Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey
Open accessAbstract
Objectives: To estimate the prevalence of dysfunctional breathing in adults with asthma treated in the community. Design: Postal questionnaire survey using Nijmegen questionnaire. Setting: One general practice with 7033 patients. Participants: All adult patients aged 17-65 with diagnosed asthma who were receiving treatment. Main outcome measure: Score23 on Nijmegen questionnaire. Results: 227/307 patients returned completed questionnaires; 219 (71.3%) questionnaires were suitable for analysis. 63 participants scored 23. Those scoring 23 were more likely to be female than male (46/132 (35%) v 17/87 (20%), P=0.016) and were younger (mean (SD) age 44.8 (14.7) v 49.0 (13.8, (P=0.05). Patients at different treatment steps of the British Thoracic Society asthma guidelines were affected equally. Conclusions: About a third of women and a fifth of men had scores suggestive of dysfunctional breathing. Although further studies are needed to confirm the validity of this screening tool and these findings, these prevalences suggest scope for therapeutic intervention and may explain the anecdotal success of the Buteyko method of treating asthma. What is already known on this topic: Abnormal breathing patterns may cause characteristic symptoms and impair quality of life Effective interventions exist for dysfunctional breathing Dysfunctional breathing has been described in patients attending hospital respiratory clinics What this study adds: 29% of adults treated for asthma in primary care had symptoms suggestive of dysfunctional breathing Affected patients were more likely to be female and younger, but no differences were found with severity of asthma Some patients with asthma may benefit from breathing therapy
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Breathing pattern disorders occur in about a third of asthma patients.
“Breathing pattern disorders occur in about a third of asthma patients”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [31]
The Additional information section reports that 29% of adults treated for asthma in primary care had symptoms suggestive of dysfunctional breathing. That supports the approximate proportion, but the study screened adults in one practice; it did not establish that breathing pattern disorders occur in a third of asthma patients generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMost data are available for HVS; prevalence is estimated at 6-10% in the general population, rising to 29% in asthmatics.
“Most data are available for HVS, the prevalence of which is estimated to be in the region of 6–10% in the general population, rising to 29% in asthmatics [5, 12].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [5]
The Results report that 29% of respondents treated for asthma in one general practice scored above the Nijmegen questionnaire threshold for dysfunctional breathing. The paper does not give a 6–10% estimate for the general population, and its Limitations of study section cautions that a questionnaire score does not establish a diagnosis of hyperventilation syndrome. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe diagnosis of hyperventilation syndrome is based on the Nijmegen questionnaire only after organic disease has been ruled out or optimally controlled.
“The diagnosis is based on the Nijmegen questionnaire only after organic disease has been ruled out or optimally controlled, and is often difficult to distinguish from asthma and anxiety disorders [5, 16, 21].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [5]
The Participants and methods section describes the Nijmegen questionnaire as a screening instrument, and the Limitations of study section says it identifies characteristic symptom patterns but cannot establish a certain diagnosis. Neither section says organic disease must first be ruled out or optimally controlled. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHyperventilation syndrome is often difficult to distinguish from asthma and anxiety disorders.
“The diagnosis is based on the Nijmegen questionnaire only after organic disease has been ruled out or optimally controlled, and is often difficult to distinguish from asthma and anxiety disorders [5, 16, 21].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [5]
The Introduction says the syndrome’s symptoms overlap with those of other diseases and that diagnosing dysfunctional breathing can be difficult. The Discussion specifically describes an unrecognised diagnostic overlap with asthma. Although the Introduction lists anxiety as a symptom, the paper does not specifically say the syndrome is difficult to distinguish from anxiety disorders; page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredHyperventilation syndrome is linked to asthma and panic disorder.
“| Hyperventilation syndrome | 43 | [1, 2, 5, 15] | Asthma Panic disorder |”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [5]
The Introduction (page not supplied) says asthma has been linked with symptomatic hyperventilation. It mentions anxiety in asthmatic patients and lists references about panic disorder, but does not establish a link between hyperventilation syndrome and panic disorder. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Around 29% to 64% of asthma patients exhibit HVS.
“Indeed, around 29% to 64% of asthma patients exhibit HVS,31,54–56”
From Physiotherapy Education and Breathing Retraining for Patients With Hyperventilation Syndrome: An Observational Study (2026) · cites this paper as [54]
The Results report that 29% of respondents with treated asthma scored above the Nijmegen questionnaire threshold, supporting the lower end of the range. The paper does not report 64%, and its Limitations of study section cautions that a positive questionnaire score cannot establish a diagnosis of hyperventilation syndrome (HVS). (LLM, conf=0.88)
Experimental — accuracy not yet measuredAsthma itself is associated with an increased prevalence of reported panic disorder at 9.7%.
“Asthma itself is associated with an increased prevalence of reported panic disorder at 9.7% [5, 23].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [5]
The Introduction links asthma with increased anxiety and depression indices, but does not report panic disorder prevalence. The Methods and Results assess dysfunctional breathing, not panic disorder; searches for “9.7%” and “panic disorder prevalence” found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Thomas, M., McKinley, R. K., Freeman, E., & Foy, C.
- Affiliations
- University of Leicester (GB)
- Corresponding author
- Thomas, Mike
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2001-05-05
- Volume
- 322
- Issue
- 7294
- Pages
- 1098-1100
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC31263
- OpenAlex
- W2141907294
- Cited by
- 294
- References
- 31
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 10 · 2023: 19 · 2022: 7 · 2021: 8 · 2020: 7 · 2019: 10 · 2018: 8 · 2017: 10 · 2016: 13 · 2015: 8 · 2014: 16 · 2013: 14 · 2012: 18
- FWCI
- 8.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Wellcome Trust (051187/Z/97/A)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- dysfunctional breathing, asthma, prevalence, Nijmegen questionnaire, primary care, breathing therapy, sex differences, age differences, asthma severity, quality of life
- MeSH terms
- Adolescent, Adult, Aged, Asthma, Cross-Sectional Studies, Diagnosis, Differential, Female, Humans, Hyperventilation, Male, Middle Aged, Primary Health Care, Surveys and Questionnaires, Syndrome, Age Distribution, Sex Distribution
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