Dysfunctional breathing in children with asthma: a rare but relevant comorbidity
Open accessAbstract
Hyperventilation and other clinical manifestations of dysfunctional breathing have been reported in childhood, but the prevalence is unknown. In adults, dysfunctional breathing may be a relevant comorbidity in asthma. We aimed to determine the prevalence of dysfunctional breathing in children with asthma and its impact on asthma control. We performed a cross-sectional survey in 203 asthmatic children (aged 5–18 years), using the Nijmegen Questionnaire and the paediatric Asthma Control Questionnaire. Dysfunctional breathing was found in 11 (5.3%) children; more females (eight (12.9%) out of 62) than males (three (2.1%) out 144, p=0.002). There was a dose–dependent relationship between increasing Nijmegen Questionnaire scores (increased risk of dysfunctional breathing) and poorer asthma control. Poor asthma control was more common in patients with dysfunctional breathing (10 (90.9%) out of 11 children) than in children without (65 (32.3%) out of 192 children; OR 19.3, 95% CI 3.14–430.70; p<0.0001). The median Asthma Control Questionnaire in children with dysfunctional breathing was higher (median (range) 2.00 (1.50–3.17)) than in children without (0.50 (0.17–1.17); p<0.001). The prevalence of dysfunctional breathing in children and adolescents referred to a hospital-based paediatric asthma clinic for severe or difficult-to-control asthma is 5%. The association between dysfunctional breathing and asthma control suggests that this may be a clinically relevant comorbidity in paediatric asthma.
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In asthmatic children the prevalence appears much lower, around 5%, although the study was in severe asthmatics and difficult to extrapolate to all patients.
“In asthmatic children the prevalence appears to be much lower in the region of 5% [17], although this study was performed in severe asthmatics and is therefore difficult to extrapolate to all patients.”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [17]
The Discussion reports dysfunctional breathing in about 5% of children with asthma, much lower than the rate reported in adults. The study was conducted in a specialist clinic, which limits extrapolation to all children with asthma, but describing its participants simply as “severe asthmatics” overstates the source: the Discussion calls them relatively severe or difficult to treat, while the Results say most had well-controlled asthma. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe Nijmegen questionnaire has not been validated in children and symptoms of dysfunctional breathing specific to children are not included in it.
“It must also be noted that the Nijmegen questionnaire has not been validated in children and that symptoms of dysfunctional breathing specific to children are not included in the Nijmegen questionnaire [17].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [17]
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).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [14]
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Cited by
Sorted by citations
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 · see citing works
The Nijmegen Questionnaire and dysfunctional breathing
van Dixhoorn, J., & Folgering, H. (2015) · ERJ Open Research · doi:10.1183/23120541.00001-2015 · Cited by 161 · see citing works
How to manage a child with difficult asthma?
Saglani, S., & Fleming, L. (2016) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2016.1191355 · Cited by 14 · see citing works
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 · see citing works
- Authors
- de Groot, E. P., Duiverman, E. J., & Brand, P. L. P.
- Affiliations
- University Medical Center Groningen (NL)
- ORCID
- Brand, Paul L.P.
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2012-09-27
- Volume
- 41
- Issue
- 5
- Pages
- 1068-1073
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W2103777079
- Cited by
- 72
- References
- 4
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 13 · 2022: 7 · 2021: 5 · 2020: 5 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 3 · 2015: 4 · 2014: 3 · 2013: 1
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- 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, childhood asthma, hyperventilation, asthma control, comorbidities, prevalence, Nijmegen questionnaire, Asthma Control Questionnaire, sex differences, difficult-to-treat asthma
- MeSH terms
- Adolescent, Allergens, Asthma, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Immunoglobulin E, Male, Nitric Oxide, Surveys and Questionnaires, Respiration, Respiration Disorders, Comorbidity, Inhalation Exposure
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