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Mohan V, Rathinam C, Yates D, Paungmali A, Boos C. Validity and reliability of outcome measures to assess dysfunctional breathing: a systematic review. BMJ Open Respir Res 2024; 11:e001884. [PMID: 38626928 PMCID: PMC11029193 DOI: 10.1136/bmjresp-2023-001884] [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: 06/23/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This study aimed to systematically review the psychometric properties of outcome measures that assess dysfunctional breathing (DB) in adults. METHODS Studies on developing and evaluating measurement properties to assess DB were included. The study investigated the empirical research published between 1990 and February 2022, with an updated search in May 2023 in the Cochrane Library database of systematic reviews and the Cochrane Central Register of Controlled Trials, the Ovid Medline (full), the Ovid Excerta Medica Database, the Ovid allied and complementary medicines database, the Ebscohost Cumulative Index to Nursing and Allied Health Literature and the Physiotherapy Evidence Database. The included studies' methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Data analysis and synthesis followed the COSMIN methodology for reviews of outcome measurement instruments. RESULTS Sixteen studies met the inclusion criteria, and 10 outcome measures were identified. The psychometric properties of these outcome measures were evaluated using COSMIN. The Nijmegen Questionnaire (NQ) is the only outcome measure with 'sufficient' ratings for content validity, internal consistency, reliability and construct validity. All other outcome measures did not report characteristics of content validity in the patients' group. DISCUSSION The NQ showed high-quality evidence for validity and reliability in assessing DB. Our review suggests that using NQ to evaluate DB in people with bronchial asthma and hyperventilation syndrome is helpful. Further evaluation of the psychometric properties is needed for the remaining outcome measures before considering them for clinical use. PROSPERO REGISTRATION NUMBER CRD42021274960.
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Affiliation(s)
- Vikram Mohan
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Chandrasekar Rathinam
- University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Derick Yates
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Aatit Paungmali
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Christopher Boos
- Cardiology Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Guy EF, Clifton JA, Calje-Van Der Klei T, Chen R, Knopp JL, Möller K, Chase JG. Respiratory monitoring dataset, with rapid expiratory occlusions, over increasing positive airway pressure ventilation. Data Brief 2024; 52:109874. [PMID: 38146285 PMCID: PMC10749260 DOI: 10.1016/j.dib.2023.109874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023] Open
Abstract
Resting breathing data was collected from 80 smokers, vapers, asthmatics, and otherwise healthy people in the low-risk clinical unit at the University of Canterbury. Subjects were asked to breathe normally through a full-face mask connected to a Fisher and Paykel Healthcare SleepStyle SPSCAA CPAP device. PEEP (Positive End-Expiratory Pressure) support was increased from 4 to 12 cmH2O in 0.5 cmH2O increments. Data was also collected during resting breathing at ZEEP (0 cmH2O) before and after the PEEP trial. The trial was conducted under University of Canterbury Human Research Ethics Committee consent (Ref: HREC 2023/04/LR-PS). Data was collected by and Dräeger PulmoVista 500 EIT machine and a custom Venturi-based pressure and flow sensor device connected in series with the CPAP and full-face mask. The outlined dataset includes pressure, flow, volume, dynamic circumference (thoracic and abdominal, and cross-sectional aeration. Subject demographic data was self-reported using a questionnaire given prior to the trial.
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Affiliation(s)
- Ella F.S. Guy
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Jaimey A. Clifton
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | | | - Rongqing Chen
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Jennifer L. Knopp
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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Peiffer C. Puzzled by dysfunctional breathing disorder(s)? Consider the Bayesian brain hypothesis! Front Neurosci 2023; 17:1270556. [PMID: 37877012 PMCID: PMC10593455 DOI: 10.3389/fnins.2023.1270556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 10/26/2023] Open
Abstract
There is currently growing clinical concern regarding dysfunctional breathing disorder(s) (DBD), an umbrella term for a set of multidimensional clinical conditions that are characterized by altered breathing pattern associated with a variety of intermittent or chronic symptoms, notably dyspnea, in the absence or in excess of, organic disease. However, several aspects of DBD remain poorly understood and/or open to debate, especially the inconsistent relationship between the array of experienced symptoms and their supposedly underlying mechanisms. This may be partly due to a more general problem, i.e., the prevailing way we conceptualize symptoms. In the present article, after a brief review of the different aspects of DBD from the current perspective, I submit a call for considering DBD under the innovating perspective of the Bayesian brain hypothesis, i.e., a potent and novel model that fundamentally changes our views on symptom perception.
