Dysfunctional breathing in children and adults with asthma
- 1University Hospital Southampton NHS Foundation Trust, United Kingdom
Asthma occurs across the life course. Its optimal treatment includes the use of personalised management plans that recognise 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 recognised in the second decade of life and girls are affected ore often. These observations tantalisingly parallel epidemiological studies characterising 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 characterise 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 characterising all types of dysfunctional breathing in paediatric 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.
Keywords: Asthma, Laryngeal dysfunction, dysfunctioal breathing, paradoxical vocal fold motion, Hyperventilation, Breathing pattern disorders, inducible laryngeal obstruction, exercise inducible laryngeal obstruction, Breathing retraining exercises, Breathing control
Received: 13 Sep 2018;
Accepted: 07 Dec 2018.
Edited by:Steve Turner, University of Aberdeen, United Kingdom
Reviewed by:Jean-Paul Praud, Université de Sherbrooke, Canada
Yusei Ohshima, University of Fukui, Japan
Copyright: © 2018 Connett and Thomas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Gary J. Connett, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, firstname.lastname@example.org