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Cited by 1Respiratory and Cough-Related ResearchPsychosomatic Disorders and Their TreatmentsAsthma and respiratory diseases

How is dysfunctional breathing characterised in the clinical literature? A scoping review

Open access
Sanchez-Bracero, Dario, Baker, Kate, Archer, Thomas, Shaw, Thomas, Palmer, Joe·2026·Respiratory Medicine
DOI 10.1016/j.rmed.2025.108546
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Abstract

INTRODUCTION: Dysfunctional breathing (DB) is a complex condition that affects health and quality of life. It can occur alone or with other conditions and presents with various symptoms. Despite its prevalence, there is no consensus among healthcare professionals on its definition, diagnosis, or classification. AIMS & METHODS: This scoping review aimed to explore how dysfunctional breathing is characterised across the literature. To achieve this, a comprehensive search strategy was employed, covering both peer-reviewed and grey literature from relevant academic databases and websites. RESULTS: Seventy one relevant sources published between 2001 and 2024 were identified resulting in 6 key themes. These consisted of 'Defining DB' (69 % of studies), 'Diagnosing and Assessing DB' (86 %), 'Symptoms and Dimensions' (87 %), 'Comorbidities' (64 %),' Psychophysiological Links' (43 %), and 'Classification' (50 %). CONCLUSION: There are inconsistencies in the terminology, assessment methods, and classification systems used to describe (DB). This highlights a lack of standardisation across the literature. The use of multiple, and at times overlapping definitions for the same condition poses a significant challenge for clinical decision-making and treatment planning. To address these issues, future research should prioritise achieving consensus across these domains acknowledging the multidimensional nature of the condition.

AI snapshot

Written from the paper’s full text.

TL;DR

This scoping review of 71 sources found that dysfunctional breathing (DB) is inconsistently defined, assessed, and classified across the clinical literature, with no consensus definition or gold-standard diagnostic method. It identifies six themes and calls for consensus on terminology, multidimensional assessment, and classification.

Key findings

  • No consensus definition: 49 publications (69%) discussed defining DB, and all stated there is no consensus; 16 (23%) defined DB or cited another definition, with Barker and Everard’s definition most cited (25%).
  • Assessment and diagnosis: 61 publications (86%) discussed diagnosis/assessment, commonly reporting no gold-standard method; the Nijmegen questionnaire was the most frequently reported tool (n=50), despite not being designed for DB; 12 articles (16%) called for a multidimensional approach.
  • Symptoms and comorbidities: 62 publications (87%) discussed symptoms/phenotypes; dyspnoea was most commonly reported (n=32), followed by chest tightness/pain (n=30) and deep sighing (n=30); asthma was the most commonly reported comorbidity (n=25).
  • Classification and terminology: 36 publications (50%) discussed classification and/or overlapping terms; four classification systems were proposed, and hyperventilation syndrome was classified as a DB subtype in 19 studies, used synonymously in 10, and identified as outdated in 9.

Methods

  • Scoping review using the Joanna Briggs Institute framework and PRISMA-ScR checklist; searched CINAHL, MEDLINE, Scopus, Science Direct, Web of Science, PubMed, Google Scholar, nursing databases, and grey literature from inception to September 2024.
  • Inclusion criteria covered human, paediatric and adult populations, any healthcare setting or country, English-language literature characterising DB; screening used Covidence with two reviewers and a third for conflicts.
  • Data were charted and synthesised narratively; 6,026 records were identified, 1,803 duplicates removed, 4,223 unique records screened, 166 full texts assessed, and 71 studies included (36 quantitative, 28 qualitative, 7 mixed-methods; 23 study designs).

Limitations

  • The paper states that marked heterogeneity in terminology, definitions, and conceptual frameworks limited cohesive synthesis and generalisable conclusions.
  • The paper states that critical appraisal was not performed, as is typical in scoping reviews, so quality of included studies was not formally assessed.
  • The paper states that restriction to English-language literature may introduce language bias, and frequent comorbidities in study populations introduced confounding that complicated characterising DB as an independent entity.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.rmed.2025.108546

Cites

75 of 75 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

40 of 63 cited sources checked · 15 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Due to a lack of a diagnostic criterion, prevalence data for DB could be over or underestimated.

