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Cited by 88Respiratory and Cough-Related ResearchCardiovascular and exercise physiologyAsthma and respiratory diseases

Dysfunctional breathing and reaching one's physiological limit as causes of exercise-induced dyspnoea

Open access
Depiazzi, Julie, Everard, Mark L.·2016·Breathe
DOI 10.1183/20734735.007216PMC PMC4933621
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Abstract

Key points: Excessive exercise-induced shortness of breath is a common complaint. For some, exercise-induced bronchoconstriction is the primary cause and for a small minority there may be an alternative organic pathology. However for many, the cause will be simply reaching their physiological limit or be due to a functional form of dysfunctional breathing, neither of which require drug therapy. The physiological limit category includes deconditioned individuals, such as those who have been through intensive care and require rehabilitation, as well as the unfit and the fit competitive athlete who has reached their limit with both of these latter groups requiring explanation and advice. Dysfunctional breathing is an umbrella term for an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms, which may be respiratory and/or nonrespiratory. This alteration may be due to structural causes or, much more commonly, be functional as exemplified by thoracic pattern disordered breathing (PDB) and extrathoracic paradoxical vocal fold motion disorder (pVFMD). Careful history and examination together with spirometry may identify those likely to have PDB and/or pVFMD. Where there is doubt about aetiology, cardiopulmonary exercise testing may be required to identify the deconditioned, unfit or fit individual reaching their physiological limit and PDB, while continuous laryngoscopy during exercise is increasingly becoming the benchmark for assessing extrathoracic causes. Accurate assessment and diagnosis can prevent excessive use of drug therapy and result in effective management of the cause of the individual’s complaint through cost-effective approaches such as reassurance, advice, breathing retraining and vocal exercises. This review provides an overview of the spectrum of conditions that can present as exercise-­induced breathlessness experienced by young subjects participating in sport and aims to promote understanding of the need for accurate assessment of an individual’s symptoms. We will highlight the high incidence of nonasthmatic causes, which simply require reassurance or simple interventions from respiratory physiotherapists or speech pathologists.

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  • Four classification systems for DB have been proposed.

    “Four classification systems for DB have been proposed, as referenced in sources (4,7,8,10), with further details provided in Supplementary Materials 2.”

    From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [4]

    The Dysfunctional breathing section presents a classification of dysfunctional breathing, including thoracic and extrathoracic forms. It does not state that four classification systems have been proposed, so this source supports the existence of a classification but not the count of four. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • DB is associated with a high symptom burden, high healthcare-related costs and a negative impact on health-related quality of life.

    “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 [4]

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Authors
Depiazzi, J., & Everard, M. L.
Affiliations
The University of Western Australia (AU)
Corresponding author
Depiazzi, Julie
ORCID
Venue
Breathe
Publisher
European Respiratory Society (ERS)
Published
2016-06
Volume
12
Issue
2
Pages
120-129
ISSN
  • 1810-6838 (ISSN-L)
  • 2073-4735
DOI
10.1183/20734735.007216
PMC
PMC4933621
OpenAlex
W2412166292
Cited by
88
References
45
Citations by year
2026: 9 · 2025: 8 · 2024: 6 · 2023: 7 · 2022: 12 · 2021: 13 · 2020: 13 · 2019: 9 · 2018: 7 · 2017: 1 · 2016: 2
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Breathe (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Keywords
exercise-induced dyspnoea, dysfunctional breathing, exercise-induced bronchoconstriction, breathing retraining, youth athletes, pulmonary rehabilitation

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