Dysfunctional breathing: what do we know?

Abstract

Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or “air hunger”, DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.

Quantifiable Breathing Pattern Components Can Predict Asthma Control: an Observational Cross-sectional Study

“…However, most of these have been described subjectively through clinicians' observations or using symptom questionnaires, such as the Nijmegen Questionnaire (NQ) (5). The use of the NQ in this way has been criticised due to its reliance on patients' perceptions, and its subjectivity (6,7). Objective measures of quantifiable breathing pattern components are needed to increase our understanding of the complex relationship between breathing patterns, symptoms and asthma control.…”

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

“…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).…”

Disruption of Pathological Patterns in a Young Population with Dysfunctional Breathing

“…Dysfunctional breathing (DB) is characterized by abnormal breathing patterns that result either from psychogenic causes in the absence of organic disease (primary DB) or from cardiopulmonary or neurological diseases such as asthma and heart failure (secondary DB) [ 1 ]. Frequently, DB is associated with hyperventilation syndrome (HVS) in which the concentration of arterial carbon dioxide (CO 2 ) is excessively lowered beyond normal physiological levels, resulting in a wide range of respiratory, neurological, and psychological problems [ 2 ].…”

“…Breathing retraining (BR), in which patients are encouraged to reduce their respiratory rate and use diaphragmatic breathing, is generally accepted as the primary option for DB treatment [ 1 , 17 ]. BR along with relaxation therapy based on yoga techniques has been reported to be more effective than relaxation therapy alone [ 18 ].…”

“…BR along with relaxation therapy based on yoga techniques has been reported to be more effective than relaxation therapy alone [ 18 ]. However, the best therapeutic strategy for patients with DB, especially for those with primary DB, has not yet been established because DB is a complex condition involving respiratory, biochemical, biomechanical, psychological, and social aspects [ 1 ]. Therefore, there has been high demand for alternative therapies for DB such as acupuncture or herbal treatment, which are safe and cost-effective, raise little risk of dependence, and have a psychosomatic effect.…”