    “However, it has been highlighted that due to a lack of a diagnostic criterion, prevalence data for the condition could be over or underestimated (8).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Vidotto, 2019, Dysfunctional breathing: what do we know?, J. Bras. Pneumol. source
  • Premisecitation

    The predominant symptom associated with DB is dyspnoea, either at rest or during exercise.

    “The predominant symptom associated with DB is dyspnoea, either at rest or during exercise (12) which may occur with or without other commonly reported respiratory symptoms such as breath-holding, air hunger, and rapid mouth breathing (4,13).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Crawford, 2022, Paroxysmal dyspnoea in asthma: wheeze, ILO or dysfunctional breathing?, Front Allergy source

      The Dysfunctional breathing section identifies dyspnoea as the predominant symptom, and The history describes breathlessness associated with exertion. The paper does not clearly state that dyspnoea from dysfunctional breathing also occurs at rest. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    DB is described in the literature as a multi-dimensional construct consisting of at least 3 dimensions: biomechanical, psychophysiological and biochemical.

    “Multiple factors are reported to contribute to DB, with it being described in the literature as a multi-dimensional construct consisting of at least 3 dimensions; biomechanical, psychophysiological and biochemical (3,9).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [3] Courtney, 2011, Medically unexplained dyspnea: partly moderated by dysfunctional (thoracic dominant) breathing pattern, J. Asthma source
    • cites [9] Courtney, 2017, Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach, ERJ Open Res. source
  • Premisecitation

    Nonrespiratory symptoms often considered related with DB include palpitations, dizziness, paresthesia and chest tightness.

    “Nonrespiratory symptoms often considered to be related with DB include palpitations, dizziness, paresthesia and chest tightness (8,14).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [8] Vidotto, 2019, Dysfunctional breathing: what do we know?, J. Bras. Pneumol. source

      The Abstract identifies dizziness and palpitations as nonrespiratory symptoms of dysfunctional breathing, and the Introduction lists paresthesia among its symptoms. The passages do not identify chest tightness as a symptom; the Respiratory muscle function section mentions upper-chest tenderness, which is not the same claim. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [14] De Groot, 2013, Dysfunctional breathing in children with asthma: a rare but relevant comorbidity, Eur. Respir. J. source
  • Premisecitation

    DB is often ill-defined, with considerable ambiguity surrounding its definition, diagnosis and optimal management.

    “This has also led to DB being often ill-defined, with considerable ambiguity surrounding its definition, diagnosis and optimal management (9,10).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [9] Courtney, 2017, Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach, ERJ Open Res. source
    • cites [10] Boulding, 2016, Dysfunctional breathing: a review of the literature and proposal for classification, Eur. Respir. Rev. source
  • Classified as probably not a substantial claim. 31
  • May combine two claims. 29
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    DB is associated with a high symptom burden, high healthcare-related costs and a negative impact on health-related quality of life.

    “It is associated with a high symptom burden, high healthcare-related costs and has a negative impact on health-related quality of life (HR-QoL) (4,5).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [4] Depiazzi, 2016, Dysfunctional breathing and reaching one's physiological limit as causes of exercise-induced dyspnoea, Breathe (Sheff) source
    • cites [5] Genecand, 2023, Dysfunctional breathing symptoms, functional impact and quality of life in patients with long COVID-19: a prospective case series, BMJ Open Respir Res. source

      The Discussion and Conclusion report a high symptom burden and low quality of life among patients with long COVID-associated dysfunctional breathing. The paper does not report healthcare-related costs, and its findings concern this long COVID population rather than dysfunctional breathing generally (searched: costs, healthcare-related costs, economic burden). (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    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).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [6] Kopitović, 2023, Dysfunctional breathing – view of pulmonologist

      Not checked in the free run.

    • cites [15] Reilly, 2020, Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): the impact of a physiotherapy intervention, Auton. Neurosci. source

      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)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Data extraction was performed using a data charting table based on JBI's standardized extraction form for scoping reviews.

