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Dysfunctional breathing symptoms, functional impact and quality of life in patients with long COVID-19: a prospective case series
Open accessAbstract
Background: Dysfunctional breathing is increasingly recognised after SARS-CoV-2 infection, but the associated symptoms, functional impact and quality of life have not been systematically studied. Methods: This study describes a prospective case series of 48 patients with dysfunctional breathing based on compatible symptoms and an abnormal breathing pattern during cardiopulmonary exercise testing. Patients with underlying disease that could explain these symptoms were excluded. Median time from COVID-19 to evaluation was 212 (IQR 121) days. Self-administered questionnaires, including the Nijmegen questionnaire, Short-Form (36) Health Survey (SF-36), Hospital Anxiety and Depression Scale, modified Medical Research Council scale, post-COVID-19 Functional Scale, and specific long COVID symptoms, were the outcome measures. Results: On average, mean V’O 2 was preserved. Pulmonary function tests were within limits of normality. Hyperventilation, periodic deep sighs/erratic breathing and mixed types of dysfunctional breathing were diagnosed in 20.8%, 47.1% and 33.3% of patients, respectively. After dyspnoea, the five most frequent symptoms using the Nijmegen scale with a cut-off of ≥3 were faster/deeper breathing (75.6%), palpitations (63.8%), sighs (48.7%), unable to breathe deeply (46.3%) and yawning (46.2%). Median Nijmegen and Hospital Anxiety and Depression Scale scores were 28 (IQR 20) and 16.5 (IQR 11), respectively. SF-36 scores were lower than the reference value. Conclusions: Long COVID patients with dysfunctional breathing have a high burden of symptoms, functional impact and a low quality of life, despite no or negligible organic damage.
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“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).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [5]
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“Although various tools designed to evaluate different aspects of the condition have been described in the literature, their diagnostic application remains limited due to insufficient rigorous validation (5).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [5]
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“While various tools for assessing different aspects of DB are discussed in the literature, their use in diagnosis is limited due to a lack of validation J o u r n a l P r e -p r o o f within this population (5).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [5]
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“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).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [5]
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Long covid—mechanisms, risk factors, and management
Crook, H., Raza, S., Nowell, J., Young, M., & Edison, P. (2021) · BMJ · doi:10.1136/bmj.n1648 · Cited by 1,655
Efficacy of Nijmegen questionnaire in recognition of the hyperventilation syndrome
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Dysfunctional breathing: a review of the literature and proposal for classification
Boulding, R., Stacey, R., Niven, R., & Fowler, S. J. (2016) · European Respiratory Review · doi:10.1183/16000617.0088-2015 · Cited by 372 · cited 2×
“considered together as this was suggested in a recent review [10].”
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How is dysfunctional breathing characterised in the clinical literature? A scoping review
Sanchez-Bracero, D., Baker, K., Archer, T., Shaw, T., & Palmer, J. (2026) · Respiratory Medicine · doi:10.1016/j.rmed.2025.108546 · Cited by 1
Metadata
- Authors
- Genecand, L., Altarelli, M., Binkova, A., Loew, S., Vaudan, S., Gex, G., Bridevaux, P.-O., & Frésard, I.
- Affiliations
- University of Geneva (CH)
- Hôpital Riviera-Chablais (CH)
- Hôpital de Sion (CH)
- Corresponding author
- Genecand, Léon
- Bridevaux, Pierre-Olivier
- Venue
- BMJ Open Respiratory Research
- Publisher
- BMJ
- Published
- 2023-07
- Volume
- 10
- Issue
- 1
- Pages
- e001770
- ISSN
- 2052-4439 (ISSN-L)
- PMC
- PMC10347459
- OpenAlex
- W4383893678
- Cited by
- 37
- References
- 3
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 10 · 2023: 2
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open Respiratory Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- long COVID, dysfunctional breathing, hyperventilation, quality of life, functional impact, anxiety and depression, Nijmegen questionnaire, cardiopulmonary exercise testing, COVID-19 pandemic
- MeSH terms
- COVID-19, SARS-CoV-2, Post-Acute COVID-19 Syndrome, Humans, Quality of Life, Respiration
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