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Cited by 58Asthma and respiratory diseasesRespiratory and Cough-Related ResearchPsychosomatic Disorders and Their Treatments

Dysfunctional breathing in children and adults with asthma

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Connett, Gary J., Thomas, Mike·2018·Frontiers in Pediatrics
DOI 10.3389/fped.2018.00406PMC PMC6306426
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Abstract

Asthma occurs across the life course. Its optimal treatment includes the use of personalized management plans that recognize the importance of co-morbidities including so-called "dysfunctional breathing." Such symptoms can arise as a result of induced laryngeal obstruction (ILO) or alterations in the mechanics of normal breathing called breathing pattern disorders. Whilst these two types of breathing abnormalities might be related, studies tend to focus on only one of them and do not consider their relationship. Evidence for these problems amongst childhood asthmatics is largely anecdotal. They seem rare in early childhood. Both types are more frequently recognized in the second decade of life and girls are affected more often. These observations tantalizingly parallel epidemiological studies characterizing the increasing prevalence and severity of asthma that also occurs amongst females after puberty. Exercise ILO is more common amongst adolescents and young adults. It should be properly delineated as it might be causally related to specific treatable factors. More severe ILO occurring at rest and breathing pattern disorders are more likely to be occurring within a psychological paradigm. Dysfunctional breathing is associated with asthma morbidity through a number of potential mechanisms. These include anxiety induced breathing pattern disorders and the enhanced perception of subsequent symptoms, cooling and drying of the airways from hyperventilation induced hyperresponsiveness and a direct effect of emotional stimuli on airways constriction via cholinergic pathways. Hyperventilation is the most common breathing pattern disorder amongst adults. Although not validated for use in asthma, the Nijmegen questionnaire has been used to characterize this problem. Studies show higher scores amongst women, those with poorly controlled asthma and those with psychiatric problems. Evidence that treatment with breathing retraining techniques is effective in a primary care population including all types of asthmatics suggests the problem might be more ubiquitous than just these high-risk groups. Future challenges include the need for studies characterizing all types of dysfunctional breathing in pediatric and adult patient cohorts and clearly defined, age appropriate, interventional studies. Clinicians caring for asthmatics in all age groups need to be aware of these co-morbidities and routinely ask about symptoms that suggest these problems.

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  • Most post-COVID-19 clinics request a physiotherapy assessment of BPD as a key management step, but diagnosis is hampered by the absence of universally accepted terminology or method of assessment.

    “While most post-­ COVID-­ 19 clinics request a physiotherapy assessment of BPD as a key management step, diagnosis is hampered by the absence of universally accepted terminology or method of assessment.”

    From Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation (2023) · cites this paper as [11]

    The Definitions and Terminology section discusses competing terms for dysfunctional breathing, and Diagnostic Considerations says breathing assessments can be difficult. These passages support the general point about diagnostic difficulty, but the paper concerns asthma and does not support the claim that most post-COVID-19 clinics request physiotherapy assessment or that it is a key management step there. (LLM, conf=0.87)

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  • The diagnosis of BPD is hampered by the lack of universally accepted terminology or methods of assessment.

    “In line with previous findings, our study suggests that the diagnosis of BPD is hampered by the lack of universally accepted terminology or methods of assessment. 11”

    From Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation (2023) · cites this paper as [11]

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Cited by

Sorted by citations

Authors
Connett, G. J., & Thomas, M.
Affiliations
University Hospital Southampton NHS Foundation Trust (GB)
Corresponding author
Connett, Gary J.
ORCID
Venue
Frontiers in Pediatrics
Publisher
Frontiers Media SA
Published
2018-12-20
Volume
6
Pages
406-406
ISSN
2296-2360 (ISSN-L)
DOI
10.3389/fped.2018.00406
PMC
PMC6306426
OpenAlex
W2906640889
Cited by
58
References
10
Citations by year
2026: 5 · 2025: 5 · 2024: 6 · 2023: 10 · 2022: 11 · 2021: 8 · 2020: 9 · 2019: 3 · 2013: 1
FWCI
0.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Pediatrics (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, breathing pattern disorders, hyperventilation, anxiety, breathing retraining, Nijmegen questionnaire, airway hyperresponsiveness, cholinergic pathways, sex differences, childhood asthma, adult asthma, asthma comorbidity

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