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Ritter O, Noureddine S, Laurent L, Roux P, Westeel V, Barnig C. Unraveling persistent dyspnea after mild COVID: insights from a case series on hyperventilation provocation tests. Front Physiol 2024; 15:1394642. [PMID: 39129752 PMCID: PMC11316270 DOI: 10.3389/fphys.2024.1394642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Dyspnea is a common yet poorly understood symptom of long COVID, affecting many patients. This brief report examines the role of dysfunctional breathing in persistent dyspnea among patients with mild post-COVID-19 using hyperventilation provocation tests (HVPT). In this case series, six patients with unexplained dyspnea and normal cardiopulmonary function underwent HVPT. Despite normal exercise testing results, all patients exhibited delayed PETCO2 recovery, indicative of a hyperventilation pattern consistent with chronic hyperventilation syndrome, without typical symptomatic manifestations. These findings suggest underlying post-COVID respiratory dysregulation, emphasizing the importance of targeted diagnostic and therapeutic approaches for persistent respiratory symptoms in long COVID patients.
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Affiliation(s)
- Ophélie Ritter
- Department of Chest Disease, University Hospital Besançon, Besançon, France
| | - Sofia Noureddine
- Department of Chest Disease, University Hospital Besançon, Besançon, France
| | - Lucie Laurent
- Department of Chest Disease, University Hospital Besançon, Besançon, France
| | - Pauline Roux
- Department of Chest Disease, University Hospital Besançon, Besançon, France
| | - Virginie Westeel
- Department of Chest Disease, University Hospital Besançon, Besançon, France
- Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, Besançon, France
| | - Cindy Barnig
- Department of Chest Disease, University Hospital Besançon, Besançon, France
- Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, Besançon, France
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Duignan N, Ridge P, Leonard S, McDonnell M, Cusack R, Harrison M, Rutherford R, O'Malley N, Dolan C. Expanded central role of the respiratory physiotherapists in the community setting. Ir J Med Sci 2023; 192:1581-1588. [PMID: 36380190 PMCID: PMC9666941 DOI: 10.1007/s11845-022-03213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
The development of community hubs through the Slaintecare initiative will rely on respiratory physiotherapists and clinical nurse specialists for the management of chronic respiratory diseases. The role of the respiratory physiotherapist has evolved dramatically over the last decade. We review the increasing scope of practice of the physiotherapist and the evidence base for same. We pay particular attention to the role of the physiotherapist in areas such as pulmonary rehabilitation, sputum clearance, neuromuscular disease, chronic respiratory failure, ambulatory oxygen assessments and dysfunctional breathing. We give an in depth review of sputum clearance techniques. We also address areas of potential future expansion for the role of the physiotherapist such as prescription and initiation of non-invasive ventilation.
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Affiliation(s)
- Niamh Duignan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Padraic Ridge
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland.
| | - Sinead Leonard
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ruth Cusack
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Michael Harrison
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Robert Rutherford
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Niamh O'Malley
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ciara Dolan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
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Montani D, Savale L, Noel N, Meyrignac O, Colle R, Gasnier M, Corruble E, Beurnier A, Jutant EM, Pham T, Lecoq AL, Papon JF, Figuereido S, Harrois A, Humbert M, Monnet X. [Post-COVID-19 syndrome]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2023; 207:812-820. [PMID: 37292432 PMCID: PMC10126882 DOI: 10.1016/j.banm.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/17/2023] [Indexed: 06/10/2023]
Abstract
In the aftermath of acute infection with the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), a large number of symptoms persist or appear, constituting a real syndrome called "long COVID-19" or "post-COVID- 19" or "post-acute COVID-19 syndrome". Its incidence is very high, half of patients showing at least one symptom at 4-6 months after Coronarovirus infectious disease 2019 (COVID-19). They can affect many organs. The most common symptom is persistent fatigue, similar to that seen after other viral infections. Radiological pulmonary sequelae are relatively rare and not extensive. On the other hand, functional respiratory symptoms, primarily dyspnoea, are much more frequent. Dysfunctional breathing is a significant cause of dyspnoea. Cognitive disorders and psychological symptoms are also very common, with anxiety, depression and post-traumatic stress symptoms being widely described. On the other hand, cardiac, endocrine, cutaneous, digestive or renal sequelae are rarer. The symptoms generally improve after several months, even if their prevalence at two years remains significant. Most of the symptoms are favored by the severity of the initial illness, and the psychic symptoms by the female sex. The pathophysiology of most symptoms is poorly understood. The influence of the treatments used in the acute phase is also important. Vaccination, on the other hand, seems to reduce their incidence. The sheer number of affected patients makes long-term COVID-19 syndrome a public health challenge.
