Dysfunctional breathing in asthma.
Thomas et al studied the prevalence of dysfunctional
breathing in patients treated for asthma in the primary care setting(1).
This interesting study has highlighted an important area for further
Keeley and Osman’s comments regarding the validity of Nijmengen
questionnaire and the authors’ interpretation of the results were highly
relevant(2). We would like to raise some additional points.
Population variations in socioeconomic status, smoking rates,
pollution exposure and concurrent lung disease may affect the prevalence
of asthma and dysfunctional breathing. Therefore, as a single centre
study, we doubt that these results can be applied to a general population.
It is important to know the prevalence of dysfunctional breathing in
asthmatics, but these data are only meaningful in relation to the
prevalence in the general population.
We believe that further research could take the form of a larger
cross-sectional study. This would allow comparison of the prevalence of
dysfunctional breathing in asthmatics and the general population, as well
as the investigation of other variables. A multi-centre study will take
account of these regional population variations. The diagnosis of
dysfunctional breathing should be made using both anxiety and symptom-
based questionnaires, rather than the Nijmengen alone. Such a study would
cast further light on an area where uncertainty over diagnosis and
Matthew A Garner
Katharine E Neville-Smith
James A Shand
Dominic P Waddington
Third Year Medical Students
Department of Epidemiology and Public Health,
The Medical School, University of Newcastle upon Tyne
1. Mike Thomas, R K McKinley, Elaine Freeman, Chris Foy, Prevalence
of dysfunctional breathing in patients treated for asthma in primary care:
cross sectional survey
2. Keeley, D., Osman, L. Dysfunctional breathing and asthma. BMJ
Competing interests: No competing interests