    “Data extraction was performed using a data charting table which included study characteristics such as title, author, year of publication, study design, key findings and overall themes, the table was created with collaboration of all researchers and based on JBIs standardized extraction form for scoping reviews (24).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Tricco, 2018, PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation, Ann. Intern. Med. source

      The Mini-glossary defines data charting as data extraction in a scoping review and links that terminology to JBI guidance. The Introduction also notes that JBI published guidance for conducting scoping reviews. Neither passage identifies a standardized JBI extraction form or supports the citing authors’ statement that their table was based on one. (LLM, conf=0.80)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Inclusion and exclusion criteria were defined using the population, concept, context (PCC) framework.

    “Inclusion and exclusion criteria (Table 1) were defined using the population, concept, context (PCC) framework, as recommended for scoping reviews (24).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Tricco, 2018, PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation, Ann. Intern. Med. source

      Table 1 (PRISMA-ScR Checklist, items 4 and 6) recommends describing review questions using elements such as population, concepts, and context, and separately recommends specifying eligibility criteria. It does not recommend using the PCC framework specifically to define inclusion and exclusion criteria, nor can it establish how the citing authors defined their own criteria. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The results were synthesised using a narrative approach aligned with the JBI framework recommendations for scoping reviews.

    “The results were synthesised using a narrative approach aligned with the JBI framework recommendations for scoping reviews (29).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [29] Hagman, 2011, Breathing retraining - a five-year follow-up of patients with dysfunctional breathing, Respir. Med. source

      The Measurements and Discussion sections describe questionnaires and outcomes in a five-year follow-up of patients with dysfunctional breathing. Our copy does not address narrative synthesis or JBI recommendations for scoping reviews (searched: JBI framework, narrative synthesis, Joanna Briggs Institute). No page numbers are available in the indexed passages. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The scoping review was conducted using the Joanna Briggs Institute (JBI) framework.

    “This scoping review was conducted using the Joanna Briggs Institute (JBI) framework (24) following advancement and refinement of the original framework for developing scoping reviews (25).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Tricco, 2018, PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation, Ann. Intern. Med. source

      The Introduction states that JBI published guidance for conducting scoping reviews, supporting the reference to a JBI approach. But this paper presents the PRISMA-ScR reporting guideline; it does not establish that the citing authors conducted their review using the JBI framework. No page number is available in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some authors argue that DB should be viewed as a multifactorial phenomenon, involving biomechanical, psychophysiological, and biochemical domains, which can independently or collectively contribute to its manifestation.

    “Some authors argue that the condition should be viewed as a multifactorial phenomenon, involving biomechanical, J o u r n a l P r e -p r o o f psychophysiological, and biochemical domains, which can independently or collectively contribute to its manifestation (20,21).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [20] Ruane, 2024, Dysfunctional breathing or breathing pattern disorder: new perspectives on a common but clandestine cause of breathlessness, Respirology source

      The main text (page unavailable) describes several types of dysfunctional breathing that can coexist and reports associations with anxiety and depression. It does not set out the claimed biomechanical, psychophysiological, and biochemical domains or say that those domains contribute independently or collectively. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [21] Mohan, 2024, Validity and reliability of outcome measures to assess dysfunctional breathing: a systematic review, BMJ Open Resp. Res. source

      The Introduction describes dysfunctional breathing as a deviation from normal biomechanical breathing and says a comprehensive evaluation should consider bodily biochemistry and psychological functioning. It does not say that these domains independently or collectively contribute to the condition’s manifestation; its statement about potential impacts runs in the other direction. (LLM, conf=0.79)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Grey literature was searched.

    “Grey literature was also searched as it has been found to be increasingly recognised as valuable sources of literature when conducting scoping reviews in recent years (27).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [27] Khalil, 2024, Automation tools to support undertaking scoping reviews, Res. Synth. Methods source

      Section 4.3 (Step 3: Searching; page unavailable) recommends searching grey literature sources when conducting scoping reviews, supporting the citing sentence’s rationale for including them. It does not say that grey literature has become increasingly recognised as valuable in recent years. The statement that grey literature was searched describes the citing authors’ own method, not a finding attributed to this source. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The prevalence of misdiagnosis in cases of DB indicates a limited understanding of the condition among healthcare professionals, which may hinder the delivery of appropriate treatment to affected patients.

    “The prevalence of misdiagnosis in cases of DB indicates a limited understanding of the condition among healthcare professionals, which may hinder the delivery of appropriate treatment to affected patients (8).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Vidotto, 2019, Dysfunctional breathing: what do we know?, J. Bras. Pneumol. source

  • May combine two claims.

