Dysfunctional Breathing Management in Asthma Care

Dysfunctional breathing encompasses a range of altered respiratory patterns that exacerbate symptoms and impair quality of life in individuals with asthma. These patterns include both breathing pattern disorders—characterised by inappropriate timing, depth or coordination of respiratory movements—and inducible laryngeal obstruction, in which paradoxical vocal cord movement triggers airway narrowing. Together they may mimic or worsen asthma, leading to misdiagnosis, overuse of bronchodilators and poor symptom control. Effective management begins with systematic recognition, using validated screening tools, clinical assessment and, where appropriate, cardiopulmonary exercise testing to distinguish dysfunctional breathing from underlying airway inflammation or hyperresponsiveness. Multidisciplinary interventions—combining respiratory physiotherapy, speech and language therapy, psychological support and personalised self‐management plans—have demonstrated improvements in symptom perception, exercise tolerance and health‐related quality of life. Remote and digital delivery of breathing retraining has widened access to non‐pharmacological care, offering cost‐effective alternatives to traditional face‐to‐face programmes. Emerging evidence highlights the need for routine assessment of co-morbid breathing disorders in asthma clinics and for integrated care pathways that align pharmacological therapy with targeted rehabilitative strategies.

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Dysfunctional Breathing Management in Asthma Care publication trend

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Technical terms

Dysfunctional breathing: A collective term for altered respiratory patterns that lead to inefficient ventilation and symptom amplification in asthma.

Breathing pattern disorder: Disordered coordination or timing of chest and abdominal muscles resulting in dyspnoea and chest discomfort without primary lung pathology.

Inducible laryngeal obstruction (ILO): Transient narrowing of the laryngeal inlet during inspiration or expiration, mimicking asthma attacks.

Nijmegen Questionnaire: A patient-reported tool that screens for symptoms of hyperventilation and breathing pattern disorders.

Cardiopulmonary exercise testing (CPET): A diagnostic method assessing respiratory, cardiovascular and metabolic responses to exercise for distinguishing dysfunctional breathing from organic disease.

References

1. Experiences of Diagnosis, Symptoms, and Use of Reliever Inhalers in Patients With Asthma and Concurrent Inducible Laryngeal Obstruction or Breathing Pattern Disorder: Qualitative Analysis of a UK Asthma Online Community. Journal of Medical Internet Research (2023).
2. Associations of Breathing Pattern Disorder and Nijmegen Score With Clinical Outcomes in Difficult-to-Treat Asthma. The Journal of Allergy and Clinical Immunology In Practice (2023).
3. Cardiopulmonary Exercise Testing in the Assessment of Dysfunctional Breathing. Frontiers in Physiology (2021).
4. Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults. European Clinical Respiratory Journal (2018).
5. A randomised controlled study of the effectiveness of breathing retraining exercises taught by a physiotherapist either by instructional DVD or in face-to-face sessions in the management of asthma in adults. Health Technology Assessment (2017).