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Affiliation(s)
- David Montani
- Université Paris-Saclay, AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- Université Paris-Saclay, AP-HP, service de médecine interne et immunologie clinique, hôpital de Bicêtre, DMU 7 endocrinologie-immunités-inflammations-cancer-urgences, Le Kremlin-Bicêtre, France
| | - Olivier Meyrignac
- Université Paris-Saclay, AP-HP, service de radiologie diagnostique et interventionnelle, Hôpital de Bicêtre, DMU 14 Smart Imaging, BioMaps, Le Kremlin-Bicêtre, France
| | - Romain Colle
- Université Paris-Saclay, AP-HP, service de psychiatrie, hôpital de Bicêtre, DMU 11 psychiatrie, santé mentale, addictologie et nutrition, équipe MOODS, Inserm U1178, centre de recherche en épidémiologie et santé des populations (CESP), Le Kremlin-Bicêtre, France
| | - Matthieu Gasnier
- Université Paris-Saclay, AP-HP, service de psychiatrie, hôpital de Bicêtre, DMU 11 psychiatrie, santé mentale, addictologie et nutrition, équipe MOODS, Inserm U1178, centre de recherche en épidémiologie et santé des populations (CESP), Le Kremlin-Bicêtre, France
| | - Emmanuelle Corruble
- Université Paris-Saclay, AP-HP, service de psychiatrie, hôpital de Bicêtre, DMU 11 psychiatrie, santé mentale, addictologie et nutrition, équipe MOODS, Inserm U1178, centre de recherche en épidémiologie et santé des populations (CESP), Le Kremlin-Bicêtre, France
| | - Antoine Beurnier
- Université Paris-Saclay, AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Etienne-Marie Jutant
- Université Paris-Saclay, AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
- Université de Poitiers, CHU de Poitiers, service de pneumologie, Inserm CIC 1402 Axe Is-ALIVE, Poitiers, France
| | - Tai Pham
- Université Paris-Saclay, AP-HP, service de médecine intensive-réanimation, hôpital de Bicêtre, DMU 4 CORREVE maladies du cœur et des vaisseaux, Inserm UMR_S999, FHU Sepsis, CARMAS, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- Université Paris-Saclay, AP-HP, centre de recherche clinique Paris-Saclay, DMU 13 santé publique, information médicale, appui à la recherche clinique, Inserm U1018, centre de recherche en épidémiologie et santé des populations (CESP), Le Kremlin-Bicêtre, France
| | - Jean-François Papon
- Université Paris-Saclay, AP-HP, service d'ORL et de chirurgie cervico-faciale, DMU 9 neurosciences, Inserm, U955, E13, CNRS ERL7000, Le Kremlin-Bicêtre, France
| | - Samy Figuereido
- Université Paris-Saclay, AP-HP, service d'anesthésie-réanimation et médecine péri-opératoire, Hôpital de Bicêtre, DMU 12 anesthésie, réanimation, douleur, Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- Université Paris-Saclay, AP-HP, service de réanimation chirurgicale, hôpital de Bicêtre, DMU 12 anesthésie, réanimation, douleur, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Université Paris-Saclay, AP-HP, service de médecine intensive-réanimation, hôpital de Bicêtre, DMU 4 CORREVE maladies du cœur et des vaisseaux, Inserm UMR_S999, FHU Sepsis, CARMAS, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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Gouzi F, Dubois-Gamez AS, Lacoude P, Abdellaoui A, Hédon C, Charriot J, Boissin C, Vachier I, Hayot M, Molinari N, Bourdin A. Feasibility of a nasal breathing training during pulmonary rehabilitation. A pilot randomized controlled study. Respir Physiol Neurobiol 2023; 308:103987. [PMID: 36372120 DOI: 10.1016/j.resp.2022.103987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Hyperventilation syndrome (HVS) is a common source of dyspnea and disability. While pulmonary rehabilitation (PR) including breathing exercises is indicated, randomized controlled trial are warranted to recommend one type of breathing exercise than another. We aimed to compare during PR, the effect of 5 sessions of nasal ventilation exercise (NV+PR) versus voluntary hypoventilation (vHV+PR) on exercise dyspnea (primary outcome) and capacity and health-related quality of life in patients. In this open label randomized controlled trial, 19 HVS patients (age=48.3 ± 15.2 y.o, female/male=18/1, Nijmegen score=33 ± 7.7) were randomized in a NV+PR (n = 9) or vHV+PR (n = 10) group. Modified Medical Research Council (mMRC) dyspnea, 6-minute walking distance (6MWD) with nasal/oral ventilation were assessed before and after 3 months of PR, and questionnaires (Nijmegen, VQ-11). There was a significant effect of PR of but no significant difference between groups in the improvements of dyspnea@max exercise (time effect (T): p < 0.01; group (G): p = 0.63; group*time interaction (G*T): p = 0.49), mMRC dyspnea (T: p < 0.01; G: p = 0.45; G*T: p = 0.62), 6MWD (T: p < 0.05; G: p = 0.36; G*T: p = 0.31), VQ-11 (T: p < 0.001; G: p = 0.16; G*T: p = 0.09) and plasma HCO3- (T: p < 0.05; G: p = 0.93; G*T; p = 0.36), Yet, Nijmegen score (T: p < 0.01; G: p = 0.32; G*T: p < 0.05) improvement was larger in NV+PR group. The exercise oronasal breathing shift during the 6MWT was significantly delayed in all patients (T: p < 0.05; G: p = 0.30; G*T: p = 0.32) and positively correlated with plasma HCO3-(r = 0.42; p < 0.05). Nasal exercise was not superior versus voluntary hypoventilation during PR in HVS patients. Yet, nasal exercise appeared feasible, leading to acquisition of a nasal breathing pattern during walking, improvement of PR outcomes and ventilatory alkalosis. The link between nasal breathing and hyperventilation is discussed in the light of the nasal ventilation rhythm in the limbic system and its role on the limbic emotional and ventilatory functions.