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Affiliation(s)
- Claudine Peiffer
- Dyspnea Clinic, Department of Physiology, University Children Hospital Robert Debré (AP-HP), Paris, France
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Vlemincx E. Dysfunctional breathing: a dimensional, transdiagnostic perspective. Eur Respir J 2023; 61:2300629. [PMID: 37290807 DOI: 10.1183/13993003.00629-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Elke Vlemincx
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Health Psychology, KU Leuven, Leuven, Belgium
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
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Smyth CME, Winter SL, Dickinson JW. Breathing Pattern Disorders Distinguished from Healthy Breathing Patterns Using Optoelectronic Plethysmography. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2816781. [PMID: 38655165 PMCID: PMC11022780 DOI: 10.1155/2022/2816781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 04/26/2024]
Abstract
There is no gold standard diagnostic method for breathing pattern disorders (BPD) which is commonly diagnosed through the exclusion of other pathologies. Optoelectronic plethysmography (OEP) is a 3D motion capture technique that provides a comprehensive noninvasive assessment of chest wall during rest and exercise. The purpose of this study was to determine if OEP can distinguish between active individuals classified with and without BPD at rest and during exercise. Forty-seven individuals with a healthy breathing pattern (HBP) and twenty-six individuals with a BPD performed a submaximal exercise challenge. OEP measured the movement of the chest wall through the calculation of timing, percentage contribution, and phase angle breathing pattern variables. A mixed model repeated measures ANOVA analysed the OEP variables between the groups classified as HBP and BPD at rest, during exercise, and after recovery. At rest, regional contribution variables including ribcage percentage contribution (HBP: 71% and BPD: 69%), abdominal ribcage contribution (HBP: 13% and BPD: 11%), abdomen percentage contribution (HBP: 29% and BPD: 31%), and ribcage and abdomen volume index (HPB: 2.5 and BPD: 2.2) were significantly (p < 0.05) different between groups. During exercise, BPD displayed significantly (p < 0.05) more asynchrony between various thoracic compartments including the ribcage and abdomen phase angle (HBP: -1.9 and BPD: -2.7), pulmonary ribcage and abdomen phase angle (HBP: -0.5 and BPD, 0.5), abdominal ribcage and shoulders phase angle (HBP: -0.3 and BPD: 0.6), and pulmonary ribcage and shoulders phase angle (HBP: 0.2 and BPD: 0.6). Additionally, the novel variables inhale deviation (HBP: 8.8% and BPD: 19.7%) and exhale deviation (HBP: -10.9% and BPD: -17.6%) were also significantly (p < 0.05) different between the groups during high intensity exercise. Regional contribution and phase angles measured via OEP can distinguish BPD from HBP at rest and during exercise. Characteristics of BPD include asynchronous and thoracic dominant breathing patterns that could form part of future objective criteria for the diagnosis of BPD.
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Affiliation(s)
- Carol M. E. Smyth
- School of Sport and Exercise Sciences, University of Kent, Chipperfield Building, Canterbury Kent CT2 7NZ, UK
| | - Samantha L. Winter
- School of Sport, Exercise and Health Sciences, Loughborough University, National Centre for Sport and Exercise Medicine, Loughborough LE11 3TT, UK
| | - John W. Dickinson
- School of Sport and Exercise Sciences, University of Kent, Chipperfield Building, Canterbury Kent CT2 7NZ, UK
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Niggemann B, Maas R, Suerbaum C, Spindler T, Kohl A, Koerner-Rettberg C, Burghardt R. "Psychological characteristics of functional respiratory disorders in children and adolescents-Pilot study". Pediatr Pulmonol 2022; 57:3027-3034. [PMID: 36114693 DOI: 10.1002/ppul.26129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Aim of our prospective, multicenter, nonrandomized study was to identify characteristic features and similarities of patients with functional respiratory disorders regarding socio-familial and behavioral aspects, in comparison with controls in a cross-sectional analysis using standardized psychological questionnaires. Furthermore, we investigated the longitudinal outcome of symptoms, effects of primary interventions and the stability of psychological traits 6 months after diagnosis and primary intervention. METHODS Initially, 106 patients (68 females, 27 males) and 58 controls (33 females, 25 males) were recruited for the study. Mean age was 12.6 years in patients and 11.9 years in controls. RESULTS The child behavior checklist (CBCL) showed significantly increased scores for anxious/depressed (p = 0.002) and schizoid/obsessive (p = 0.001) behavior in patients. A trend was evident for internalizing behavior (p = 0.009) and for a higher total score (p = 0.008). In the self-assessment youth self-report (YSR), there was a trend towards higher values for anxious/depressed behavior in patients (p = 0.06) and towards more externalizing behavior (p = 0.029) in the control group. After 6 months, 31% of the patients were free of symptoms, 42% had improved. For themselves, parents reported a decreased burden from 56% to 23% (p < 0.001) and decreased impairment from 57% to 30% (p < 0.008). For their children, parents reported a decrease from 45% to 16% (p < 0.0001) and from 74% to 37% (p < 0.0001), respectively. A longitudinal comparison from T1 to T2 showed no statistically significant changes in all three psychological questionnaires (CBCL, YSR, and SOMS-KJ). CONCLUSIONS In summary, we show that patients with functional respiratory disorders differ from healthy subjects, with internalizing behavior being a characteristic trait. The outcome in terms of symptoms, perceived psycho-familial burden and impairment after 6 months is encouraging. However, we are aware that our preliminary data offer thought-provoking impulses rather than firm findings.
