Bradypnea is a pattern of regular but abnormally slow respirations — fewer than 10 breaths per minute. It often precedes apnea or respiratory arrest and requires immediate intervention.

Causes

Neurologic & Metabolic

• Increased intracranial pressure (ICP)

• Neurologic infections, tumors, stroke, or trauma

• Diabetic ketoacidosis (late stage)

• Hepatic failure (end-stage)

• Renal failure (end-stage)

• Respiratory failure

Drug-Induced

• Opioid overdose (most common)

• Sedatives, barbiturates, phenothiazines

• Drug interactions (especially with alcohol)

Assessment

• Vital Signs: Monitor closely

• Neurologic Evaluation:

  • Pupil size and reactivity

  • Level of consciousness (LOC)

  • Motor function

• History: Ask about:

  • Drug use (type, amount, route, time)

  • Chronic illnesses (diabetes, renal/hepatic issues)

  • CNS disease or trauma

• Physical Signs:

  • Needle marks

  • Fruity breath (DKA)

  • Fetor hepaticus

  • Asterixis

  • Uremic frost

  • Cyanosis

Emergency interventions

• Stimulation: Shake and instruct patient to breathe

• Positioning: Lateral or head-up 30° to prevent aspiration

• Airway Management:

  • Prepare for suction, intubation, ventilation

  • Apply apnea monitor and pulse oximeter

• Medication:

  • Administer naloxone IV if opioid overdose is suspected

  • Avoid CNS depressants

  • Oxygen therapy – use cautiously in COPD patients

• Investigations:

  • ABG, electrolytes, drug screen

  • Chest X-ray

  • Possible head CT

Special considerations

Pediatrics

• Definition varies by age – respiratory rates are naturally higher.

Geriatrics

• Higher risk due to polypharmacy and altered drug metabolism.

• Extra caution with CNS depressants.

Patient Counseling

• Educate about:

  • Risks of opioid therapy and overdose

  • Early signs of bradypnea and when to seek help

  • The treatment plan and importance of follow-up

Classic Sign of Increased ICP

• Cushing’s Triad:

  • Bradypnea

  • Bradycardia

  • Hypertension

References

1. Chung, F., Abrishami, A., & Khajehdehi, A. (2010). A systematic review of screening questionnaires for obstructive sleep apnea. Canadian Journal of Anaesthesia, 57(5), 423–438.

2. Dahan, A., Aarts, L., & Smith, T. W. (2010). Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology, 112(1), 226–238.