    Premisecitation

    Some authors have confirmed that the NQ was validated against the hyperventilation provocation test, however it may lack sensitivity to detect non-hyperventilation DB patterns and lacks rigorous validation in these contexts.

    “Some authors have confirmed that the NQ was validated against the hyperventilation provocation test, however it may lack sensitivity to detect non-hyperventilation DB patterns and lacks rigorous validation in these contexts (5,84).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [5] Genecand, 2023, Dysfunctional breathing symptoms, functional impact and quality of life in patients with long COVID-19: a prospective case series, BMJ Open Respir Res. source

      The Introduction (page not provided) says the Nijmegen Questionnaire was validated for symptoms associated with hyperventilation syndrome, acknowledges limited diagnostic accuracy, and says its use for other dysfunctional-breathing types lacks rigorous validation. It does not specify validation against the hyperventilation provocation test or establish reduced sensitivity for non-hyperventilation patterns. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [84]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Courtney previously discussed this issue, suggesting that it may contribute to the ongoing conceptual confusion surrounding the condition.

    “Courtney (82) previously discussed this issue, suggesting that it may contribute to the ongoing conceptual confusion surrounding the condition.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [82] Vlemincx, 2023, Dysfunctional breathing: a dimensional, transdiagnostic perspective, Eur. Respir. J. source

      The Abstract (page unavailable) describes differing definitions of dysfunctional breathing, and the References list Courtney’s work on a multidimensional model. Neither passage, nor the additional passages searched for Courtney and conceptual confusion, says that Courtney suggested the issue contributes to ongoing conceptual confusion. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Contemporary perspectives acknowledge DB as a multidimensional clinical phenomenon.

    “This is despite contemporary perspectives acknowledging DB as a multidimensional clinical phenomenon (15).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Reilly, 2020, Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): the impact of a physiotherapy intervention, Auton. Neurosci. source

  • May combine two claims.

    Premisecitation

    Hancox et al. reported wheeze as a cardinal feature of asthma which is not regarded as a DB symptom.

    “Hancox et al. reported wheeze as a cardinal feature of asthma which is not regarded as a DB symptom (42).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [42] Frésard, 2022, Dysfunctional breathing diagnosed by cardiopulmonary exercise testing in 'long COVID' patients with persistent dyspnoea, BMJ Open Respir Res. source

      The Discussion describes dysfunctional breathing in these long-COVID patients as erratic breathing with deep sighs, but does not address whether wheeze is an asthma feature or a dysfunctional-breathing symptom. Searches for “Hancox” and “wheeze” found no passage supporting the attributed statement; the copy does not establish what Hancox et al. reported. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    A recent literature review highlighted the multidimensional nature of DB renders the use of a single assessment criterion as inadequate.

    “A notion supported in a recent literature review highlighted the multidimensional nature of DB renders the use of a single assessment criterion as inadequate (43).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [43] Hancox, 2020, Rape, asthma and dysfunctional breathing, Eur. Respir. J. source

      The discussion (@ERSpublications; page unavailable) says the Nijmegen questionnaire was developed as a screening rather than a diagnostic tool and that there are no objective criteria for diagnosing dysfunctional breathing. That supports caution about relying on one measure for diagnosis, but this paper is a cohort study, not a literature review, and it does not attribute that limitation to the multidimensional nature of dysfunctional breathing. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    This lack of clarity has the potential to negatively influence the patient experience, with DB patients expressing frustration with a lack of recognition and delays in diagnosis.

    “This lack of clarity also has the potential to negatively influence the patient experience, with DB patients expressing frustration with a lack of recognition and delays in diagnosis (19,43).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [19] Courtney, 2022, Dysfunctional breathing, J. Aust. Tradit. Med. Soc.

      Not checked in the free run.

    • cites [43] Hancox, 2020, Rape, asthma and dysfunctional breathing, Eur. Respir. J. source

      The discussion (@ERSpublications; page unavailable) says there are no objective criteria for diagnosing dysfunctional breathing and describes difficulty distinguishing it from asthma. It does not report patients expressing frustration, feeling unrecognised, or experiencing diagnostic delays, so the patient-experience claim is unsupported by this paper. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    The absence of a consensus definition in DB potentially limits its identification in clinical practice.

