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Cited by 48Cardiovascular Syncope and Autonomic DisordersPsychosomatic Disorders and Their TreatmentsHeart Rate Variability and Autonomic Control

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

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Reilly, Charles C., Floyd, Sarah V., Lee, Kai, Warwick, Geoffrey, James, Stephen, Gall, Nicholas, Rafferty, Gerrard F.·2020·Autonomic Neuroscience
DOI 10.1016/j.autneu.2019.102601
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Abstract

Postural orthostatic tachycardia syndrome (POTS) is a chronic, multifactorial syndrome with complex symptoms of orthostatic intolerance. Breathlessness is a prevalent symptom, however little is known about the aetiology. Anecdotal evidence suggests that breathless POTS patients commonly demonstrate dysfunctional breathing/hyperventilation syndrome (DB/HVS). There are, however, no published data regarding DB/HVS in POTS, and whether physiotherapy/breathing retraining may improve patients' breathing pattern and symptoms. The aim of this study was to explore the potential impact of a physiotherapy intervention involving education and breathing control on DB/HVS in POTS. A retrospective observational cohort study of all patients with POTS referred to respiratory physiotherapy for treatment of DB/HVS over a 20-month period was undertaken. 100 patients (99 female, mean (standard deviation) age 31 (12) years) with a clinical diagnosis of DB/HV were referred, of which data was available for 66 patients pre - post intervention. Significant improvements in Nijmegen score, respiratory rate and breath hold time (seconds) were observed following treatment. These data provide a testable hypothesis that breathing retraining may provide breathless POTS patients with some symptomatic relief, thus improving their health-related quality of life. The intervention can be easily protocolised to ensure treatment fidelity. Our preliminary findings provide a platform for a subsequent randomised controlled trial of breathing retraining in POTS.

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  • DB is commonly observed in patients with anxiety; the presence of symptoms may exacerbate anxiety and, in turn, provoke further breathing irregularities, creating a self-perpetuating vicious cycle.

    “DB is also commonly observed in patients with anxiety; the presence of the aforementioned symptoms may exacerbate anxiety and, in turn, provoke further breathing irregularities, creating a self-J o u r n a l P r e -p r o o f perpetuating vicious cycle (6,15).”

    From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [15]

    The Significance of the findings (p. 15) says DB/HVS symptoms can cause anxiety or panic, which can provoke further breathing irregularity, supporting the proposed cycle. It also says anxiety predisposes patients to DB/HVS and that approximately 50% of this POTS cohort had anxiety, but it does not establish how commonly DB occurs among patients with anxiety generally. (LLM, conf=0.83)

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  • Contemporary perspectives acknowledge DB as a multidimensional clinical phenomenon.

    “This is despite contemporary perspectives acknowledging DB as a multidimensional clinical phenomenon (15).”

    From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [15]

  • Contemporary perspectives recognize HVS as a subtype of DB.

    “While contemporary perspectives recognize HVS as a subtype of DB (15), the findings of this study indicate that HVS, along with several other terms, is still used interchangeably to describe what seems to be the J o u r n a l P r e -p r o o f same condition, albeit with a different and incomplete definitional approach.”

    From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [15]

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Authors
Reilly, C. C., Floyd, S. V., Lee, K., Warwick, G., James, S., Gall, N., & Rafferty, G. F.
Affiliations
  • King's College Hospital NHS Foundation Trust (GB)
  • King's College London (GB)
Corresponding author
Reilly, Charles C.
ORCID
Venue
Autonomic Neuroscience
Publisher
Elsevier BV
Published
2020-01
Volume
223
Pages
102601
ISSN
1566-0702 (ISSN-L)
DOI
10.1016/j.autneu.2019.102601
OpenAlex
W2983393868
Cited by
48
References
39
Citations by year
2026: 9 · 2025: 8 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 6 · 2020: 4
FWCI
4.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Autonomic Neuroscience (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
postural orthostatic tachycardia syndrome, dyspnea, dysfunctional breathing, hyperventilation syndrome, breathing retraining, respiratory physiotherapy, orthostatic intolerance, breath-hold time, respiratory rate, health-related quality of life
MeSH terms
Adult, Breathing Exercises, Dyspnea, Female, Humans, Hyperventilation, Male, Respiration Disorders, Retrospective Studies, Outcome Assessment, Health Care, Postural Orthostatic Tachycardia Syndrome, Young Adult

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