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Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey
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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”
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]
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“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]
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“| 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]
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
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Self-citation
Metadata
- 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 › Pulmonary and Respiratory Medicine › 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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