Dysfunctional breathing is common in children and adolescents with asthma, especially in older patients and girls. These patients have poor perceived asthma control as indicated by the greater use of β2-agonist reliever medication, according to a study published in Pediatric Allergy and Immunology.¹

In this study, researchers from the University Hospital of Southern Denmark enrolled Danish children and adolescents with asthma, aged 10 to 17 years, from the Pediatric and Adolescent Outpatient Clinic starting in February 2021 for a period of 15 months. They had been treated with inhaled steroids within the preceding 3 months before the start of the study. The exclusion criteria were presence of significant cardiopulmonary, neurologic, or musculoskeletal disorders. Boys comprised almost half of the study group (49%). Through this study, they endeavored to determine the prevalence of dysfunctional breathing in the study participants with asthma. Their aim was also to investigate the impact of dysfunctional breathing on asthma control. Dysfunctional breathing was evaluated with the help of the Nijmegen Questionnaire (NQ) and the Asthma Control Questionnaire (ACQ) was used to assess asthma symptoms.

Out of the 363 participants, 67 (18%) scored ≥23 on the Nijmegen Questionnaire suggesting dysfunctional breathing. Patients with dysfunctional breathing were older (15.6 years) compared to those without dysfunctional breathing (13.7 years). Most of the subjects with dysfunctional breathing were girls (84%). Patients in the dysfunctional breathing group had higher percentage of FEV1 (89.4 vs 85.7, respectively) and higher ratios of FEV1 to forced vital capacity (0.87 to 0.82).

The ACQ score was higher in the dysfunctional breathing group compared to the non-dysfunctional breathing group; 2.0 vs 0.6, respectively. Patients in the dysfunctional breathing group used β2-agonist puffs two times in a week compared to zero puffs in a week in the non-dysfunctional breathing group. The dose of inhaled steroids and the use of a second controller medication was comparable between the two groups. Compliance with ICS or ICS/long-acting beta agonist prescriptions was high to the tune of 80% and was similar in the two groups.

According to these findings, older age, female sex, higher FEV1 and higher ACQ scores were predictors of dysfunctional breathing. Higher NQ scores, higher body mass index‐standard deviation score (BMI‐SDS) and higher use of β2-agonists were predictive of poor control of asthma according to ACQ scores. Patients with asthma and dysfunctional breathing did not have more severe asthma compared to asthmatics without dysfunctional breathing.

Dysfunctional breathing is characterized by abnormal breathing patterns. The major symptoms are dyspnea, hyperventilation, yawning, or shortness of breath, which occur in an intermittent manner or are persistent; other symptoms include dizziness and palpitations. It is a clinical diagnosis.

This study shows that dysfunctional breathing is frequently present in children and adolescents with asthma and has a negative impact on asthma control as judged by the patients. The authors suggest dysfunctional breathing as “a confounder of asthma symptoms” because of which asthma control may be erroneously interpreted as worse than what it actually is. Hence, physicians treating these patients should be aware of this association. Children and adolescents who present with difficult to treat asthma should be customarily screened for dysfunctional breathing to avoid overtreatment of the condition.

Reference

1. Vahlkvist S, et al. Dysfunctional breathing and its impact on asthma control in children and adolescents. Pediatr Allergy Immunol. 2023 Jan;34(1):e13909. doi: 10.1111/pai.13909.