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Affiliation(s)
- F Gouzi
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France.
| | - A S Dubois-Gamez
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - P Lacoude
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - A Abdellaoui
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - C Hédon
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - J Charriot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - C Boissin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - I Vachier
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - M Hayot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - N Molinari
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - A Bourdin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
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Grillo L, Russell AM, Shannon H, Lewis A. Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation. BMJ Open Respir Res 2023; 10:e001395. [PMID: 36627142 PMCID: PMC9835958 DOI: 10.1136/bmjresp-2022-001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To explore physiotherapists' opinions of physiotherapy assessment of Breathing Pattern Disorder (BPD). METHODS Qualitative study using focus groups (FGs) with reflexive thematic analysis and survey methods. The survey was distributed via social media and email to UK specialist physiotherapy interest groups. Two FGs, conducted in different settings, included physiotherapists based in hospital outpatients/community, private practice and higher education. RESULTS One-hundred-and-three physiotherapists completed the survey. Respondents identified a lack of consensus in how to define BPD, but some agreement in the components to include in assessment. Fifteen physiotherapists participated in the FGs. Three themes emerged from FG discussions: (1) nomenclature and language of breathing, (2) BPD and breathlessness and (3) The value of assessment of breathlessness. CONCLUSION The inconsistent nomenclature of dysfunctional breathing pattern impacts assessment, management and understanding of the diagnosis. Clarity in diagnosis, informing consistency in assessment, is fundamental to improving recognition and treatment of BPD. The findings are useful in the planning of education, training, future research and guideline development in BPD assessment.
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Affiliation(s)
- Lizzie Grillo
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Physiotherapy, Royal Brompton and Harefield Hospitals, London, UK
| | | | - Harriet Shannon
- Physiotherapy, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
| | - Adam Lewis
- Department of Health Sciences, Brunel University London, London, UK
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Moreira J, Fonseca P, Miguel S. A Pilot Study on a Nurse Rehabilitation Program: Could It Be Applied to COVID-19 Patients? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14365. [PMID: 36361244 PMCID: PMC9654829 DOI: 10.3390/ijerph192114365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: An aging population, pollution and an increase in life habits that are harmful to respiratory health, and more recently the COVID-19 pandemic, have led to an increase in chronic respiratory diseases. Thus, this pilot study aims to describe an intervention program on the training of respiratory patients to maintain airway permeability and preventing complications. (2) Methods: An observational, analytical, and prospective study was proposed. After the initial evaluation of each user during hospitalization, the program started with two sessions, at discharge for the second phase, and fifteen days after discharge for the third phase. Throughout the program's implementation, the modified Medical Research Council scale and the Barthel Index were applied. (3) Results: The population studied aged between 39 and 76 years, diagnosed with pneumonia or chronic obstructive pulmonary disease, showed a significant improvement in the degrees of dyspnea and levels of functionality, as well as an adequate level of learning. (4) Conclusions: This program positively impacted the patients' independence by reducing dyspnea and increasing functionality of the patients included in this study. The set of exercises and techniques can be replicated at home and may be fundamental in the management of respective recovery, as well as in the COVID-19 pandemic.