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Affiliation(s)
- Bodo Niggemann
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany
| | - Ronja Maas
- Pediatric Psychiatry, Psychotherapy and Psychosomatics, Children's Hospital, Klinikum Frankfurt/Oder, Frankfurt/Oder, Brandenburg, Germany
| | - Claudia Suerbaum
- Centre for Pneumology and Pediatric Pneumology, Düsseldorf, Germany
| | - Thomas Spindler
- Specialized Clinic for Pediatric Pneumology and Allergology, Wangen, Germany
| | - Andreas Kohl
- Pediatric Respiratory Medicine Practice, Kiel, Germany
| | | | - Roland Burghardt
- Pediatric Psychiatry, Psychotherapy and Psychosomatics, Children's Hospital, Klinikum Frankfurt/Oder, Frankfurt/Oder, Brandenburg, Germany
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Price OJ, Walsted ES, Bonini M, Brannan JD, Bougault V, Carlsen K, Couto M, Kippelen P, Moreira A, Pite H, Rukhadze M, Hull JH. Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper. Allergy 2022; 77:2909-2923. [PMID: 35809082 PMCID: PMC9796481 DOI: 10.1111/all.15431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.
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Affiliation(s)
- Oliver J. Price
- School of Biomedical SciencesFaculty of Biological Sciences, University of LeedsLeedsUK,Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | - Emil S. Walsted
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK,Department of Respiratory MedicineBispebjerg HospitalCopenhagenDenmark
| | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli – IRCCSUniversità Cattolica del Sacro CuoreRomeItaly,National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | | | | | - Kai‐Håkon Carlsen
- Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway,Faculty of Medicine, University of OsloInstitute of Clinical MedicineOsloNorway
| | - Mariana Couto
- Allergy CenterCUF Descobertas HospitalLisbonPortugal
| | - Pascale Kippelen
- Division of Sport, Health and Exercise SciencesCollege of Health, Medicine and Life Sciences, Brunel University LondonUK
| | - André Moreira
- Centro Hospitalar Universitário de São JoãoPortoPortugal,Epidemiology Unit (EPIUnit)Laboratory for Integrative and Translational Research in Population Health (ITR)Basic and Clinical Immunology, Department of Pathology, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Helena Pite
- Allergy Center, CUF Descobertas Hospital and CUF Tejo HospitalCEDOC, NOVA University, Universidade NOVA de LisboaLisbonPortugal
| | | | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK,Institute of Sport, Exercise and Health (ISEH)Division of Surgery and Interventional Science, University College London (UCL)LondonUK
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Hylton H, Long A, Francis C, Taylor RR, Ricketts WM, Singh R, Pfeffer PE. Real-world use of the Breathing Pattern Assessment Tool in assessment of breathlessness post-COVID-19. Clin Med (Lond) 2022; 22:376-379. [PMID: 38589144 PMCID: PMC9345218 DOI: 10.7861/clinmed.2021-0759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Breathing pattern disorders (BPDs) are a common cause of chronic breathlessness, including after acute respiratory illnesses such as COVID pneumonia. BPD is however underdiagnosed, partly as a result of difficulty in clinically assessing breathing pattern. The Breathing Pattern Assessment Tool (BPAT) has been validated for use in diagnosing BPD in patients with asthma but to date has not been validated in other diseases. METHODS Patients undergoing face-to-face review in a post-COVID clinic were assessed by a respiratory physician and specialist respiratory physiotherapist. Assessment included a Dyspnoea-12 (D12) questionnaire to assess breathlessness, physiotherapist assessment of breathing pattern including manual assessment of respiratory motion, and BPAT assessment. The sensitivity and specificity of BPAT for diagnosis of BPD in post-COVID patients was assessed. RESULTS BPAT had a sensitivity of 89.5% and specificity of 78.3% for diagnosing BPD in post-COVID breathlessness. Patients with a BPAT score above the diagnostic cut-off had higher levels of breathlessness than those with lower BPAT scores (D12 score mean average 19.4 vs 13.2). CONCLUSION BPAT has high sensitivity and moderate specificity for BPD in patients with long COVID. This would support its use as a screening test in clinic, and as a diagnostic tool for large cohort studies.