    “It has also been noted by Karkouli et al how the absence of a consensus definition in DB potentially limits its identification in clinical practice (43).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [43] Hancox, 2020, Rape, asthma and dysfunctional breathing, Eur. Respir. J. source

      In the discussion (@ERSpublications; page unavailable), the paper says there are no objective criteria for diagnosing dysfunctional breathing and that the Nijmegen questionnaire is a screening rather than a diagnostic tool. This supports concern about identifying the condition, but the paper does not specifically say that an absence of a consensus definition limits identification in clinical practice; its discussion of identification concerns epidemiological research. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 6026 records were identified through the database search published between 2001 and 2024.

    “A total of 6026 records were identified through the database search published between 2001 and 2024.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Other symptoms variably reported to be associated with DB include chest tightness/pain (n=30), thoracic/upper chest/apical dominant breathing (n=25), (deep) sighing (n=30), frequent yawning (n=14), fatigue (n=4), anxiety (n=11), dizziness (n=13), hyperventilation (n=17) and paraesthesia (n=3).

    “Other symptoms were variably reported to be associated with DB including: chest tightness/pain (n =30), thoracic/upper chest/apical dominant breathing (n = 25), (deep) sighing (n= 30), frequent yawning (n=14), fatigue (n = 4), anxiety (n= 11), dizziness (n= 13), hyperventilation (n = 17) and paraesthesia (n = 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Twelve articles (16%) commented on the need for a multidimensional approach to assessment and diagnosis, and highlighted how combinations of tools are required for a comprehensive assessment of DB.

    “Twelve articles (16%) commented on the need for a multidimensional approach to assessment and diagnosis, and highlighted how combinations of tools are required for a comprehensive assessment of DB.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Other tools reported for DB assessment included spirometry (n=5), breathing pattern analysis (n=2), respiratory inductance plethysmography (n=2), cardiopulmonary exercise testing (CPET) (n=8), Hi-Lo breathing assessment (n=4), manual assessment of respiratory motion (MARM) (n=9), Self-Evaluation of Breathing Questionnaire (SEBQ) (n=14), breathing pattern assessment tool (BPAT) (n=5), capnography (

    “Other tools reported for DB assessment included: spirometry (n= 5), breathing pattern analysis (n= 2), respiratory inductance plethysmography (n= 2), cardiopulmonary exercise testing (CPET) (n= 8), Hi-Lo breathing assessment (n= 4), manual assessment of respiratory motion (MARM) (n =9), Self-Evaluation of Breathing Questionnaire (SEBQ) (n= 14), breathing pattern assessment tool (BPAT) (n= 5), J o”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingcitation

    The most cited definition of DB was that proposed by Barker and Everard (25%).

    “The definition proposed by Barker and Everard was the most cited in the literature (16).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Barker, 2015, Getting to grips with ‘dysfunctional breathing’, Paediatr. Respir. Rev. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Out of 166 full text articles, 95 were excluded as a result of not meeting the eligibility criteria.

    “Out of these 166, 95 were excluded as a result of not meeting the eligibility criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After removing 1803 duplicates, 4223 unique records remained.

    “After removing 1803 duplicates, 4223 unique records remained.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Title and abstract screening excluded 4057 articles, leaving 166 full text articles to be assessed for eligibility.

    “These records underwent title and abstract screening, from which 4057 articles were excluded, leaving 166 full text articles to be assessed for eligibility.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Forty nine publications (69%) discussed the concept of defining DB, all of which state that there is no consensus.

    “Forty nine publications (69%) discussed the concept of defining DB, all of which state that there is no consensus.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both respiratory and non-respiratory symptoms were commonly reported to be associated with DB, and these symptoms can be linked to different phenotypes (biomechanical, psychophysiological, biochemical) of DB.

    “Both respiratory and non-respiratory symptoms were commonly reported to be associated with DB, and these symptoms can be linked to different phenotypes (biomechanical, psychophysiological, biochemical) of DB.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Sixty one publications (86%) discussed diagnosis and assessment of DB, commonly reporting the lack of gold-standard diagnostic method or criteria.