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Affiliation(s)
- José Moreira
- Nursing Department, University of Évora, Largo do Senhor da Pobreza, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre, 1600-560 Lisbon, Portugal
- National School of Public Health, 1600-560 Lisbon, Portugal
| | | | - Susana Miguel
- Department of Head and Neck Surgery and Endocrinology, Portuguese Institute of Oncology, 1099-023 Lisbon, Portugal
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Lewis A, Kal E, Nolan CM, Cave P, Grillo L, Conway J, Jones M. Pilot study of physiotherapist-led versus music therapist-led breathing control exercises for young adults living with breathing pattern disorder: a randomised controlled trial protocol. BMJ Open Respir Res 2022; 9:e001414. [PMID: 36104105 PMCID: PMC9476152 DOI: 10.1136/bmjresp-2022-001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Breathing pattern disorder (BPD) is an abnormal breathing pattern associated with biochemical, biomechanical and psychophysiological changes. While physiotherapy is often offered, limited evidence-based therapies for BPD are available. Music therapy-based singing exercises have been shown to improve quality of life for individuals with respiratory conditions and may also be beneficial for individuals living with BPD. No study has previously compared these participatory interventions in the treatment of people living with BPD. METHODS AND ANALYSIS This is a study protocol for an assessor blinded 1:1 randomised controlled trial and qualitative interview study. Forty participants aged 18-40 years who score at least 19 on the Nijmegen Questionnaire (NQ) and do not have any underlying respiratory conditions will be recruited. Participants will be randomised to receive either physiotherapy-led or music therapy-led breathing exercises for 6 weeks. The primary outcome will be between-group difference in NQ post-intervention. Semistructured interviews with a purposive sample of participants will be performed. Qualitative data will be analysed using thematic analysis to better understand participants' intervention and trial experiences. ETHICS AND DISSEMINATION This study has received ethical approval by Brunel University London College of Health, Medicine and Life Science's Research Ethics Committee (32483-MHR-Mar/2022-38624-3). The anonymised completed dataset will be made available as an open-access file via Brunel University London Figshare and the manuscript containing anonymised patient data will be published in an open-access journal. TRIAL REGISTRATION NUMBER This trial is registered on the Open Science Framework Registry (https://osf.io/u3ncw).
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Affiliation(s)
- Adam Lewis
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Elmar Kal
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Claire Marie Nolan
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, London, UK
| | - Phoene Cave
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Lizzie Grillo
- National Heart and Lung Institute, Imperial College London, London, UK
- Physiotherapy Department, Royal Brompton and Harefield Hospitals, London, UK
| | - Joy Conway
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Mandy Jones
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
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Urushidani S, Kuriyama A, Matsumura M. Blood Gas Analysis Results and Serum Lactate Levels in Patients with Psychogenic Hyperventilation and Urinary Tract Infection with Suspected Sepsis: A Retrospective Comparative Study. Intern Med 2022; 61:1699-1706. [PMID: 34707052 PMCID: PMC9259313 DOI: 10.2169/internalmedicine.8434-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The prognosis differs considerably between patients with psychogenic hyperventilation syndrome (HVS) and those with urinary tract infection (UTI)-associated sepsis; however, the nonspecific symptoms and signs make the diagnosis and management difficult. We herein report the utility of a blood gas analysis for distinguishing HVS from UTI with suspected sepsis. Methods This single-center retrospective cohort study was conducted in a tertiary-care hospital in Japan. Patients ≥18 years old with a quick Sequential Organ Failure Assessment (qSOFA) score ≥2 and HVS or UTIs were included. The results of an arterial blood gas (ABG) or venous blood gas (VBG) analysis of the two groups were compared using the Mann-Whitney U test. We used a receiver-operating characteristic (ROC) curve analysis of the arterial pH and arterial PCO2 to assess the ability of these analyses to distinguish HVS from UTI with suspected sepsis. Results A total of 64 patients with HVS (ABG, n=14; VBG, n=50) and 53 with UTI with suspected sepsis (ABG, n=35; VBG, n=18) were included. Patients with HVS had alkalemia and lower PCO2 levels than patients with UTI with suspected sepsis, but the serum lactate levels were similar between the groups. The ROC analysis determined the pH cut-off value to be 7.509 (sensitivity: 0.91; specificity: 0.86) and the PCO2 cut-off value to be 21.6 mmHg (sensitivity: 1.00; specificity: 0.64). Conclusion Elevated serum lactate levels alone cannot be used to differentiate between patients with HVS and those with UTI with suspected sepsis, but the degree of pH and PCO2 abnormality can help with the differential diagnosis.