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Affiliation(s)
| | | | | | | | - William M Ricketts
- Barts Health NHS Trust, London, UK and Barts and The London School of Medicine and Dentistry, London, UK
| | | | - Paul E Pfeffer
- Barts Health NHS Trust, London, UK and honorary senior lecturer, Barts and The London School of Medicine and Dentistry, London, UK.
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Mohan V, Branney J, Clark C, Neal R, Jagannathan M, Paungmali A, Perri M. Reliability and preliminary reference values for the Total Faulty Breathing Scale (TFBS): A cross-sectional study. Health Sci Rep 2022; 5:e661. [PMID: 35620546 PMCID: PMC9128177 DOI: 10.1002/hsr2.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Aims The evaluation of breathing function is crucial in the clinical examination of the respiratory system. The Total Faulty Breathing Scale (TFBS) could be used in clinical settings to quantify the measurement of breathing dysfunction. Reliability data for the TFBS are available for males, but there is a requirement to determine reliability for females and to develop reference values. The aim of this study, therefore, was to determine the reliability in females and to establish the preliminary reference values for the TFBS. Methods Twenty-three healthy female participants for reliability and 44 (7 male and 37 female) participants for preliminary reference values participated in this cross-sectional study. For both aspects of the study, participants were instructed to breathe at their own pace with no specific instruction. Then each participant was observed carrying out normal breathing for a period of 10 breaths and deep breathing for a period of 10 breaths while being assessed with the TFBS. Results Intrarater and interrater reliability of the TFBS showed a kappa value of 0.769 and 0.751, respectively, indicating substantial agreement for female participants. The preliminary reference categories for TFBS were reported to be normal for 20 (45.5%) participants and mild faulty breathing for the remaining 24 (54.4%) participants. Conclusions The findings of this study suggested that TFBS was reliable to measure breathing function among female participants, and the reference categories may be helpful in the identification of normal and faulty breathing.
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Affiliation(s)
- Vikram Mohan
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | - Jonathan Branney
- Department of Nursing Science, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | - Carol Clark
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | - Rebecca Neal
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences Bournemouth University Bournemouth UK
| | | | - Aatit Paungmali
- Neuro-Musculoskeletal and Pain Research Unit, Department of Physical Therapy, Faculty of Associated Medical Sciences Chiang Mai University Chiang Mai Thailand
| | - Maria Perri
- Perri Chiropractic, Wellness Springs Highland Mills New York USA
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Schwellnus M, Adami PE, Bougault V, Budgett R, Clemm HH, Derman W, Erdener U, Fitch K, Hull JH, McIntosh C, Meyer T, Pedersen L, Pyne DB, Reier-Nilsen T, Schobersberger W, Schumacher YO, Sewry N, Soligard T, Valtonen M, Webborn N, Engebretsen L. International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness. Br J Sports Med 2022; 56:bjsports-2022-105567. [PMID: 35623888 DOI: 10.1136/bjsports-2022-105567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 01/03/2023]
Abstract
Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to 'core' members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.
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Affiliation(s)
- Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- SEMLI, IOC Research Centre, Pretoria, Gauteng, South Africa
| | - Paolo Emilio Adami
- Health & Science Department, World Athletics, Monaco, Monaco Principality
| | - Valerie Bougault
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, Provence-Alpes-Côte d'Azu, France
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Hege Havstad Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Wayne Derman
- Institute of Sport and Exercise Medicine (ISEM), Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- ISEM, IOC Research Center, South Africa, Stellenbosch, South Africa
| | - Uğur Erdener
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Ken Fitch
- School of Human Science; Sports, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London (UCL), London, UK
| | - Cameron McIntosh
- Dr CND McIntosh INC, Edge Day Hospital, Port Elizabeth, South Africa
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - David B Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Tonje Reier-Nilsen
- Oslo Sports Trauma Research Centre, The Norwegian Olympic Sports Centre, Oslo, Norway
- Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Wolfgang Schobersberger
- Insitute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), Kliniken Innsbruck and Private University UMIT Tirol, Hall, Austria
| | | | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- SEMLI, IOC Research Centre, Pretoria, Gauteng, South Africa
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Maarit Valtonen
- KIHU, Research Institute for Olympic Sports, Jyväskylä, Finland
| | - Nick Webborn
- Centre for Sport and Exercise Science and Medicine, University of Brighton, Brighton, UK
