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Dysfunctional breathing: Clinical characteristics and treatment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Center for Clinical Research Dalarna.ORCID iD: 0000-0003-4701-1535
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Dysfunctional breathing (DB) is a respiratory disorder involving an upper chest breathing pattern and respiratory symptoms that cannot be attributed to a medical diagnosis.

Aim: The overall aim of this thesis was to describe patients with DB and investigate clinical outcomes after physiotherapy treatment.

Methods: Study I was descriptive and comparative, that included 25 patients with DB and 25 age- and sex-matched patients with asthma. Health-related quality of life (HRQoL), anxiety, depression, sense of coherence, influence on daily life due to breathing problems, respiratory symptoms, emergency room visits and asthma medication were investigated. Study II, a 5-year follow-up study based on the same sample as study I (22 patients with DB, 23 patients with asthma), studied treatment outcomes after information and breathing retraining. Study III was descriptive and correlational (20 healthy subjects), investigating whether the Respiratory Movement Measuring Instrument (RMMI) can discriminate between different breathing patterns in varying body positions. Study III also studied correlations between respiratory movements and breathing volumes (12 healthy subjects). Study IV was a single-subject AB design with follow-ups. Self-registered patient-specific respiratory symptoms and respiratory-related activity limitations and breathing pattern (measured with the RMMI) were evaluated after an intervention consisting of information and breathing retraining in five patients with DB.

Results: Patients with DB had lower HRQoL (SF-36): vitality (mean 47 vs. 62), social functioning (70 vs. 94) and role emotional (64 vs. 94) (p<0.05) than patients with asthma. The DB group had a higher prevalence of anxiety (56% vs. 24%) and experienced more breathing problems than the asthma group. Patients with DB had made several emergency room visits and had been treated with asthma medication. At the 5-year follow-up, patients with DB showed improved HRQoL (SF-36): physical function 77 to 87 (p=0.04), decreased breathing problems and emergency room visits, and they were not treated with asthma medication. The RMMI can differentiate between different breathing patterns in different body positions. Strong correlations between respiratory movements and breathing volumes were observed (rs 0.86-1.00). The results in study IV indicate that patients with DB benefit from information and breathing retraining regarding decreased respiratory symptoms and activity limitations and improved breathing pattern.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1239
Keyword [en]
dysfunctional breathing, breathing pattern, breathing retraining, respiratory movement measuring instrument, respiratory symptoms, respiratory-related activity limitations
National Category
Medical and Health Sciences
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-295667ISBN: 978-91-554-9629-6OAI: oai:DiVA.org:uu-295667DiVA: diva2:950488
Public defence
2016-09-16, Falu lasarett, Föreläsningssalen, Söderbaums väg 8, Falun, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2016-08-26 Created: 2016-06-08 Last updated: 2016-09-05
List of papers
1. A comparison between patients with dysfunctional breathing and patients with asthma
Open this publication in new window or tab >>A comparison between patients with dysfunctional breathing and patients with asthma
2008 (English)In: Clinical Respiratory Journal, ISSN 1752-6981, Vol. 2, no 2, 86-91 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: The term dysfunctional breathing (DB) has been introduced to describe patients who display a divergent breathing pattern and have breathing problems that cannot be attributed to a specific medical diagnosis such as asthma, chronic obstructive pulmonary disease or sensory hyper-reactivity. Objective: The objective of this study was to investigate similarities and differences in patients with DB, and patients with well-controlled asthma regarding health-related quality of life, anxiety, depression, sense of coherence (SOC), hyperventilation and effects on daily life. Methods: Twenty-five consecutive patients with DB, and 25 age- and sex-matched patients with asthma (ages 20–73 years) participated in the study. The diagnosis of DB was based on the presence of a dysfunctional breathing pattern and at least five symptoms associated with DB. Results: The group with DB had lower health-related quality of life (short form 36): vitality (mean) 47 vs 62, social functioning 70 vs 94 and role emotional 64 vs 94 (P < 0.05) than the asthmatic group. The DB group also had a higher prevalence of anxiety (56% vs 24%) and a lower SOC (134 vs 156) (P < 0.05). Hyperventilation, defined according to the Nijmegen symptoms questionnaire, was observed in 56% of patients with DB vs 20% in the asthma group (P = 0.02). Conclusions: The results of the study indicate that patients with DB are more disabled than patients with well-controlled asthma. There is a great need for more knowledge about breathing symptoms of a dysfunctional nature, to be able to identify and manage these patients adequately.

