Page 24 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 24
Introduction of breathing that results in intermittent or
chronic symptoms which may be respirato-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma Dysfunctional breathing (DB) is a chronic ry and/or non-respiratory”.9 Various terms
or recurrent alteration of normal breathing have been used: earlier it was mainly de-
pattern, recognized as an important differ- scribed as a hyperventilation syndrome, while
ential diagnosis for individuals with “unex- nowadays it is more often called dysfunction-
plained” dyspnoea.1 Hidden in the complex al breathing, functional breathing disorder,
management of many respiratory diseases, breathing pattern disorder and behavioural
such as asthma, COPD and “long-COVID”, or psychogenic breathlessness, etc. The later
DB may exacerbate these diseases/disorders, terminology results from better understand-
reduce symptom control and increase medi- ing of pathophysiological processes underly-
cation and healthcare service use.2–6 Recent- ing the abnormal pattern of breathing which
ly, more evidence-based classification, diag- itself does not necessarily include hyperventi-
nostic criteria and treatment modalities of DB lation. In this narrative review we will prefer
have been developed.2 the term “dysfunctional breathing”.
Dysfunctional breathing in the modern Aetiology and pathophysiology
era?
Efficient breathing results from balanced
Eighty-five years ago a group of authors re- motion between the upper rib cage and the
marked: “Patients presenting well known pat- lower rib cage and the abdomen. It requires
tern of symptoms haunt the offices of physi- synchronized movement of diaphragm, ab-
cians and specialists in every field of medical dominal and rib cage muscles.10 Discoordi-
practice. They are often shunted from one nation of muscle contractions results in sen-
physician to another, and the sins of commis- sations of dyspnoea and is often present in
sion inflicted upon them fill many black pages DB, especially in apical, thoracic dominant
in our book of achievement.”7 breathing.11
In 1975, in the respiratory physiology de- A simplified physiological process en-
partment of Papworth Hospital, Cambridge, countered in hyperventilation may help part-
England, the specialists dubbed this phenom- ly understand relationships between causes of
enon simply as the “multiple doctor” or the DB and its consequences (Figure 1). Hyper-
“fat folder syndrome”.8 In the late 1960’s, one ventilation is an increase in ventilation that is
of the newly reported major side effects of re- greater than that required by metabolic needs
cently introduced oral contraceptives was ve- or arterial blood gas tensions. It may be acute,
nous thromboembolism. Since then, as many episodic, and chronic. Furthermore, it has
physicians encountered young ladies taking been well-described that stressful events, es-
birth-control pills that reported syncopal at- pecially emotional upset, can elicit a habitual
tacks and other possible manifestations of change in breathing pattern.12 Indeed, chang-
pulmonary embolism, dysfunctional breath- es in breathing depend on a variety of exter-
ing (most known as “h yperventilation syn- nal and internal factors (i.e. cold, heat, hypox-
drome” (HVS) has become more and more ia, pain and panic).13 DB can be described as a
recognized in different clinical settings. habit in breathing and in some cases includes
over-breathing (increase in both tidal volume
Definition and respiratory rate). Thus, it may result in
decrease in carbon dioxide. Consequently, hy-
There is no formal definition of DB. Bark- pocapnia directly induces cerebral vasocon-
er and Everard reviewed the literature and striction and cerebral hypoxia, while kidneys
suggested a new definition of DB: “an alter-
ation in the normal biomechanical patterns
chronic symptoms which may be respirato-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma Dysfunctional breathing (DB) is a chronic ry and/or non-respiratory”.9 Various terms
or recurrent alteration of normal breathing have been used: earlier it was mainly de-
pattern, recognized as an important differ- scribed as a hyperventilation syndrome, while
ential diagnosis for individuals with “unex- nowadays it is more often called dysfunction-
plained” dyspnoea.1 Hidden in the complex al breathing, functional breathing disorder,
management of many respiratory diseases, breathing pattern disorder and behavioural
such as asthma, COPD and “long-COVID”, or psychogenic breathlessness, etc. The later
DB may exacerbate these diseases/disorders, terminology results from better understand-
reduce symptom control and increase medi- ing of pathophysiological processes underly-
cation and healthcare service use.2–6 Recent- ing the abnormal pattern of breathing which
ly, more evidence-based classification, diag- itself does not necessarily include hyperventi-
nostic criteria and treatment modalities of DB lation. In this narrative review we will prefer
have been developed.2 the term “dysfunctional breathing”.
Dysfunctional breathing in the modern Aetiology and pathophysiology
era?
Efficient breathing results from balanced
Eighty-five years ago a group of authors re- motion between the upper rib cage and the
marked: “Patients presenting well known pat- lower rib cage and the abdomen. It requires
tern of symptoms haunt the offices of physi- synchronized movement of diaphragm, ab-
cians and specialists in every field of medical dominal and rib cage muscles.10 Discoordi-
practice. They are often shunted from one nation of muscle contractions results in sen-
physician to another, and the sins of commis- sations of dyspnoea and is often present in
sion inflicted upon them fill many black pages DB, especially in apical, thoracic dominant
in our book of achievement.”7 breathing.11
In 1975, in the respiratory physiology de- A simplified physiological process en-
partment of Papworth Hospital, Cambridge, countered in hyperventilation may help part-
England, the specialists dubbed this phenom- ly understand relationships between causes of
enon simply as the “multiple doctor” or the DB and its consequences (Figure 1). Hyper-
“fat folder syndrome”.8 In the late 1960’s, one ventilation is an increase in ventilation that is
of the newly reported major side effects of re- greater than that required by metabolic needs
cently introduced oral contraceptives was ve- or arterial blood gas tensions. It may be acute,
nous thromboembolism. Since then, as many episodic, and chronic. Furthermore, it has
physicians encountered young ladies taking been well-described that stressful events, es-
birth-control pills that reported syncopal at- pecially emotional upset, can elicit a habitual
tacks and other possible manifestations of change in breathing pattern.12 Indeed, chang-
pulmonary embolism, dysfunctional breath- es in breathing depend on a variety of exter-
ing (most known as “h yperventilation syn- nal and internal factors (i.e. cold, heat, hypox-
drome” (HVS) has become more and more ia, pain and panic).13 DB can be described as a
recognized in different clinical settings. habit in breathing and in some cases includes
over-breathing (increase in both tidal volume
Definition and respiratory rate). Thus, it may result in
decrease in carbon dioxide. Consequently, hy-
There is no formal definition of DB. Bark- pocapnia directly induces cerebral vasocon-
er and Everard reviewed the literature and striction and cerebral hypoxia, while kidneys
suggested a new definition of DB: “an alter-
ation in the normal biomechanical patterns
