Intended for healthcare professionals

Rapid response to:

Primary Care

Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey

BMJ 2001; 322 doi: (Published 05 May 2001) Cite this as: BMJ 2001;322:1098

Rapid Response:

Physiotherapy for Dysfunctional Breathing

We found the results of Thomas et al interesting but unsurprising.
We have used the Nijmegan questionnaire as part of an audit to evaluate
respiratory intervention in out patients presenting with dysfunctional

Following a course of physiotherapy treatment, including education,
relaxation, breathing control and exercise, all patients showed an
improvement in their Nijmegan questionnaire (p=0.0001) and we noted a
reduction in respiratory rate.

In an attempt to measure the ‘avoidable morbidity’ described by
Thomas et al (2001) we used two visual analogue scales (VAS) measuring
perceived breathlessness and degree of ‘bother’. The VAS relating to how
much the patients’ breathing troubled them was reduced significantly
(p=0.0014) following treatment. Patients were less ‘bothered’ by their
breathing and this may demonstrate that our patients are better able to
cope with their breathing disorder, even if other objective measures, such
as the Nijmegan questionnaire and resting respiratory rate, showed less

The suggestion that patients experienced an improvement in their
quality of life following their course of treatment was supported by the
positive comments we received, although not formally measured.

We agree with Thomas et al that effective intervention exists and our
audit shows that respiratory physiotherapy is an important component in
the diagnosis and management of these patients.

Further research of these interventions is needed in the form of a
randomised-controlled trail.

Competing interests: No competing interests

02 July 2001
Victoria Johnson
Senior Respiratory Physiotherapists
Jacqueline Crosby
Nottingham City Hospital