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Hull JH, Burns P, Carre J, Haines J, Hepworth C, Holmes S, Jones N, MacKenzie A, Paton JY, Ricketts WM, Howard LS. BTS clinical statement for the assessment and management of respiratory problems in athletic individuals. Thorax 2022; 77:540-551. [DOI: 10.1136/thoraxjnl-2021-217904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Frésard I, Genecand L, Altarelli M, Gex G, Vremaroiu P, Vremaroiu-Coman A, Lawi D, Bridevaux PO. Dysfunctional breathing diagnosed by cardiopulmonary exercise testing in ‘long COVID’ patients with persistent dyspnoea. BMJ Open Respir Res 2022; 9:9/1/e001126. [PMID: 35354589 PMCID: PMC8968537 DOI: 10.1136/bmjresp-2021-001126] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background ‘Long COVID’-associated dyspnoea may persist for months after SARS-CoV-2 infection. Among the causes of persistent dyspnoea, dysfunctional breathing (DB), defined as an erratic or inappropriate ventilation at rest or exercise, has been observed, but little is known about its occurrence and pathophysiology among individuals with ‘long COVID’. We aimed to describe the occurrence and identify clinical predictors of DB among patients following SARS-CoV-2 infection. Methods Cardiopulmonary exercise testing (CPET) was performed in 51 SARS-CoV-2 patients (median age, 64 years (IQR, 15)); male, 66.7%) living with ‘long COVID’ and persistent dyspnoea. CPET was classified into three dominant patterns: respiratory limitation with gas exchange abnormalities (RL); normal CPET or O2 delivery/utilisation impairment (D); and DB. Non-parametric and χ2 tests were applied to analyse the association between CPET dominant patterns and demographics, pulmonary function tests and SARS-CoV-2 severity. Results Among 51 patients, DB mostly without hyperventilation was found in 29.4% (n=15), RL in 54.9% (n=28) and D in 15.7% (n=8). When compared with RL individuals, patients with DB were younger, had significantly less severe initial infection, a better transfer capacity for carbon monoxide (median 85% (IQR, 28)), higher oxygen consumption (22.9 mL/min/kg (IQR, 5.5)), a better ventilatory efficiency slope (31.6 (IQR, 12.8)), and a higher SpO2 (95% (IQR, 3)). Conclusions Our findings suggest that DB without hyperventilation could be an important pathophysiological mechanism of disabling dyspnoea in younger outpatients following SARS-CoV-2 infection, which appears to be a feature of COVID-19 not described in other viral diseases.
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Affiliation(s)
- Isabelle Frésard
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
- Service de pneumologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Léon Genecand
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
- Faculté de médecine, Université de Genève, Geneva, Switzerland
| | - Marco Altarelli
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
- Service de pneumologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Grégoire Gex
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
- Service de pneumologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Petrut Vremaroiu
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Andreea Vremaroiu-Coman
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
- Service de pneumologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - David Lawi
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Pierre-Olivier Bridevaux
- Service de pneumologie, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
- Service de pneumologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
- Faculté de médecine, Université de Genève, Geneva, Switzerland
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13
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Coker RK, Armstrong A, Church AC, Holmes S, Naylor J, Pike K, Saunders P, Spurling KJ, Vaughn P. BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax 2022; 77:329-350. [PMID: 35228307 PMCID: PMC8938676 DOI: 10.1136/thoraxjnl-2021-218110] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robina Kate Coker
- Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Armstrong
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Katharine Pike
- Department of Paediatric Respiratory Medicine, Bristol Royal Hospital for Children, Bristol, UK
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14
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Hudler A, Holguin F, Althoff M, Fuhlbrigge A, Sharma S. Pathophysiology and Clinical evaluation of the patient with unexplained persistent dyspnea. Expert Rev Respir Med 2022; 16:511-518. [PMID: 35034521 PMCID: PMC9276544 DOI: 10.1080/17476348.2022.2030222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Dyspnea is a complex symptom, which largely results from an imbalance between an afferent sensory stimulus and the corresponding efferent respiratory neuromuscular response. In addition, it is heavily influenced by the patient's prior experiences and sociocultural factors. AREAS COVERED The diagnostic approach to these patients requires a graded, systematic, and often multidisciplinary approach to determine what is the underlying pathophysiologic process. Utilization of objective data obtained through lab testing, imaging, and advanced testing, such as cardiopulmonary exercise testing, is often required to help identify underlying pathology contributing to a patient's symptoms. This article will review dyspnea's underlying pathophysiological mechanisms and standardized approaches to diagnoses. In the expert opinion section, we will discuss our own clinical approach to evaluating patients with persistent dyspnea. EXPERT OPINION Unexplained dyspnea is a challenging diagnosis that occurs in patients with and without underlying cardiopulmonary diseases. It requires a systematic approach, which initially uses clinical evaluation in addition to standard imaging and clinical biomarkers. When diagnoses are not made during the initial evaluation, subsequent tests can include cardiopulmonary exercise test and methacholine challenge. To be certain of the correct diagnosis, It is imperative that the clinician determines dyspnea's response to a particular therapeutic intervention.
