Dysfunctional Breathing Associated With Poorer Asthma Control, Lower Quality of Life

asthma attack in woman with inhaler
Dysfunctional breathing is common in patients with difficult asthma and is associated with significantly poorer asthma control and lower quality of life.

Dysfunctional breathing, characterized by divergent breathing patterns with several different accompanying symptoms, is associated with poor asthma control and reduced quality of life in patients with asthma requiring high-dose treatment, according to study results published in Respiratory Medicine.

In this cross-sectional study, researchers prospectively recruited 117 adult patients with possible severe asthma (median age, 46.1 years; 59% women) who were seen in 4 respiratory outpatient clinics in eastern Denmark over a 1-year period. Patients had “difficult” asthma, defined as asthma requiring a high-dose inhaled steroid plus another controller.

The subjective Nijmegen questionnaire (NQ) was used to assess symptoms of dysfunctional breathing. Intermittent and chronic symptoms associated with dysfunctional breathing included dyspnea, chest pain, chest tightness, frequent yawning, hyperventilation, and shortness of breath at rest. In addition, objective signs of dysfunctional breathing were assessed with the Asthma Control Questionnaire (ACQ). The mini Asthma Quality of Life Questionnaire (AQLQ) was also used to examine asthma control and quality of life in this cohort.

Overall, 29.9% of patients (n=35) in this study had dysfunctional breathing, based on a ≥23 total symptom score on the NQ. The presence of dysfunctional breathing was associated with poorer asthma control compared with the absence of dysfunctional breathing (ACQ mean scores, 2.86±1.05 vs 1.46±0.93, respectively; P =.001). Patients with dysfunctional breathing also had a mean lower quality of life score on the AQLQ (4.2±1.04 vs 5.49±0.85; P =.001). Based on the Breathing Pattern Assessment Tool (BPAT) score (BPAT ≥4 vs <4), worse asthma control was observed in patients with objective signs of dysfunctional breathing (ACQ mean, 3.15±0.93 vs 2.03±1.15).

Study limitations included the lack of objective hyperventilation measurements and a lack of specialist patient reviewers experienced with dysfunctional breathing.

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“Physicians should be aware that some patients may have an alternative explanation for their symptoms as there are many other diseases which may give a similar picture,” suggested the investigators.

Disclosure: This clinical trial was supported by Novartis Healthcare, Denmark. Please see the original reference for a full list of authors’ disclosures.


Sedeh FB, Von Bülow A, Backer V, et al. The impact of dysfunctional breathing on the level of asthma control in difficult asthma. Respir Med. 2020;163:105894.