    “Sixty one publications (86%) discussed diagnosis and assessment of DB, commonly reporting the lack of gold-standard diagnostic method or criteria.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Stress (n=11), anxiety (n=20), PTSD (n=2) and panic disorder (n=4) were reported to be linked to DB.

    “Stress (n = 11), anxiety (n= 20), PTSD (n = 2) and panic disorder (n =4) were reported to be linked to DB.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Other comorbidities associated with DB included COPD (n=4), long COVID (n=2), musculoskeletal (MSK) complaints (n=3), postural orthostatic tachycardia syndrome (POTS) (n=2) and bronchiectasis (n=1).

    “Other comorbidities associated with DB included: chronic obstructive pulmonary disorder (COPD) (n= 4), long COVID (n= 2), musculoskeletal (MSK) complaints (n= 3), postural orthostatic tachycardia syndrome (POTS) (n=2) and bronchiectasis (n=1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The findings of this study indicate that HVS, along with several other terms, is still used interchangeably to describe what seems to be the same condition, albeit with a different and incomplete definitional approach.

    “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.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The review identified 36 quantitative, 28 qualitative, and 7 mixed-methods sources, collectively encompassing 23 different study designs.

    “review identified a diverse range of sources consisting of 36 quantitative, 28 qualitative, and 7 mixed-methods approaches, collectively encompassing 23 different study designs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    These efforts have predominantly focused solely on biological and structural factors, overlooking the broader multidimensional nature of DB.

    “However, these efforts have predominantly focused solely on biological and structural factors, overlooking the broader multidimensional nature of DB.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Several authors have attempted to classify DB based on phenotypes and symptoms with no single system gaining widespread acceptance.

    “Several authors have attempted to classify DB based on phenotypes and symptoms with no single system gaining widespread acceptance (see supplementary materials 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Our findings showed frequent associations of DB with conditions such as asthma, long COVID, neck pain, musculoskeletal (MSK) complaints, chronic obstructive pulmonary disease (COPD), postural orthostatic tachycardia syndrome (POTS), bronchiectasis, and vocal cord dysfunction.

    “Our findings showed frequent associations of DB with conditions such as asthma, long COVID, neck pain, musculoskeletal (MSK) complaints, chronic obstructive pulmonary disease (COPD), postural orthostatic tachycardia syndrome (POTS), bronchiectasis, and vocal cord dysfunction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The review systematically synthesised evidence from 71 studies, selected from over 6,000 screened records.

    “the review systematically synthesised evidence from 71 studies, selected from over 6,000 screened records.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Various studies report DB prevalence in the general population ranging from 6-10% but with some estimates reaching up to 60-80%, particularly in patients with asthma.

    “Various studies report its prevalence in the general population ranging from 6-10% but with some estimates reaching up to 60-80%, particularly in patients with asthma (6,7).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Kopitović, 2023, Dysfunctional breathing – view of pulmonologist

      Not checked in the free run.

    • cites [7] Kiesel, 2020, Exercise intervention for individuals with dysfunctional breathing: a matched controlled trial, Int. J. Sports Phys. Ther. source

  • May combine two claims.

    Premisecitation

    This variability in terminology has compounded confusion among healthcare professionals (HCPs) and contributed to the inconsistent assessment and management of DB.

    “This variability in terminology has compounded confusion among healthcare professionals (HCPs) and contributed to the inconsistent assessment and management of DB (19).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Courtney, 2022, Dysfunctional breathing, J. Aust. Tradit. Med. Soc.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Screening required consensus from two members of the research team.

    “Screening involved a three stage process using Covidence TM software and required consensus from two members of the research team (28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Gassner, 2021

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    This lack of clarity may lead to inappropriate management and reduced quality of care, including the overprescription of corticosteroids when symptoms experienced during DB exacerbations are misattributed to an underlying organic respiratory condition.

    “It has been suggested that this may lead to inappropriate management and reduced quality of care, including the overprescription of corticosteroids when symptoms experienced during DB exacerbations are misattributed to an underlying organic respiratory condition (16).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Barker, 2015, Getting to grips with ‘dysfunctional breathing’, Paediatr. Respir. Rev. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The PRISMA-ScR checklist was used to structure and ensure quality of the review.

