Dysfunctional breathing and asthma
Editor- Thomas et al (1) recently showed that 29% of asthmatic patients in general practice have a high score on Nijmegen questionnaire, indicating the presence of dysfunctional breathing and suggesting scope for therapeutic intervention. Their point is that asthmatic breathlessness may coexist with breathlessness due to dysfunctional breathing and respond to breathing therapy, which has been shown to reduce complaints on Nijmegen questionnaire (2).
Keeley and Osman, in their critical comment (3), misunderstood this point and assumed that the authors meant that 29% was wrongly diagnosed. Furthermore, Keeley and Osman equated dysfunctional breathing and hypocapnia. The authors however tried to avoid this very equation, which reduces all breathing abnormalities to hyperventilation, by using the term dysfunctional breathing. This refers to unnecessary tension in breathing, unrelated to the extent of the somatic illness.
It has recently been shown to be also present in patients with lung cancer and respond to proper treatment, including breathing and relaxation therapy (4). I feel therefore that the next step of Thomas et al is valid, that is to assess the response to breathing therapy. A positive response includes a shift towards a more functional breathing pattern and a reduction of complaints on Nijmegen questionnaire. This confirms dysfunctional breathing to be a cause of complaints. It is different from psychological help to patients with asthma to cope with anxiety, that Keeley & Osman advice.
1. Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. Brit Med J 2001; 322: 1098 1100.
2. Han JN, Stegen K, DeValck C, Clement J, van de Woestijne KP. Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders. J Psychosom Res 1996; 41:481-93.
3. Keeley D, Osman L. Dysfunctional breathing and asthma. Brit Med J 2001; 322:1075-6.
4. Bredin M, Corner J, Krishnasamy M, Plant H, Bailey C, A'Hern R. Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. Brit Med J 1999; 318:901-4.
Competing interests: No competing interests