Medically Unexplained Dyspnea: Partly Moderated by Dysfunctional (Thoracic Dominant) Breathing Pattern
Abstract
Background Dysfunctional breathing (DB) may contribute to disproportionate dyspnea and other medically unexplained symptoms. The extent of dysfunctional breathing is often evaluated using the Nijmegen Questionnaire (NQ) or by the presence of abnormal breathing patterns. The NQ was originally devised to evaluate one form of dysfunctional breathing - hyperventilation syndrome. However, the symptoms identified by the NQ are not primarily due to hypocapnia and may be due to other causes including breathing pattern dysfunction. Objectives The relationships between breathing pattern abnormalities and the various categories of NQ symptoms including respiratory or dyspnea symptoms have not been investigated. This study investigates these relationships. Method 62 patients with medically unexplained complaints, that seemed to be associated with tension and breathing dysfunction, were referred, or self-referred, for breathing and relaxation therapy. Dysfunctional breathing symptoms and breathing patterns were assessed at the beginning and end of treatments using the NQ for assessment of DB symptoms, and the Manual Assessment of Respiratory Motion (MARM) to quantify the extent of thoracic dominant breathing. Subscales for the NQ were created in 4 categories, tension, central neurovascular, peripheral neurovascular and dyspnea. Relationships between the NQ (sum scores and subscales) and the MARM were explored. Results Mean NQ scores were elevated and mean MARM values for thoracic breathin…
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There is limited and largely uncontrolled evidence that when dyspnoea is related to an abnormal breathing pattern it may be improved by breathing retraining, but the sensation of dyspnoea may still remain.
“There is limited and largely uncontrolled evidence that when dyspnoea is related to an abnormal breathing pattern it may be improved by breathing retraining, but the sensation of dyspnoea may still remain [11].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [11]
One study found a weak relationship between hyperventilation symptoms and breathing pattern in 74% of patients, indicating that a large number of patients with elevated Nijmegen questionnaire score had abnormal breathing patterns.
“One study found a weak relationship between hyperventilation symptoms and breathing pattern in 74% of patients indicating that a large number of patients with elevated Nijmegen questionnaire score had abnormal breathing patterns [11].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [11]
Thoracic dominant breathing is linked to asthma, COPD, heart failure and panic disorder.
“| Thoracic dominant breathing | 4 | [11, 47–49] | Asthma COPD Heart failure Panic disorder |”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [11]
Thoracic dominant breathing often occurs in patients with increasing ventilation needs such as cardiac or respiratory disease or decreased abdominal compliance such as morbid obesity, but in their absence it can be termed dysfunctional.
“This type of breathing often occurs in patients with increasing ventilation needs such as those with cardiac or respiratory disease or those with decreased abdominal compliance such as the morbidly obese, but in their absence it can be termed dysfunctional [11, 48, 49].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [11]
DB is described in the literature as a multi-dimensional construct consisting of at least 3 dimensions: biomechanical, psychophysiological and biochemical.
“Multiple factors are reported to contribute to DB, with it being described in the literature as a multi-dimensional construct consisting of at least 3 dimensions; biomechanical, psychophysiological and biochemical (3,9).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [3]
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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
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- Authors
- Courtney, R., van Dixhoorn, J., Greenwood, K. M., & Anthonissen, E. L. M.
- Affiliations
- RMIT University (AU)
- Venue
- Journal of Asthma
- Publisher
- Informa UK Limited
- Published
- 2011-02-22
- Volume
- 48
- Issue
- 3
- Pages
- 259-265
- ISSN
- 0277-0903 (ISSN-L)
- 1532-4303
- OpenAlex
- W1964517841
- Cited by
- 68
- References
- 9
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 3 · 2016: 5 · 2015: 2 · 2014: 3 · 2013: 7 · 2012: 5
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Asthma (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline - JCU (James Cook University) (submittedVersion)
- RMIT Research Repository (RMIT University Library) (submittedVersion)
- Figshare (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- dysfunctional breathing, Nijmegen questionnaire, tension, hyperventilation syndrome, hypocapnia
- MeSH terms
- Adult, Breathing Exercises, Dyspnea, Female, Humans, Male, Middle Aged, Respiration Disorders, Time Factors, Respiratory Mechanics, Treatment Outcome, Young Adult
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