    “The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used to structure and ensure quality of the review (26).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Veritas Health Innovation. Covidence systematic review software [software]. Melbourne: Veritas Health Innovation; accessed 22 May 2025. Available from: https://www.covidence.org.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Key themes and gaps within literature were identified and agreed upon within the research team.

    “Key Themes and gaps within literature were identified and agreed upon within the research team.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Agreement among the research team is sufficient to identify valid key themes and gaps.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Conflicts encountered at all stages of the screening process required a third independent researcher for consensus decision.

    “Conflicts encountered at all stages of the screening process required a third independent researcher for consensus decision.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The absence of critical appraisal means the quality of included studies was not formally assessed, necessitating cautious interpretation of reported findings, especially concerning diagnostic tools and classification systems.

    “The absence of critical appraisal-typical in scoping review methodology-means the quality of included studies was not formally assessed, necessitating cautious interpretation of reported findings, especially concerning diagnostic tools and classification systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    This creates challenges for researchers in comparing and validating findings, and for professionals in providing accurate diagnoses and effective treatments, ultimately impacting patient care.

    “This creates challenges for researchers in comparing and validating findings, and for professionals in providing accurate diagnoses and effective treatments, ultimately impacting patient care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Comorbid anxiety has been described as both a cause and consequence of DB.

    “This has also been considered in regards to comorbid anxiety, it being described as both a cause and consequence of DB (83).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Grammatopoulou, 2014, Hyperventilation in asthma: a validation study of the Nijmegen Questionnaire--NQ, J. Asthma source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Kopitović and Mirić suggest that combining different assessment tools could enhance diagnostic accuracy.

    “Kopitović and Mirić suggest that combining different assessment tools could enhance diagnostic accuracy (6).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Kopitović, 2023, Dysfunctional breathing – view of pulmonologist

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The high prevalence of DB among individuals with asthma underscores a significant diagnostic challenge.

    “Of these, asthma was the most frequently reported comorbidity (35% of results), and this high prevalence of DB among individuals with asthma underscores a significant diagnostic challenge.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent editorial by Vlemincx explores how this, along with its apparent existence in the absence of organic respiratory disease, places DB as a potential 'transdiagnostic dimension' associated with a range of disease states.

    “A recent editorial by Vlemincx explores how this, along with its apparent existence in the absence of organic respiratory disease places DB as a potential 'transdiagnostic dimension' associated with a range of disease states (83).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Grammatopoulou, 2014, Hyperventilation in asthma: a validation study of the Nijmegen Questionnaire--NQ, J. Asthma source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The review was conducted using the Joanna Briggs Institute framework and adhered to PRISMA-ScR guidelines.

    “by the Joanna Briggs Institute (JBI) framework and adhering to the PRISMA-ScR guidelines”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The thematic synthesis, encompassing definitions, diagnostic approaches, symptoms and phenotypes, comorbidities, psychophysiological associations, and classification systems, offers a structured and comprehensive overview that fills a critical gap in current literature.

    “The thematic synthesis-encompassing definitions, diagnostic approaches, symptoms and phenotypes, comorbidities, psychophysiological associations, and classification systems-offers a structured and comprehensive overview that fills a critical gap in current literature.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The application of broad inclusion criteria ensured a multidisciplinary perspective.

    “The application of broad inclusion criteria ensured a multidisciplinary perspective”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The restriction to English-language literature introduces a potential language bias, which may have excluded pertinent international research.

    “The restriction to English-language literature introduces a potential language bias, which may have excluded pertinent international research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    This review reveals significant inconsistency and conceptual ambiguity in the characterisation of dysfunctional breathing within clinical literature.

    “This review reveals significant inconsistency and conceptual ambiguity in the characterisation of dysfunctional breathing within clinical literature.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The NQ was not designed for assessing DB; it was initially developed to screen for 'hyperventilation complaints'.

    “This is despite it not being designed for this purpose, having been initially developed to screen for 'hyperventilation complaints' (22,46).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22] Peters, 2020, Updated methodological guidance for the conduct of scoping reviews, JBI Evid Synth source
    • cites [46] Mitchell, 2016, Reliability and determinants of Self-Evaluation of Breathing Questionnaire (SEBQ) score: a symptoms-based measure of dysfunctional breathing, Appl. Psychophysiol. Biofeedback source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A multidisciplinary perspective is essential given the complex nature of dysfunctional breathing.

