Hyperventilation in asthma: A validation study of the Nijmegen Questionnaire – NQ
Abstract
Introduction The Nijmegen questionnaire (NQ) has previously been used for screening the hyperventilation syndrome (HVS) in asthmatics. However, no validity study has been reported so far. Objective To examine the validity and reliability of the NQ in asthma patients and identify the prevalence of HVS. Methods The NQ (n = 162) was examined for translation, construct, cross-sectional and discriminant validity as well as for internal consistency and test-retest reliability. Results Principal component analysis and exploratory factor analysis revealed a single factor solution with 11 items and 58.6% of explained variability. These 11 NQ items showed high internal consistency (Cronbach's alpha = 0.92) and test-retest reliability (IR = 0.98). Higher NQ scores were found in the following subgroups: women versus men (p 35 mmHg (p 17 discriminated the participants with regard to the presence of HVS. The NQ showed 92.73% sensitivity and 91.59% specificity. The total NQ score was found significantly correlated with ETCO2 (r = -0.68), RR (r = 0.66) and BHT (r = -0.65). The prevalence of HVS was found 34%. Conclusion The NQ is a valid and reliable questionnaire for screening HVS in patients with stable mild-to-moderate asthma.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The approximate prevalence of HVS in asthmatics was found to be 34%.
“The approximate prevalence of HVS in asthmatics was found to be 34% [13].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [13]
Historically 'hyperventilation syndrome' (HVS) was the most common way of describing BPD.
“Historically 'hyperventilation syndrome' (HVS) was the most common way of describing BPD. 15”
From Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation (2023) · cites this paper as [15]
Some patient-reported outcome measures are not validated in all presentations of BPD (NQ, D-12) or have limited validity (Short Evaluation of Breathing Questionnaire).
“Some patient- reported outcome measures are not validated in all presentations of BPD (NQ, 15 D- 12 29 ) or have limited validity (Short Evaluation of Breathing Questionniare 30 ).”
From Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation (2023) · cites this paper as [15]
A recent editorial by Vlemincx explores how this, along with its apparent existence in the absence of organic respiratory disease, places DB as a potential 'transdiagnostic dimension' associated with a range of disease states.
“A recent editorial by Vlemincx explores how this, along with its apparent existence in the absence of organic respiratory disease places DB as a potential 'transdiagnostic dimension' associated with a range of disease states (83).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [83]
Comorbid anxiety has been described as both a cause and consequence of DB.
“This has also been considered in regards to comorbid anxiety, it being described as both a cause and consequence of DB (83).”
From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [83]
Cites
Guidelines for the process of cross-cultural adaptation of self-report measures
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000) · Spine · doi:10.1097/00007632-200012150-00014 · Cited by 14,542 · see citing works
Development of the asthma control test
Nathan, R. A., Sorkness, C. A., Kosinski, M., Schatz, M., Li, J. T., Marcus, P., Murray, J. J., & Pendergraft, T. B. (2004) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2003.09.008 · Cited by 2,906 · see citing works
Efficacy of Nijmegen questionnaire in recognition of the hyperventilation syndrome
van Dixhoorn, J., & Duivenvoorden, H. J. (1985) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(85)90042-x · Cited by 445 · see citing works
Thomas, M., McKinley, R. K., Freeman, E., & Foy, C. (2001) · BMJ · doi:10.1136/bmj.322.7294.1098 · Cited by 294 · see citing works
Holloway, E. A., & West, R. J. (2007) · Thorax · doi:10.1136/thx.2006.076430 · Cited by 170 · see citing works
Hornsveld, H., Garssen, B., Dop, M. F., van Spiegel, P., & de Haes, J. (1996) · The Lancet · doi:10.1016/s0140-6736(96)02024-7 · Cited by 168 · see citing works
Hyperventilation in panic disorder and asthma: Empirical evidence and clinical strategies
Meuret, A. E., & Ritz, T. (2010) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2010.05.006 · Cited by 118 · see citing works
Courtney, R., Greenwood, K. M., & Cohen, M. (2011) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2010.06.004 · Cited by 96 · see citing works
A comparison between patients with dysfunctional breathing and patients with asthma
Hagman, C., Janson, C., & Emtner, M. (2008) · The Clinical Respiratory Journal · doi:10.1111/j.1752-699x.2007.00036.x · Cited by 67 · see citing works
Flagged first, then by citations
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
Reilly, C. C., Floyd, S. V., Lee, K., Warwick, G., James, S., Gall, N., & Rafferty, G. F. (2020) · Autonomic Neuroscience · doi:10.1016/j.autneu.2019.102601 · Cited by 48 · see citing works
Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation
Grillo, L., Russell, A.-M., Shannon, H., & Lewis, A. (2023) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2022-001395 · Cited by 27 · see citing works
“15 The items were selected and informed by clinical expertise and included the common components of physiotherapy assessments in usual accepted practice, with reference to published guidance where physiotherapy assessment had been described.”
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
- Grammatopoulou, E. P., Skordilis, E. K., Georgoudis, G., Haniotou, A., Evangelodimou, A., Fildissis, G., Katsoulas, T., & Kalagiakos, P.
- Affiliations
- Technological Educational Institute of Athens (GR)
- National and Kapodistrian University of Athens (GR)
- Simanogleio-Amalia Fleming General Hospital (GR)
- Corresponding author
- Grammatopoulou, Eirini P.
- Venue
- Journal of Asthma
- Publisher
- Informa UK Limited
- Published
- 2014-05-29
- Volume
- 51
- Issue
- 8
- Pages
- 839-846
- ISSN
- 0277-0903 (ISSN-L)
- 1532-4303
- OpenAlex
- W1966646614
- Cited by
- 104
- References
- 9
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 14 · 2023: 20 · 2022: 8 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 6 · 2017: 6 · 2016: 4 · 2015: 3 · 2014: 1 · 2013: 1
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Asthma (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- hyperventilation syndrome, asthma, Nijmegen questionnaire, questionnaire validity, screening, breath-hold time, end-tidal carbon dioxide, asthma control, prevalence, psychometric properties
- MeSH terms
- Adult, Aged, Asthma, Cross-Sectional Studies, Female, Humans, Hyperventilation, Male, Middle Aged, Surveys and Questionnaires, Reproducibility of Results, Prevalence, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