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Affiliation(s)
- Andi Hudler
- Division of Pulmonary Sciences and Critical Care, University of Colorado
| | - Fernando Holguin
- Division of Pulmonary Sciences and Critical Care, University of Colorado
| | - Meghan Althoff
- Division of Pulmonary Sciences and Critical Care, University of Colorado
| | - Anne Fuhlbrigge
- Division of Pulmonary Sciences and Critical Care, University of Colorado
| | - Sunita Sharma
- Division of Pulmonary Sciences and Critical Care, University of Colorado
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15
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Everard ML. Precision Medicine and Childhood Asthma: A Guide for the Unwary. J Pers Med 2022; 12:82. [PMID: 35055397 PMCID: PMC8779146 DOI: 10.3390/jpm12010082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 01/13/2023] Open
Abstract
Many thousands of articles relating to asthma appear in medical and scientific journals each year, yet there is still no consensus as to how the condition should be defined. Some argue that the condition does not exist as an entity and that the term should be discarded. The key feature that distinguishes it from other respiratory diseases is that airway smooth muscles, which normally vary little in length, have lost their stable configuration and shorten excessively in response to a wide range of stimuli. The lungs' and airways' limited repertoire of responses results in patients with very different pathologies experiencing very similar symptoms and signs. In the absence of objective verification of airway smooth muscle (ASM) lability, over and underdiagnosis are all too common. Allergic inflammation can exacerbate symptoms but given that worldwide most asthmatics are not atopic, these are two discrete conditions. Comorbidities are common and are often responsible for symptoms attributed to asthma. Common amongst these are a chronic bacterial dysbiosis and dysfunctional breathing. For progress to be made in areas of therapy, diagnosis, monitoring and prevention, it is essential that a diagnosis of asthma is confirmed by objective tests and that all co-morbidities are accurately detailed.
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Affiliation(s)
- Mark L Everard
- Division of Child Health, Children's Hospital, Faculty of Medicine, University of Western Australia, Perth, WA 6009, Australia
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16
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Hengeveld VS, Keijzer PB, Diamant Z, Thio BJ. An Algorithm for Strategic Continuation or Restriction of Asthma Medication Prior to Exercise Challenge Testing in Childhood Exercise Induced Bronchoconstriction. Front Pediatr 2022; 10:800193. [PMID: 35273926 PMCID: PMC8902070 DOI: 10.3389/fped.2022.800193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Exercise induced bronchial (EIB) constriction is a common and highly specific feature of pediatric asthma and should be diagnosed with an exercise challenge test (ECT). The impact of EIB in asthmatic children's daily lives is immense, considering the effects on both physical and psychosocial development. Monitoring childhood asthma by ECT's can provide insight into daily life disease burden and the control of asthma. Current guidelines for bronchoprovocation tests restrict both the use of reliever and maintenance asthma medication before an exercise challenge to prevent false-negative testing, as both have significant acute bronchoprotective properties. However, restricting maintenance medication before an ECT may be less appropiate to evaluate EIB symptoms in daily life when a diagnosis of asthma is well established. Rigorous of maintenance medication before an ECT according to guidelines may lead to overestimation of the real, daily life asthma burden and lead to an inappropiate step-up in therapy. The protection against EIB offered by the combined acute and chronic bronchoprotective effects of maintenance medication can be properly assessed whilst maintaining them. This may aid in achieving the goal of unrestricted participation of children in daily play and sports activities with their peers without escalation of therapy. When considering a step down in medication, a strategic wash-out of maintenance medication before an ECT aids in providing objective support of potential discontinuation of maintenance medication.
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Affiliation(s)
- Vera S Hengeveld
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Pascal B Keijzer
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Zuzana Diamant
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium.,Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden.,Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czechia.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Boony J Thio
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
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17
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de Carvalho-Pinto RM, Cançado JED, Pizzichini MMM, Fiterman J, Rubin AS, Cerci A, Cruz ÁA, Fernandes ALG, Araujo AMS, Blanco DC, Cordeiro G, Caetano LSB, Rabahi MF, de Menezes MB, de Oliveira MA, Lima MA, Pitrez PM. 2021 Brazilian Thoracic Association recommendations for the management of severe asthma. J Bras Pneumol 2021; 47:e20210273. [PMID: 34932721 PMCID: PMC8836628 DOI: 10.36416/1806-3756/e20210273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/05/2021] [Indexed: 12/20/2022] Open
Abstract
Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.