    “which is essential given the complex nature of DB”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    This may be a contributing factor to misdiagnosis rates in DB patients.

    “It has also been suggested that this may be a contributing factor to misdiagnosis rates in DB patients (6).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Kopitović, 2023, Dysfunctional breathing – view of pulmonologist

      Not checked in the free run.

56 of 56

  • The paper relies on this without support.

    DB is a condition where abnormal breathing patterns are present without an identifiable organic cause.

    “Dysfunctional breathing (DB), a condition where abnormal breathing patterns are present without an identifiable organic cause, has become a subject of increasing clinical interest.”

  • The paper relies on this without support.

    This scoping review represents the most comprehensive exploration of this topic to date.

    “The aim of this scoping review was to explore how DB is characterised in the clinical literature and represents the most comprehensive exploration of this topic to date.”

  • The paper relies on this without support.

    Agreement among the research team is sufficient to identify valid key themes and gaps.

    “Key Themes and gaps within literature were identified and agreed upon within the research team.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Courtney model citation points to a Ruane reference

    Minor

    The sentence attributes the multidimensional model to Courtney but cites reference 21, which is by Ruane and colleagues. A Courtney paper is listed at reference 20.

  • PRISMA-ScR checklist citation points to a grey-literature paper

    Minor

    Reference 26 is about searching grey literature, not the PRISMA-ScR checklist, which is listed at reference 25.

  • Vlemincx citation points to a Henderson reference

    Minor

    The cited reference 83 is by Henderson, whereas the Vlemincx editorial is listed as reference 86.

  • Barker and Everard definition points to a Reilly reference

    Minor

    The cited reference 16 is authored by Reilly and colleagues; Barker and Everard appear at reference 17.

  • Morgan citation points to a Maltinsky reference

    Minor

    Reference 67 is by Maltinsky and colleagues. The Morgan paper appears at reference 69.

  • Multidimensional-assessment percentage is rounded down

    Minor

    Twelve of 71 included articles is 16.9%, which rounds to 17%, not 16%.

    Reported 16 · recomputed 16.901408

  • Grillo citation points to a Kiesel reference

    Minor

    The discussion attributes the evaluation to Grillo et al. at reference 19, but reference 19 is by Kiesel and colleagues; Grillo et al. is reference 18.

  • JBI framework citation points to Arksey and O'Malley

    Minor

    The stated JBI framework citation, reference 24, is an Arksey and O'Malley paper; the listed JBI scoping-review guidance is reference 23.

  • Covidence software citation points to an automation-tools paper

    Minor

    The citation attached to Covidence software is reference 28, an automation-tools paper; the Covidence software entry is reference 27.

9 of 9

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Courtney, 2022, Dysfunctional breathing, J. Aust. Tradit. Med. Soc., 28, 76
  2. Veritas Health Innovation. Covidence systematic review software [software]. Melbourne: Veritas Health Innovation; accessed 22 May 2025. Available from: https://www.covidence.org.
  3. Stonehewer, 2009, Dysfunctional breathing for women's health physiotherapists, J. Assoc. Chartered Physiother Women Health, 104, 38

Cited by

Sorted by citations

Authors
Sanchez-Bracero, D., Baker, K., Archer, T., Shaw, T., & Palmer, J.
Affiliations
Sheffield Hallam University (GB)
Corresponding author
Sanchez-Bracero, Dario
ORCID
Venue
Respiratory Medicine
Publisher
Elsevier BV
Published
2026-01
Volume
251
Pages
108546
ISSN
0954-6111 (ISSN-L)
DOI
10.1016/j.rmed.2025.108546
OpenAlex
W4416757504
Semantic Scholar
f718cc85354d32ccc6626a42b54387ad6d814381
Cited by
1
References
63
Citations by year
2026: 1
FWCI
0.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Respiratory Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Keywords
dysfunctional breathing, definitions, diagnosis, classification, clinical symptoms, comorbidities, standardization, terminology, quality of life
MeSH terms
Humans, Terminology as Topic, Quality of Life, Respiration Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-23.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-23.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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