The Breathing Pause

C. Biot’s breathing

Discussion

Camille Biot, a French physician first described Biot's breathing pattern in 1876. While studying the breathing pattern now known as Cheyne-Stokes respiration, Dr. Biot made observations in a 16-year-old child with tuberculous meningitis. He described this breathing pattern as lacking crescendo–decrescendo morphology, instead being completely irregular with varying periods of apnea. The breathing pattern shown in his original tracing demonstrated ataxia of respiration and not regular phasic breathing pattern.

"This irregularity of the respiratory movements is not periodic, sometimes slow, sometimes rapid, sometimes superficial, sometimes deep, but without any constant relation of succession between the two types, with pauses following irregular intervals, preceded and often followed by a sigh more or less prolonged." ²

Biot’s breathing pattern has been described to be associated with lesions of brainstem, namely upper medulla. Brain imaging should thus be considered in the patient’s presenting with Biot’s respiration.

The irregularity is a key differentiation between Biot’s breathing and the other answer choices. In cluster breathing, a series of breaths are separated by regular intervals of pauses, while in Cheyne Stokes breathing, a crescendo-decresendo pattern is seen. Central apnea lacks the pattern of irregularity noted in the patients with Biot’s breathing.

References

1. Powell, R Douglas. Biot on Cheyne Stokes The London Medical Record. 1877 Feb 15; 4:6566.
2. Biot Contribution a l’etude du phenomene respiratoire de CheyneStokes. Lyon Med. 1876;23:517528, 561-567.
3. Fisher CM. The neurological examination of the comatose patient. Acta Neurol Scand. 1969;45(S36):5-56.
4. Wijdicks EF. Biot's breathing. J Neurol Neurosurg Psychiatry. 2007;78(5):512-513.