Published in Science Advances, study identifies a brain circuit that determines whether dangerous breathing changes are consciously detected or go unnoticed

Beyond automatic breathing reflexes, new research out of Northwell Health’s Feinstein Institutes for Medical Research discovered a brain circuit that keeps track of every inhale and exhale, explaining critical differences in how we perceive, or miss, breathing distress.

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Research done in the labs at the Feinstein Institutes for Medical Research identified a brain circuit that acts like an internal alarm system for breathing. (Credit: Feinstein Institutes for Medical Research)

Published in Science Advances, the study shows that a region deep in the brain called the anterior insular cortex (AIC) rapidly detects mismatches between expected and actual breathing sensations, for example, when inhaling suddenly feels harder than anticipated. The AIC then relays this information to other brain regions, including the orbitofrontal cortex, which helps us determine whether the change is important enough to trigger action. Stronger communication within this circuit was linked to better detection of breathing disturbances and faster compensatory responses.

“Breathing is fundamental to life, and how the brain consciously monitors breathing has remained largely unknown,” said José L. Herrero, PhD, assistant professor in the Institute of Bioelectronic Medicine at the Feinstein Institutes and senior author of the study. “We identified a dynamic brain circuit that acts like an internal alarm system for breathing. Understanding how this system works may help explain why some patients fail to recognize dangerous breathing problems, while others experience persistent breathlessness without major lung abnormalities.”

The research team recorded intracranial brain activity (iEEG) from neurosurgical patients already undergoing monitoring for epilepsy treatment. During the experiment, participants breathed through a mouthpiece while mild, unexpected flow-resistive loads were occasionally added to individual breaths. Patients reported whether they detected the resistance and how intense it felt, allowing researchers to directly link brain activity to conscious breathing perception. The study found that the AIC generated fast, short-lived responses that signaled breathing mismatch (‘I feel something’), while frontal and motor brain regions showed more sustained activity linked to evaluation (‘my breathing is compromised’) and compensation (‘I need to breathe harder’).

Although the brainstem continuously generates and regulates breathing without conscious effort, forebrain circuits determine when breathing changes become consciously perceived and behaviorally relevant. Our findings directly address this, providing a new framework for understanding why some individuals fail to perceive life-threatening respiratory disturbances, while others experience disabling breathlessness despite relatively preserved lung function.

“The ability to observe these complex processes in the human brain is a rare and powerful tool,” said Kevin J. Tracey, MD, president and CEO of Feinstein Institutes and Karches Family Distinguished Chair in Medical Research. “These findings provide a roadmap for future research, including developing personalized neuro-interventions to restore breathing control in a variety of neurological and respiratory diseases.”

About the Feinstein Institutes
The Feinstein Institutes for Medical Research is the home of the research institutes of Northwell Health, the largest health care provider and private employer in New York State. Encompassing 50+ research labs, 3,000 clinical research studies and 5,000 researchers and staff, the Feinstein Institutes raises the standard of medical innovation through its six institutes of behavioral science, bioelectronic medicine, cancer, health system science, molecular medicine, and translational research. We are the global scientific leader in bioelectronic medicine – an innovative field of science that has the potential to revolutionize medicine. The Feinstein Institutes publishes two open-access, international peer-reviewed journals Molecular Medicine and Bioelectronic Medicine. Through the Elmezzi Graduate School of Molecular Medicine, we offer an accelerated PhD program. For more information about how we produce knowledge to cure disease, visit http://feinstein.northwell.edu and follow us on LinkedIn.

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