Dysfunctional breathing phenotype in adults with asthma ‐ incidence and risk factors
Open accessAbstract
Background: Abnormal breathing patterns may cause characteristic symptoms and impair quality of life. In a cross‐sectional survey 29% of adults treated for asthma in primary care had symptoms suggestive of dysfunctional breathing (DB), more likely to be female and younger, with no differences for severity of asthma. No clear risk factors were demonstrated for DB in asthma, nor the impact of asthma medication was evaluated. The objective of this study was to describe the DB phenotype in adults with asthma treated in a specialised asthma centre. Methods: Adult patients aged 17–65 with diagnosed asthma were screened for DB using the Nijmegen questionnaire (positive predictive score >23) and confirmed by progressive exercise testing. The following were evaluated as independent risk factors for DB in the multiple regression analysis: female sex; atopy, obesity, active smoker, moderate/severe rhinitis, psychopathology, GERD, arterial hypertension; severe asthma, asthma duration > 5 years, lack of asthma control, fixed airway obstruction, fast lung function decline, frequent exacerbator and brittle asthma phenotypes; lack of ICS, use of LABA or LTRA. Results: 91 adults with asthma, mean age 35.04 ±1.19 years, 47(51.65%) females were evaluated. 27 (29.67%) subjects had a positive screening score on Nijmegen questionnaire and 16(17.58%) were confirmed by progressive exercise testing as having DB. Independent risk factors for DB were psychopathology (p = 0.000002), frequent exacerbator asthma phenotype (p = 0.01) and uncontrolled asthma (p < 0.000001). Conclusion: Dysfunctional breathing is not infrequent in asthma patients and should be evaluated in asthma patients presenting with psychopathology, frequent severe asthma exacerbations or uncontrolled asthma. Asthma medication (ICS, LABA or LTRA) had no significant relation with dysfunctional breathing.
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Asthmatics with HVS tend to be female, have poor asthma control, frequent exacerbations and comorbid anxiety states.
“Asthmatics with HVS tend to be female, have poor asthma control, frequent exacerbations and comorbid anxiety states [16].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [16]
The Results (Table 1; page unavailable) show that asthmatics with dysfunctional breathing were more often female, lacked asthma control, and were frequent exacerbators; the Results and Discussion also report anxiety disorders in this group. The study assessed dysfunctional breathing, however, not a separately identified hyperventilation syndrome (HVS) group, so it does not establish the full profile specifically for asthmatics with HVS. (LLM, conf=0.82)
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 [16]
The Material and methods section says the Nijmegen questionnaire was used to screen for dysfunctional breathing in adults with asthma, with positive results confirmed by progressive exercise testing. The Discussion (Incidence of dysfunctional breathing) likewise distinguishes a positive questionnaire score from a confirmed diagnosis. The paper does not state that organic disease must first be ruled out or optimally controlled, or that the questionnaire alone establishes the diagnosis. (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 [16]
The Introduction (page unavailable) says dysfunctional breathing can be misdiagnosed as asthma and that no technique has been validated to identify it in the presence of asthma. The Discussion on asthma co-morbidities (page unavailable) links dysfunctional breathing with anxiety disorders, especially panic disorder, but does not say it is difficult to distinguish from anxiety disorders. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMore recent studies of dysfunctional breathing in asthma have looked at combining use of the Nijmegen questionnaire with symptom limited exercise testing in an attempt to improve specificity for dysfunctional breathing.
“More recent studies of dysfunctional breathing in asthma have looked at combining use of the Nijmegen questionnaire with symptom limited exercise testing in attempt to improve specificity for dysfunctional breathing [16, 19].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [16]
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Sorted by citations
Dysfunctional breathing: a review of the literature and proposal for classification
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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 · see citing works
- Authors
- Agache, I., Ciobanu, C., Paul, G., & Rogozea, L.
- Affiliations
- Transilvania University of Brașov (RO)
- Department of Allergy and Clinical Immunology Theramed Medical Center 16 Spatarul Luca Arbore Brasov Romania
- Corresponding author
- Agache, Ioana
- Venue
- Clinical and Translational Allergy
- Publisher
- Wiley
- Published
- 2012-01
- Volume
- 2
- Issue
- 1
- Pages
- 18-18
- ISSN
- 2045-7022 (ISSN-L)
- PMC
- PMC3502326
- OpenAlex
- W2102324978
- Cited by
- 60
- References
- 8
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 9 · 2020: 4 · 2019: 8 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 1 · 2014: 2 · 2013: 4
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical and Translational Allergy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, adults, risk factors, psychopathology, asthma exacerbations, uncontrolled asthma, Nijmegen questionnaire, inhaled corticosteroids, asthma phenotypes, quality of life
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