What Is Paradoxical Breathing? Everything to Know

Medically Reviewed By Thomas Johnson, PA-C
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Paradoxical breathing is a type of breathing pattern disorder or dysfunctional breathing. It can occur in both adults and children. When a person breathes, their abdomen typically expands to inhale and contracts to exhale. In contrast, paradoxical breathing occurs when the abdomen contracts to inhale and expands to exhale.

Paradoxical breathing is the most severe type of breathing pattern disorder. It can lead to respiratory distress and musculoskeletal imbalances.

This article will discuss the symptoms of paradoxical breathing and how to treat the condition. It will also explain when to contact a doctor, how doctors diagnose paradoxical breathing, and more.

What are the symptoms of paradoxical breathing?

A woman has her hands on her diaphragm.
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Paradoxical breathing can cause insufficient gas exchange, which can lead to distressing respiratory symptoms.

Some common symptoms of paradoxical breathing are:

  • breathlessness
  • trouble sleeping
  • hyperventilation
  • dizziness
  • exhaustion
  • frequent yawning
  • inability to take a deep breath

Seek immediate help if you or someone you are with experiences shortness of breath with a blue tint to the lips or nail beds. This may indicate a respiratory emergency that requires prompt treatment.

Learn more about respiratory symptoms.

What causes paradoxical breathing?

Both physiological and psychological factors can affect breathing. The exact cause of paradoxical breathing is unknown. However, individuals with paradoxical breathing may have neuromuscular patterns associated with dysfunctional breathing.

Postural and structural irregularities could result in dysfunction of the muscles, ligaments, or joints. This can lead to paradoxical breathing.

The diaphragm is a muscle that provides 70–80% of inhalation force. If the diaphragm becomes paralyzed due to phrenic nerve problems, it can result in paradoxical breathing or other breathing pattern disorders.

What are the treatments for paradoxical breathing?

Breathing retraining is the primary intervention for paradoxical breathing. The most common method of breathing retraining is diaphragmatic breathing. Therapists will also address posture through stretching, strengthening, and core stability exercises.

Learn about diaphragmic breathing.

If you have a history of other respiratory problems, such as asthma, your doctor may treat those before treating paradoxical breathing.

When should I see a doctor?

Contact your doctor if you have concerns about paradoxical breathing.

You should seek immediate medical help if you are in respiratory distress. This can include symptoms such as:

  • hyperventilation
  • shortness of breath
  • trouble talking
  • blue tint to the lips or nail beds

How do doctors diagnose paradoxical breathing?

Doctors diagnose paradoxical breathing by performing a physical exam and taking your medical history. Your doctor will listen to your lungs with a stethoscope and observe your chest and abdomen when you breathe.

They may order exercise tests to further assess your lung function. They may also order tests to assess for diaphragm dysfunction. Common tests include chest X-ray and fluoroscopy.

Your doctor will be able to explain the tests in detail and answer any questions you may have.

What are the risk factors for paradoxical breathing?

Some people may be more at risk than others for developing paradoxical breathing. However, not all people with risk factors will go on to develop the condition.

Possible risk factors include:

  • asthma
  • stress or anxiety
  • injury to the chest
  • heart problems
  • paralyzed diaphragm
  • blood clot in the lungs

What are the complications of paradoxical breathing?

Paradoxical breathing can lead to respiratory distress. Signs of respiratory distress include:

  • pale or blue-tinted skin, on people with light skin
  • blue-tinted nail beds
  • increased breathing
  • flared nostrils
  • clammy skin
  • wheezing or grunting sounds when breathing

Learn more warning signs of respiratory distress.

Paradoxical breathing can also lead to musculoskeletal imbalances. This is due to the improper use of the diaphragm and abdominal muscles. When this happens, accessory muscles replace the primary muscles’ function in typical breathing.

Contact your doctor if you have concerns about the complications of paradoxical breathing.


Paradoxical breathing is when the breathing pattern is opposite to the expected. Typically, the abdomen expands during inhalation and contracts during exhalation. In paradoxical breathing, this reverses.

The exact cause of paradoxical breathing is unknown. However, experts believe it is a combination of physiological and psychological factors.

Paradoxical breathing may lead to respiratory distress. Seek immediate medical help if you experience respiratory distress. For recurrent symptoms of paradoxical breathing, contact your doctor for advice.

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Medical Reviewer: Thomas Johnson, PA-C
Last Review Date: 2022 Sep 5
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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