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Affiliation(s)
- Regina Maria de Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração − InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Jussara Fiterman
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS) Brasil
| | - Adalberto Sperb Rubin
- . Universidade Federal de Ciências da Saúde de Porto Alegre − UFCSPA − Porto Alegre (RS) Brasil
- . Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Alcindo Cerci
- . Universidade Estadual de Londrina − UEL − Londrina (PR) Brasil
- . Pontifícia Universidade Católica do Paraná − PUCPR − Londrina (PR) Brasil
| | - Álvaro Augusto Cruz
- . Universidade Federal da Bahia − UFBA − Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | | | - Ana Maria Silva Araujo
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro − IDT/UFRJ − Rio de Janeiro (RJ) Brasil
| | - Daniela Cavalet Blanco
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS), Brasil
| | - Gediel Cordeiro
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
- . Hospital Madre Teresa, Belo Horizonte (MG) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás − UFG − Goiânia (GO) Brasil
| | - Marcelo Bezerra de Menezes
- . Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
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18
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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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19
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Watson M, Ionescu MF, Sylvester K, Fuld J. Minute ventilation/carbon dioxide production in patients with dysfunctional breathing. Eur Respir Rev 2021; 30:30/160/200182. [PMID: 33853884 DOI: 10.1183/16000617.0182-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/11/2020] [Indexed: 11/05/2022] Open
Abstract
Dysfunctional breathing refers to a multi-dimensional condition that is characterised by pathological changes in an individual's breathing. These changes lead to a feeling of breathlessness and include alterations in the biomechanical, psychological and physiological aspects of breathing. This makes dysfunctional breathing a hard condition to diagnose, given the diversity of aspects that contribute to the feeling of breathlessness. The disorder can debilitate individuals without any health problems, but may also be present in those with underlying cardiopulmonary co-morbidities. The ventilatory equivalent for CO2 (V eqCO2 ) is a physiological parameter that can be measured using cardiopulmonary exercise testing. This review will explore how this single measurement can be used to aid the diagnosis of dysfunctional breathing. A background discussion about dysfunctional breathing will allow readers to comprehend its multidimensional aspects. This will then allow readers to understand how V eqCO2 can be used in the wider diagnosis of dysfunctional breathing. Whilst V eqCO2 cannot be used as a singular parameter in the diagnosis of dysfunctional breathing, this review supports its use within a broader algorithm to detect physiological abnormalities in patients with dysfunctional breathing. This will allow for more individuals to be accurately diagnosed and appropriately managed.
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Affiliation(s)
- Matthew Watson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Karl Sylvester
- Lung Function, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Respiratory Physiology, Papworth Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jonathan Fuld
- Dept of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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20
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Sakkatos P, Bruton A, Barney A. Changes in quantifiable breathing pattern components predict asthma control: an observational cross-sectional study. Asthma Res Pract 2021; 7:5. [PMID: 33823934 PMCID: PMC8022412 DOI: 10.1186/s40733-021-00071-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components may provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods One hundred twenty-two asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-min. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n = 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing can be an indicator of poor asthma control.
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Affiliation(s)
| | - Anne Bruton
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Anna Barney
- Institute for Sound and Vibration Research, University of Southampton, Southampton, UK
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21
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Ionescu MF, Mani-Babu S, Degani-Costa LH, Johnson M, Paramasivan C, Sylvester K, Fuld J. Cardiopulmonary Exercise Testing in the Assessment of Dysfunctional Breathing. Front Physiol 2021; 11:620955. [PMID: 33584339 PMCID: PMC7873943 DOI: 10.3389/fphys.2020.620955] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/14/2020] [Indexed: 01/07/2023] Open
Abstract
Dysfunctional breathing (DB) is a disabling condition which affects the biomechanical breathing pattern and is challenging to diagnose. It affects individuals in many circumstances, including those without underlying disease who may even be athletic in nature. DB can also aggravate the symptoms of those with established heart or lung conditions. However, it is treatable and individuals have much to gain if it is recognized appropriately. Here we consider the role of cardiopulmonary exercise testing (CPET) in the identification and management of DB. Specifically, we have described the diagnostic criteria and presenting symptoms. We explored the physiology and pathophysiology of DB and physiological consequences in the context of exercise. We have provided examples of its interplay with co-morbidity in other chronic diseases such as asthma, pulmonary hypertension and left heart disease. We have discussed the problems with the current methods of diagnosis and proposed how CPET could improve this. We have provided guidance on how CPET can be used for diagnosis, including consideration of pattern recognition and use of specific data panels. We have considered categorization, e.g., predominant breathing pattern disorder or acute or chronic hyperventilation. We have explored the distinction from gas exchange or ventilation/perfusion abnormalities and described other potential pitfalls, such as false positives and periodic breathing. We have also illustrated an example of a clinical pathway utilizing CPET in the diagnosis and treatment of individuals with suspected DB.