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Affiliation(s)
- Seigo Urushidani
- Emergency and Critical Care Center, Kurashiki Central Hospital, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Japan
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Novel Real-Time OEP Phase Angle Feedback System for Dysfunctional Breathing Pattern Training-An Acute Intervention Study. SENSORS 2021; 21:s21113714. [PMID: 34073590 PMCID: PMC8199249 DOI: 10.3390/s21113714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
Dysfunctional breathing patterns (DBP) can have an impact on an individual’s quality of life and/or exercise performance. Breathing retraining is considered to be the first line of treatment to correct breathing pattern, for example, reducing ribcage versus abdominal movement asynchrony. Optoelectronic plethysmography (OEP) is a non-invasive 3D motion capture technique that measures the movement of the chest wall. The purpose of this study was to investigate if the use of a newly developed real-time OEP phase angle and volume feedback system, as an acute breathing retraining intervention, could result in a greater reduction of phase angle values (i.e., an improvement in movement synchrony) when compared to real-time OEP volume feedback alone. Eighteen individuals with a DBP performed an incremental cycle test with OEP measuring chest wall movement. Participants were randomly assigned to either the control group, which included the volume-based OEP feedback or to the experimental group, which included both the volume-based and phase angle OEP feedback. Participants then repeated the same cycle test using the real-time OEP feedback. The phase angle between the ribcage versus abdomen (RcAbPhase), between the pulmonary ribcage and the combined abdominal ribcage and abdomen (RCpAbPhase), and between the abdomen and the shoulders (AbSPhase) were calculated during both cycle tests. Significant increases in RcAbPhase (pre: −2.89°, post: −1.39°, p < 0.01), RCpAbPhase (pre: −2.00°, post: −0.50°, p < 0.01), and AbSPhase (pre: −2.60°, post: −0.72°, p < 0.01) were found post-intervention in the experimental group. This indicates that the experimental group demonstrated improved synchrony in their breathing pattern and therefore, reverting towards a healthy breathing pattern. This study shows for the first time that dysfunctional breathing patterns can be acutely improved with real-time OEP phase angle feedback and provides interesting insight into the feasibility of using this novel feedback system for breathing pattern retraining in individuals with DBP.
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10
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McKeown P, O’Connor-Reina C, Plaza G. Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. J Clin Med 2021; 10:jcm10030471. [PMID: 33530621 PMCID: PMC7865730 DOI: 10.3390/jcm10030471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.
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Affiliation(s)
- Patrick McKeown
- Buteyko Clinic International, Loughwell, Moycullen, Co., H91 H4C1 Galway, Ireland;
| | - Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain;
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28023 Madrid, Spain
- Correspondence:
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11
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Posadzki P, Pieper D, Bajpai R, Makaruk H, Könsgen N, Neuhaus AL, Semwal M. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health 2020; 20:1724. [PMID: 33198717 PMCID: PMC7670795 DOI: 10.1186/s12889-020-09855-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes. METHODS Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised. RESULTS Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions. CONCLUSION There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns. TRIAL REGISTRATION Registered in PROSPERO ( CRD42019120295 ) on 10th January 2019.
