Novel assessment tool to detect breathing pattern disorder in patients with refractory asthma
Abstract
Background and objective: Breathing pattern disorder (BPD) can co‐exist with and mimic asthma, acting to amplify symptoms and confound assessment of disease control, resulting in inappropriate treatment escalation. The aim of this research was to report the utility of a novel breathing pattern assessment tool (BPAT) to detect BPD in treatment‐refractory asthma. Methods: As a component of a multidisciplinary assessment, adult patients referred with treatment‐refractory asthma underwent respiratory physiotherapy assessment to diagnose BPD. Based on this assessment, patients were classified as having asthma, asthma + BPD or BPD alone. BPAT data were collected in addition to questionnaire data (Asthma Quality of Life Questionnaire (AQLQ) and Nijmegen Questionnaire (NQ)), pulmonary function and an assessment of exercise capacity. Results: Data were retrospectively analysed for 150 (female; 69%) patients, mean (SD) age of 43 (14) years; characterized as asthma‐only (n = 54, 36%), asthma + BPD (n = 63, 42%) and BPD‐only (n = 33, 22%). Of the total population, 113 (76%) had an NQ score ≥23, but of these only 68% had physiotherapy evidence of BPD. Exercise capacity and AQLQ were lower in the asthma + BPD group than in the asthma‐only group (P < 0.05), whilst lung function was similar between groups. Sensitivity analysis indicated that a BPAT score of ≥4 corresponded to a sensitivity of 0.92 and a specificity of 0.75 for diagnosis of BPD in this cohort. Conclusion: Breathing pattern irregularities are highly prevalent in individuals referred with treatment‐refractory asthma and can be characterized using the BPAT. Further work is needed to determine inter‐observer and within‐subject variability and ensure the BPAT is a robust clinical tool. Watch the video abstract
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Objective assessment tools lack sufficient evidence (BH and BPAT) or are perceived to be too complex for general use (Manual Assessment of Respiratory Motion).
“Objective assessment tools lack sufficient evidence (BH 31 and BPAT 14 ) or are perceived to be too complex for general use (Manual Assessment of Respiratory Motion 32 ).”
From Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation (2023) · cites this paper as [14]
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“Another limitation of this study is the lack of standardized diagnostic criteria for BPD (Todd et al., 2018).”
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“…post-rehabilitation to assess symptoms of OI, dysfunctional breathing, depression and anxiety, respectively: the Malmö POTS score [11], breathing pattern assessment tool (BPAT) [12], Nijmegen Questionnaire [13], Fatigue Severity Score [14] and hospital anxiety and depression scale (HADS) [15].”
Breathing exercises as adjunct therapy in adult asthma: a systematic review
Lessmann, A. C., Segovia, E. A. V., Paz, L., & Plaza, V. (2026) · F1000Research · doi:10.12688/f1000research.180230.1
Brandl, T., Pichler, F., Grabovac, I., Waldhoer, T., Keller, H., Fenneker, D., Niessner, A., & Kapan, A. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-120159
“If any severe or concerning symptoms arise, participants will be instructed to contact the study team immediately.”
The Imbalance of Breathing: Recognizing and Assessing Dysfunctional Breathing
Tütüneken, Y. E., & Kabasakal, E. (2026) · İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.61399/ikcusbfd.1715508
Alemi, B., Peirce, S., & van Niekerk, S.-M. (2026) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2026.05.014
Sakkatos, P. (2026) · Exploration of Asthma & Allergy · doi:10.37349/eaa.2026.1009122
Dysfunctional breathing mimicking asthma exacerbation with acute hypoxemia: a case report
Yamada, K., Hirai, K., Mizuoka, S., Mondori, K., Akioka, M., Sato, K., Nagamine, H., Matsumoto, Y., Nakai, T., Watanabe, T., et al. (2026) · Respiratory Medicine Case Reports · doi:10.1016/j.rmcr.2026.102419
“A BPAT score ≥ 4 has been suggested to indicate a breathing pattern disorder or DB [9].”
Breathing pattern disorder: assessment and diagnosis
Bondarenko, J., Grillo, L. J., Denton, E. J., Button, B., Hew, M. J., & Holland, A. (2026) · ERJ Open Research · doi:10.1183/23120541.00092-2026
“A BPAT score of ⩾ 4 had a sensitivity of 0.92 and a specificity of 0.75 for detecting physiotherapist-diagnosed BrPD [13], and these test characteristics have been reproduced in people with long-COVID and postural orthostatic tachycardia syndrome [50, 51].”
InfluentialSelf-citationHull, J. H., & Grillo, L. (2026) · Respirology (Carlton South. Print) · doi:10.1002/resp.70245
Self-citationLiving with breathing pattern disorder: a scoping review
Moffat, C., Walker, S. H., Fuld, J. P., & Higgins, S. (2026) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-026-00495-5
“Depression was prevalent in those with BPD 19,37,43,58 .”
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Zafran, M., Yousif, M., Bhaskaran, D., Robinson, J., Read, J., Keele, A., & Bateman, K. (2021) · Thinking outside the lung: monitoring and management of patients with CF, PCD and bronchiectasis · doi:10.1136/thorax-2021-btsabstracts.226
Severe asthma management in adults
Gibson, P., Chung, K., & Israel, E. (2019) · Severe Asthma · doi:10.1183/2312508x.10035718
Contemporary Concise Review 2018: Asthma and chronic obstructive pulmonary disease
Upham, J. (2019) · Respirology (Carlton South. Print) · doi:10.1111/resp.13553
- Authors
- Todd, S., Walsted, E. S., Grillo, L., Livingston, R., Menzies‐Gow, A., & Hull, J. H.
- Affiliations
- Royal Brompton Hospital (GB)
- Bispebjerg Hospital (DK)
- University College Hospital (GB)
- Department of Respiratory Medicine Royal Brompton Hospital London UK
- Corresponding author
- Hull, James H.
- Venue
- Respirology
- Publisher
- Wiley
- Published
- 2017-09-14
- Volume
- 23
- Issue
- 3
- Pages
- 284-290
- ISSN
- 1323-7799 (ISSN-L)
- 1440-1843
- OpenAlex
- W2755877069
- Cited by
- 96
- References
- 0
- Citations by year
- 2026: 16 · 2025: 8 · 2024: 16 · 2023: 16 · 2022: 12 · 2021: 11 · 2020: 6 · 2019: 7 · 2018: 3 · 2013: 1
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Respirology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- breathing pattern disorders, refractory asthma, respiratory physiotherapy, Nijmegen questionnaire, Asthma Quality of Life Questionnaire, exercise capacity, lung function, asthma diagnosis, sensitivity and specificity
- MeSH terms
- Adult, Asthma, Exercise Test, Female, Humans, Lung, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Respiration Disorders, Respiratory Function Tests, Retrospective Studies
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