DB is also common in patients with musculoskeletal pain and movement dysfunction ,( 8 ) particularly those who are unresponsive to standard manual therapy and exercise rehabilitation treatment .( 9 )
TABLE 2 : THE NIJMEGEN QUESTIONNAIRE Please indicate which column reflects how often you suffer from the symptoms listed below
Chest pain
Feeling tense
Blurred vision
Never ( score 0 )
Rare ( score 1 )
Sometimes ( score 2 )
Often ( score 3 )
Very often ( score 4 )
DB in children Certain types of DB are more common in children . For example , around 50 % of children present with mouth breathing .( 10 ) This is an abnormal breathing behaviour which impacts on sleep , attention , mood and learning , as well as on craniofacial and postural development .( 11 ) However , mouth breathing is often the tip of the iceberg of breathing dysfunction in children and more general types of breathing pattern disorders are also common and typically go undiagnosed .( 12 ) It has been reported that hyperventilation occurs in 18.6 % of children without asthma and 55 % of those with asthma .( 3 ) The extrathoracic breathing dysfunction exercise-induced laryngeal obstruction ( EILO ) is highly prevalent in teenage girls in particular and is reported to affect up to 10 % of this group .( 13 )
Assessment of DB
The following are common and easily observed signs of DB :
• Rapid breathing ;
• Excessively irregular breathing with frequent sighing ;
• Mouth breathing ;
• Upper rib-cage-dominant breathing ;
• Hurried speech with breaths taken mid-sentence ;
• Throat clearing and unproductive cough .
A proper assessment of DB should be multidimensional and requires more than one assessment tool .( 14,15 ) Breathing assessment tools used in multidimensional assessments include :
• The Nijmegen Questionnaire ( NQ ) ( see Table 2 );
• The Self Evaluation of Breathing Questionnaire ( SEBQ ) ( see Table 3 );
• The Breathing Pattern Assessment Tool ;
• The Manual Assessment of Respiratory Motion ;
• Breath holding time ;
• Capnometry .
Dizzy spells
Feeling confused
Faster and deeper breathing
Short of breath
Tight feelings in the chest
Bloated feelings in the stomach
Tingling fingers
Unable to breathe deeply
Stiff fingers or arms
Tight feelings around mouth
Cold hands or feet
Palpitations
Feelings of anxiety
Subtotals
TOTAL
These tools are most useful when practitioners are trained in understanding their context and correct interpretation to help guide individualised and precise breathing training .
Scoring breathing symptoms Even if practitioners have not received training , symptom measures such as the NQ and SEBQ are still useful as screening tools and for tracking symptoms over Time . An NQ score of more than 20 is suggestive of DB . Cut-offs for the SEBQ have not been as clearly established , but clinical experience suggests that scores above 20 on this questionnaire indicate that the patient has a high number of respiratory symptoms .
Importance of Treating DB
In practical terms , the resolution of breathing dysfunction can be pivotal to the successful treatment of chronic back and neck pain , and to the rehabilitation of faulty patterns of movement and posture . Successful restoration of functional breathing can also be an important contributor to achieving best clinical outcomes for patients with cardiorespiratory conditions such as asthma , COPD , hypertension and heart disease , gastrointestinal dysfunction , anxiety , speech disorders and chronic ill health – all situations in which dysregulation of fundamental homeostatic mechanisms prevents the healing response from proceeding optimally . Correction of poor breathing habits is also an essential component in ensuring health and correct structural and postural development of children . Manual therapy to mobilise the rib cage , release the diaphragm and relax and lengthen respiratory muscles does have a role to play in treating patients with DB . However , it is often necessary to combine manual therapy with breathing retraining . The correction of DB can be challenging and requires persistent and regular practice . It also needs to be individualised as no single type of breathing retraining suits all patients or all types of DB .
78 | vol28 | no2 | JATMS