- nothing that really made a difference. Then I went to a pulmonologist to do a sleep test cause I was falling asleep all the time- the test showed I had shallow breathing (hypopnea) and that my oxygen went down to 60 when I slept- they put me on oxygen and an apnea machine when I sleep. Then they did the test you talked about and showed I had trapped air- they’ve put me on Breo – which seems to help with the shortness of breath and wheezing. Two questions or thoughts- I was a premmie back in the 1950’s- could that have effected my lung development causing the shallow breathing and trapped air? I’ve had pneumonia and bronchitis on and off all my life and sometimes choak when eating or just breathing- is this related to the air trapping too?

    1. Hi and thanks for writing. Sorry to hear about your breathing problems.

      Air trapping occurs in asthma and other chronic obstructive lung diseases, and is usually caused my mucus that gets stuck in the smaller airways.These tiny mucus plugs can create a sort of one-way valve, where air can get in OK, but not so easy to get out. Hence the term, “air trapping” .

      Of all the health conditions you mentioned, only asthma and possibly chronic bronchitis, would cause air trapping. The other conditions, such as sleep apnea and re occurring pneumonia, are fairly common comorbidities seen in people with asthma and COPDs.

      Prematurity can definitely cause breathing problems later in the life, though again, air-trapping is only seen in asthma and COPD. Whether being premature increases the risk for the development of asthma, is still a matter of debate.

      Hope this helps a little.

      Steve G

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