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Affiliation(s)
- Pawel Posadzki
- Kleijnen Systematic Reviews Ltd., York, UK
- Nanyang Technological University, Singapore, Singapore
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.
| | - Ram Bajpai
- School of Medicine, Keele University, Staffordshire, UK
| | - Hubert Makaruk
- Jozef Pilsudski University of Physical Education in Warsaw, Faculty Physical Education and Health, Biala Podlaska, Poland
| | - Nadja Könsgen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Annika Lena Neuhaus
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Monika Semwal
- Health Outcomes Division, University of Texas at Austin College of Pharmacy, Austin, USA
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Hamasaki H. Effects of Diaphragmatic Breathing on Health: A Narrative Review. MEDICINES 2020; 7:medicines7100065. [PMID: 33076360 PMCID: PMC7602530 DOI: 10.3390/medicines7100065] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
Background: Breathing is an essential part of life. Diaphragmatic breathing (DB) is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions. However, the effects of DB on human health need to be further investigated. Methods: The author conducted a PubMed search regarding the current evidence of the effect of DB on health. Results: This review consists of a total of 10 systematic reviews and 15 randomized controlled trials (RCTs). DB appears to be effective for improving the exercise capacity and respiratory function in patients with chronic obstructive pulmonary disease (COPD). Although the effect of DB on the quality of life (QoL) of patients with asthma needs to be investigated, it may also help in reducing stress; treating eating disorders, chronic functional constipation, hypertension, migraine, and anxiety; and improving the QoL of patients with cancer and gastroesophageal reflux disease (GERD) and the cardiorespiratory fitness of patients with heart failure. Conclusions: Based on this narrative review, the exact usefulness of DB in clinical practice is unclear due to the poor quality of studies. However, it may be a feasible and practical treatment method for various disorders.
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Affiliation(s)
- Hidetaka Hamasaki
- Hamasaki Clinic, 2-21-4 Nishida, Kagoshima, Kagoshima 890-0046, Japan
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13
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Vidotto LS, Carvalho CRFD, Harvey A, Jones M. Dysfunctional breathing: what do we know? ACTA ACUST UNITED AC 2019; 45:e20170347. [PMID: 30758427 PMCID: PMC6534396 DOI: 10.1590/1806-3713/e20170347] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or “air hunger”, DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.
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Affiliation(s)
- Laís Silva Vidotto
- . Department of Clinical Sciences, Brunel University London, United Kingdom
| | | | - Alex Harvey
- . Department of Clinical Sciences, Brunel University London, United Kingdom
| | - Mandy Jones
- . Department of Clinical Sciences, Brunel University London, United Kingdom
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14
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Vidotto LS, Bigliassi M, Jones MO, Harvey A, Carvalho CRF. Stop Thinking! I Can't! Do Attentional Mechanisms Underlie Primary Dysfunctional Breathing? Front Physiol 2018; 9:782. [PMID: 29988475 PMCID: PMC6024915 DOI: 10.3389/fphys.2018.00782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/05/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Laís S Vidotto
- Department of Clinical Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Marcelo Bigliassi
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Mandy O Jones
- Department of Clinical Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Alex Harvey
- Department of Clinical Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Celso R F Carvalho
- Department of Physical Therapy, University of São Paulo, São Paulo, Brazil
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15
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Saito J, Amanai E, Hirota K. Dexmedetomidine-treated hyperventilation syndrome triggered by the distress related with a urinary catheter after general anesthesia: a case report. JA Clin Rep 2017; 3:22. [PMID: 29457066 PMCID: PMC5804608 DOI: 10.1186/s40981-017-0101-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023] Open
Abstract
Background Hyperventilation syndrome (HVS) sometimes occurs in patients under stressful conditions and may provoke severe complications such as myocardial infarction and death. The authors report a case of HVS following general anesthesia, where a continuous intravenous infusion of dexmedetomidine was effective for HVS. Case presentation A 23-year-old male patient with recurrent tongue cancer was scheduled to undergo partial glossectomy and neck dissection. Emergence from general anesthesia was prompt. Twenty-two minutes after extubation, the patient complained of unbearable distress caused by the urinary catheter. He began to cry, with an increased respiratory rate of over 40 breaths per minute. Intravenous infusion of flurbiprofen, droperidol, and morphine was not effective. Electrocardiography and laryngofiberscopy indicated the absence of acute coronary syndrome and airway obstruction, respectively. An arterial blood gas determination showed pH 7.63, PaCO2 18.2 mmHg, PaO2 143 mmHg on O2 mask 4 L/min, Ca2+ 4.29 mmol/L, and lactate 3.4 mmol/L. The patient was diagnosed with HVS. Dexmedetomidine infusion 2.0 μg/kg/h for 10 min followed by 0.7 μg/kg/h reduced respiratory rate, suppressed arousal, and disappeared the complaint of bladder distension. One hour after extubation, an arterial blood gas determination showed pH 7.33, PaCO2 51.3 mmHg, PaO2 196 mmHg on O2 mask 4 L/min, Ca2+ 4.70 mmol/L, and lactate 1.5 mmol/L. After admission to the intensive care unit, dexmedetomidine infusion was maintained at the rate of 0.2 to 0.7 μg/kg/h until the following morning, and he did not complain of distress caused by the urinary catheter. Conclusions HVS can occur after emergence from general anesthesia, and dexmedetomidine infusion was effective for HVS.
