Dysfunctional breathing: a review of the literature and proposal for classification

Abstract

Dysfunctional breathing is a term describing breathing disorders where chronic changes in breathing pattern result in dyspnoea and other symptoms in the absence or in excess of the magnitude of physiological respiratory or cardiac disease. We reviewed the literature and propose a classification system for the common dysfunctional breathing patterns described. The literature was searched using the terms: dysfunctional breathing, hyperventilation, Nijmegen questionnaire and thoraco-abdominal asynchrony. We have summarised the presentation, assessment and treatment of dysfunctional breathing, and propose that the following system be used for classification. 1) Hyperventilation syndrome: associated with symptoms both related to respiratory alkalosis and independent of hypocapnia. 2) Periodic deep sighing: frequent sighing with an irregular breathing pattern. 3) Thoracic dominant breathing: can often manifest in somatic disease, if occurring without disease it may be considered dysfunctional and results in dyspnoea. 4) Forced abdominal expiration: these patients utilise inappropriate and excessive abdominal muscle contraction to aid expiration. 5) Thoraco-abdominal asynchrony: where there is delay between rib cage and abdominal contraction resulting in ineffective breathing mechanics.This review highlights the common abnormalities, current diagnostic methods and therapeutic implications in dysfunctional breathing. Future work should aim to further investigate the prevalence, clinical associations and treatment of these presentations.

FIGURE 1

Recordings of quiet tidal breathing at rest, followed by maximal expiration then inspiration. Breathing patterns are shown for: a) a healthy volunteer; b) hyperventilation syndrome, note the rapid respiratory rate, and tidal breathing closer to inspiratory capacity than in panel a; c) erratic breathing pattern, note that the patient was unable to coordinate a maximal expiratory and inspiratory manoeuvre at the end of the recording; d) thoracic dominant breathing, note the large volume breaths with minimal inspiratory reserve capacity; e) forced expiratory pattern before (grey) and after (black) exercise, note tidal breathing occurs at low lung volumes, with minimal expiratory reserve volume; and f) thoraco-abdominal asynchrony, this panel shows recordings from sensors detecting thoracic and abdominal movement, demonstrating asynchrony during quiet tidal breathing.