Dysfunctional breathing and reaching one’s physiological limit as causes of exercise-induced dyspnoea

Abstract

Key pointsExcessive exercise-induced shortness of breath is a common complaint. For some, exercise-induced bronchoconstriction is the primary cause and for a small minority there may be an alternative organic pathology. However for many, the cause will be simply reaching their physiological limit or be due to a functional form of dysfunctional breathing, neither of which require drug therapy.The physiological limit category includes deconditioned individuals, such as those who have been through intensive care and require rehabilitation, as well as the unfit and the fit competitive athlete who has reached their limit with both of these latter groups requiring explanation and advice.Dysfunctional breathing is an umbrella term for an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms, which may be respiratory and/or nonrespiratory. This alteration may be due to structural causes or, much more commonly, be functional as exemplified by thoracic pattern disordered breathing (PDB) and extrathoracic paradoxical vocal fold motion disorder (pVFMD).Careful history and examination together with spirometry may identify those likely to have PDB and/or pVFMD. Where there is doubt about aetiology, cardiopulmonary exercise testing may be required to identify the deconditioned, unfit or fit individual reaching their physiological limit and PDB, while continuous laryngoscopy during exercise is increasingly becoming the benchmark for assessing extrathoracic causes.Accurate assessment and diagnosis can prevent excessive use of drug therapy and result in effective management of the cause of the individual’s complaint through cost-effective approaches such as reassurance, advice, breathing retraining and vocal exercises.This review provides an overview of the spectrum of conditions that can present as exercise-­induced breathlessness experienced by young subjects participating in sport and aims to promote understanding of the need for accurate assessment of an individual’s symptoms. We will highlight the high incidence of nonasthmatic causes, which simply require reassurance or simple interventions from respiratory physiotherapists or speech pathologists.

Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention

“…DB/HVS may coexists alongside chronic respiratory diseases such as asthma (Thomas et al, 2005; Todd et al, 2018) and chronic obstructive pulmonary disease (Law et al, 2018) although whether the relationship is causal or coincidental remains unclear. More frequently DB/HVS occurs in the absence of respiratory disease (Depiazzi and Everard, 2016), in keeping with our data. Although the changes in the Nijmegen score, respiratory rate and breath hold time outcomes for the patient cohort as a whole were all statistically significant post intervention, it is clear from the range of values observed for each outcome measure that not all patients had complete resolution of their DB/HVS following treatment.…”

“…5) Thoraco-abdominal asynchrony: a respiratory pattern in which there is delay between rib cage and abdominal contraction resulting in ineffective breathing movements. DB is not a continuously symptomatic state but a syndrome of episodic symptoms that occur with or without recognisable provocation (Boulding et al, 2016;Depiazzi and Everard, 2016;Vidotto et al, 2019).…”

The impact of a dedicated physiotherapist clinic for children with dysfunctional breathing

“…These subjects are not routinely referred to a psychologist as, in our experience, the vast majority of subjects with thoracic or extrathoracic dysfunctional breathing do not have significant psychological issues. Early reports in the literature did suggest that significant psychological distress was frequently associated with pronounced symptoms of dysfunctional breathing, but subsequent experience suggests that psychological intervention is required in only a minority of subjects [24]. In future studies of the condition, it would be interesting to explore whether a psychotherapeutic intervention would augment the outcomes of treatment or provide an alternative for subgroups of patients.…”

Therapeutic options for dysfunctional breathing in children and adolescents

“…Very little is known about therapeutic options, despite intensive efforts to describe single items, standardise nomenclature, distinguish them from psychosomatic or even psychiatric diseases and agree on diagnostic procedures . This report summarises our personal experiences of therapeutic prospects.…”