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Affiliation(s)
- Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562 Japan
| | - Erika Amanai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562 Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562 Japan
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16
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van Dixhoorn J, Folgering H. Use of the Nijmegen Questionnaire in asthma. ERJ Open Res 2015; 1:00037-2015. [PMID: 27730144 PMCID: PMC5005144 DOI: 10.1183/23120541.00037-2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/28/2015] [Indexed: 11/05/2022] Open
Abstract
It remains to be seen whether dysfunctional breathing will acquire the status of an illness per se http://ow.ly/P60J7.
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Affiliation(s)
- Jan van Dixhoorn
- Centre for Breathing Therapy, Amersfoort, The Netherlands; Science Bureau, Linneaus Institute, Harlem, The Netherlands
| | - Hans Folgering
- Emeritus Professor of Respiratory Physiology, Nijmegen, The Netherlands
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17
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Primary Hyperventilation in the Emergency Department: A First Overview. PLoS One 2015; 10:e0129562. [PMID: 26110771 PMCID: PMC4482441 DOI: 10.1371/journal.pone.0129562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/10/2015] [Indexed: 11/30/2022] Open
Abstract
Background Primary hyperventilation is defined as a state of alveolar ventilation in excess of metabolic requirements, leading to decreased arterial partial pressure of carbon dioxide. The primary aim of this study was to characterise patients diagnosed with primary hyperventilation in the ED. Methods Our retrospective cohort study comprised adult (≥16 years) patients admitted to our ED between 1 January 2006 and 31 December 2012 with the primary diagnosis of primary (=psychogenic) hyperventilation. Results A total of 616 patients were eligible for study. Participants were predominantely female (341 [55.4%] female versus 275 [44.6%] male respectively, p <0.01). The mean age was 36.5 years (SD 15.52, range 16-85). Patients in their twenties were the most common age group (181, 29.4%), followed by patients in their thirties (121, 19.6%). Most patients presented at out-of-office hours (331 [53.7%]. The most common symptom was fear (586, 95.1%), followed by paraesthesia (379, 61.5%) and dizziness (306, 49.7%). Almost a third (187, 30.4%) of our patients had previously experienced an episode of hyperventilation and half (311, 50.5%) of patients had a psychiatric co-morbidity. Conclusion Hyperventilation is a diagnostic chimera with a wide spectrum of symptoms. Patients predominantly are of young age, female sex and often have psychiatric comorbidities. The severity of symptoms accompanied with primary hyperventilation most often needs further work-up to rule out other diagnosis in a mostly young population. In the future, further prospective multicentre studies are needed to evaluate and establish clear diagnostic criteria for primary hyperventilation and possible screening instruments.
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18
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Barker N, Everard ML. Getting to grips with 'dysfunctional breathing'. Paediatr Respir Rev 2015; 16:53-61. [PMID: 25499573 DOI: 10.1016/j.prrv.2014.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 11/25/2022]
Abstract
Dysfunctional breathing (DB) is common, frequently unrecognised and responsible for a substantial burden of morbidity. Previously lack of clarity in the use of the term and the use of multiple terms to describe the same condition has hampered our understanding. DB can be defined as an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms. It can be subdivided into thoracic and extra thoracic forms. Thoracic DB is characterised by breathing patterns involving relatively inefficient, excessive upper chest wall activity with or without accessory muscle activity. This is frequently associated with increased residual volume, frequent sighing and an irregular pattern of respiratory effort. It may be accompanied by true hyperventilation in the minority of subjects. Extra thoracic forms include paradoxical vocal cord dysfunction and the increasingly recognised supra-glottic 'laryngomalacia' commonly seen in young sportsmen and women. While the two forms would appear to be two discreet entities they often share common factors in aetiology and respond to similar interventions. Hence both forms are considered in this review which aims to generate a more coherent approach to understanding, diagnosing and treating these conditions.
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Affiliation(s)
- Nicki Barker
- Department of Respiratory Medicine, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Roberts Road, Subiaco 6008, Western Australia.