Keyword
asthma, breathing pattern, dysfunctional breathing, health-related quality of life, sense of coherence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-106102 (URN)10.1111/j.1752-699X.2007.00036.x (DOI)000257155900005 ()
Available from: 2009-06-15 Created: 2009-06-15 Last updated: 2016-09-05Bibliographically approved
2. Breathing retraining: A five-year follow-up of patients with dysfunctional breathing
Open this publication in new window or tab >>Breathing retraining: A five-year follow-up of patients with dysfunctional breathing
2011 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 105, no 8, 1153-1159 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: The term dysfunctional breathing (DB) has been introduced to describe patients who display divergent breathing patterns and have breathing problems that cannot be attributed to a specific medical diagnosis. Patients with DB are often misdiagnosed as having asthma. Objectives: To describe patients with DB, five years after a breathing retraining intervention. Methods: Out of initially 25 patients with DB and 25 age and sex-matched patients with asthma, 22 patients with DB and 23 patients with asthma (ages 25-78 years) were followed up after five years. Data were collected from posted self-report questionnaires. Only patients with DB had received breathing retraining, consisting of information; advice and diaphragmatic breathing. Patients were evaluated regarding quality of life (SF-36), anxiety, depression, sense of coherence, hyperventilation, influence on daily life, emergency room (ER) visits, and symptoms associated with DB. Results: Quality of life (SF-36), physical component summary scale (PCS), had improved in patients with DB from 43 to 47 (p = 0.03). The number of ER visits had decreased from 18 to 2 in patients with DB (p = 0.02). Symptoms associated with DB had decreased extensively, from a mean score of 6.9 to 2.7, on a DB criterion list (p < 0.001). Patients with DB were less impaired by their breathing problems both in daily life and when exercising (p < 0.001). The only difference found over time in the asthma group concerned quality of health, bodily pain, which had deteriorated, from 77 to 68 (p = 0.049). Conclusion: This five-year follow-up study indicates that patients with dysfunctional breathing benefit from breathing retraining.

Keyword
Dysfunctional breathing, Asthma, Breathing retraining, Health-related quality of life, Emergency room visits, Influence on daily life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-156613 (URN)10.1016/j.rmed.2011.03.006 (DOI)000292672000006 ()
Available from: 2011-08-07 Created: 2011-08-04 Last updated: 2016-09-05Bibliographically approved
3. Measuring breathing patterns and respiratory movements with the respiratory movement measuring instrument
Open this publication in new window or tab >>Measuring breathing patterns and respiratory movements with the respiratory movement measuring instrument
Show others...
2016 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 36, no 5, 414-420 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The respiratory movement measuring instrument (RMMI) is a laser-based non-invasive technique to measure breathing patterns and respiratory movements (RMs). Little knowledge is known about the ability of the RMMI to measure breathing patterns and the correlation between RMs and breathing volumes.

OBJECTIVES: One aim was to investigate whether the RMMI could discriminate between normal versus abdominal versus high costal breathing patterns in different body positions. A second aim was to determine the correlation between RMs and breathing volumes in different body positions.

METHOD: Twenty adult, healthy subjects (10 women) were included in the study. The RMMI was used to study the above-mentioned breathing patterns in supine, sitting and standing positions. A subgroup of 12 subjects (6 women) simultaneously performed measurements of breathing volumes while RMs were recorded.

RESULTS: The RMMI was able to discriminate between different breathing patterns in different body positions (P<0·001). The upper thoracic contribution to RMs in the sitting position was 47% for natural breathing, 32% for abdominal breathing and 64% for high costal breathing; similar results were found in the supine and standing positions. A strong correlation was observed between RMs as measured by the RMMI and different breathing volumes in all three body positions (Spearman's rho 0·86-1·00).

CONCLUSION: The RMMI can be used to measure and analyse different breathing patterns in different body positions, and the correlation between measured RMs and breathing volumes is strong.

Keyword
body positions, breathing volumes, correlation, laser distance sensors, non-invasive technique
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-278041 (URN)10.1111/cpf.12302 (DOI)
External cooperation:
Available from: 2016-02-23 Created: 2016-02-23 Last updated: 2016-09-09Bibliographically approved
4. Breathing retraining for patients with dysfunctional breathing: A series of five single-subject AB designs with long-term follow-up
Open this publication in new window or tab >>Breathing retraining for patients with dysfunctional breathing: A series of five single-subject AB designs with long-term follow-up
(English)Manuscript (preprint) (Other academic)
Keyword
dysfunctional breathing, breathing retraining, breathing pattern, respiratory symptoms, activity limitations, single-subject design
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-295662 (URN)
Available from: 2016-07-06 Created: 2016-06-08 Last updated: 2016-09-05

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