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19
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Barker NJ, Jones M, O'Connell NE, Everard ML. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in children. Cochrane Database Syst Rev 2013; 2013:CD010376. [PMID: 24347088 PMCID: PMC11366082 DOI: 10.1002/14651858.cd010376.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Dysfunctional breathing is described as chronic or recurrent changes in breathing pattern causing respiratory and non-respiratory symptoms. It is an umbrella term that encompasses hyperventilation syndrome and vocal cord dysfunction. Dysfunctional breathing affects 10% of the general population. Symptoms include dyspnoea, chest tightness, sighing and chest pain which arise secondary to alterations in respiratory pattern and rate. Little is known about dysfunctional breathing in children. Preliminary data suggest 5.3% or more of children with asthma have dysfunctional breathing and that, unlike in adults, it is associated with poorer asthma control. It is not known what proportion of the general paediatric population is affected. Breathing training is recommended as a first-line treatment for adults with dysfunctional breathing (with or without asthma) but no similar recommendations are available for the management of children. As such, breathing retraining is adapted from adult regimens based on the age and ability of the child. OBJECTIVES To determine whether breathing retraining in children with dysfunctional breathing has beneficial effects as measured by quality of life indices.To determine whether there are any adverse effects of breathing retraining in young people with dysfunctional breathing. SEARCH METHODS We identified trials for consideration using both electronic and manual search strategies. We searched CENTRAL, MEDLINE and EMBASE. We searched the National Research Register (NRR) Archive, Health Services Research Projects in Progress (HSRProj), Current Controlled Trials register (incorporating the metaRegister of Controlled Trials and the International Standard Randomised Controlled Trial Number (ISRCTN) to identify research in progress and unpublished research. The latest search was undertaken in October 2013. SELECTION CRITERIA We planned to include randomised, quasi-randomised or cluster-randomised controlled trials. We excluded observational studies, case studies and studies utilising a cross-over design. The cross-over design was considered inappropriate due to the purported long-lasting effects of breathing retraining. Children up to the age of 18 years with a clinical diagnosis of dysfunctional breathing were eligible for inclusion. We planned to include children with a primary diagnosis of asthma with the intention of undertaking a subgroup analysis. Children with symptoms secondary to cardiac or metabolic disease were excluded.We considered any type of breathing retraining exercise for inclusion in this review, such as breathing control, diaphragmatic breathing, yoga breathing, Buteyko breathing, biofeedback-guided breathing modification and yawn/sigh suppression. We considered programmes where exercises were either supervised (by parents or a health professional, or both) or unsupervised. We also considered relaxation techniques and acute episode management as long as it was clear that breathing exercises were a component of the intervention.Any intervention without breathing exercises or where breathing exercises were not key to the intervention were excluded. DATA COLLECTION AND ANALYSIS We planned that two authors (NJB and MJ) would extract data independently using a standardised form. Any discrepancies would be resolved by consensus. Where agreement could not be reached a third review author (MLE) would have considered the paper. MAIN RESULTS We identified 264 potential trials and reviews from the search. Following removal of duplicates, we screened 224 papers based on title and abstract. We retrieved six full-text papers and further evaluated them but they did not meet the inclusion criteria. There were, therefore, no studies suitable for inclusion in this review. AUTHORS' CONCLUSIONS The results of this systematic review cannot inform clinical practice as no suitable trials were identified for inclusion. Therefore, it is currently unknown whether these interventions offer any added value in this patient group or whether specific types of breathing exercise demonstrate superiority over others. Given that breathing exercises are frequently used to treat dysfunctional breathing/hyperventilation syndrome, there is an urgent need for well-designed clinical trials in this area. Future trials should conform to the CONSORT statement for standards of reporting and use validated outcome measures. Trial reports should also ensure full disclosure of data for all important clinical outcomes.
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Affiliation(s)
- Nicola J Barker
- Sheffield Children's NHS Foundation TrustRespiratory MedicineSheffieldUKS10 2TH
| | - Mandy Jones
- Brunel UniversityCentre for Research in Rehabilitation, School of Health Sciences and Social CareKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | - Neil E O'Connell
- Brunel UniversityCentre for Research in Rehabilitation, School of Health Sciences and Social CareKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | - Mark L Everard
- University of Western Australia, Princess Margaret HospitalSchool of Paediatrics and Child HealthSubiacoWestern AustraliaAustralia
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