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Affiliation(s)
- Maria F Ionescu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sethu Mani-Babu
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - Martin Johnson
- Golden Jubilee National Hospital, Clydebank, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom.,Gartnavel General Hospital, Glasgow, United Kingdom
| | - Chelliah Paramasivan
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Karl Sylvester
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Jonathan Fuld
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
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22
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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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23
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Pedersen ESL, Ardura-Garcia C, de Jong CCM, Jochmann A, Moeller A, Mueller-Suter D, Regamey N, Singer F, Goutaki M, Kuehni CE. Diagnosis in children with exercise-induced respiratory symptoms: A multi-center study. Pediatr Pulmonol 2021; 56:217-225. [PMID: 33079473 DOI: 10.1002/ppul.25126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments. DESIGN An observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC). PATIENTS We included children with EIS as the main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2-17, 54% males) referred for EIS. RESULTS The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%-CI 46%-60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise-challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy. CONCLUSIONS Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow-up differed between clinics and diagnostic groups highlighting the need for evidence-based diagnostic guidelines and harmonized procedures for children seen for EIS.
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Affiliation(s)
- Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | | | - Carmen C M de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Anja Jochmann
- Division of Paediatric Pulmonology, University Children's Hospital, University of Basel, Basel, Switzerland
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, Zürich, Switzerland
| | | | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital Lucerne, Switzerland
| | - Florian Singer
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.,PedNet, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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24
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Azizmohammad Looha M, Masaebi F, Abedi M, Mohseni N, Fakharian A. The Optimal Cut-off Score of the Nijmegen Questionnaire for Diagnosing Hyperventilation Syndrome Using a Bayesian Model in the Absence of a Gold Standard. Galen Med J 2020; 9:e1738. [PMID: 34466581 PMCID: PMC8397298 DOI: 10.31661/gmj.v9i0.1738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/13/2019] [Accepted: 02/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background The Nijmegen questionnaire is one of the most common tools for diagnosing hyperventilation syndrome (HVS). However, there is no precise cut-off score for differentiating patients with HVS from those without HVS. This study was conducted to evaluate the accuracy of Nijmegen questionnaire for detecting patients with HVS and to provide the best cut-off score for differentiating patients with HVS from normal individuals using a Bayesian model in the absence of a gold standard. Materials and Methods A total of 490 students from a rehabilitation center in Tehran, Iran, were asked to participate in this case study of HVS from January to August 2018. Results A total of 215 students (40% male and 60% female) completed the Nijmegen questionnaire. The area under the receiver operating characteristic curve (AUC) was 0.93 (male: 0.95; female: 94) for all of the cut-off scores. The optimal cut-off score of ≥20 could predict HVS with sensitivity of 0.91 (male: 0.99; female: 91) and specificity of 0.92 (male: 96; female: 89). Conclusion Accurate differentiation of HVS patients from individuals without HVS can be accomplished by estimating the cut-off score of Nijmegen questionnaire based on a non-parametric Bayesian model.
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Affiliation(s)
- Mehdi Azizmohammad Looha
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to: Mehdi Azizmohammad Looha, Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Telephone Number: +98-910-2121983 Email Address:
| | - Fatemeh Masaebi
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Abedi
- Physiotherapy Research Centre, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Mohseni
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Anthracopoulos MB, Everard ML. Asthma: A Loss of Post-natal Homeostatic Control of Airways Smooth Muscle With Regression Toward a Pre-natal State. Front Pediatr 2020; 8:95. [PMID: 32373557 PMCID: PMC7176812 DOI: 10.3389/fped.2020.00095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
The defining feature of asthma is loss of normal post-natal homeostatic control of airways smooth muscle (ASM). This is the key feature that distinguishes asthma from all other forms of respiratory disease. Failure to focus on impaired ASM homeostasis largely explains our failure to find a cure and contributes to the widespread excessive morbidity associated with the condition despite the presence of effective therapies. The mechanisms responsible for destabilizing the normal tight control of ASM and hence airways caliber in post-natal life are unknown but it is clear that atopic inflammation is neither necessary nor sufficient. Loss of homeostasis results in excessive ASM contraction which, in those with poor control, is manifest by variations in airflow resistance over short periods of time. During viral exacerbations, the ability to respond to bronchodilators is partially or almost completely lost, resulting in ASM being "locked down" in a contracted state. Corticosteroids appear to restore normal or near normal homeostasis in those with poor control and restore bronchodilator responsiveness during exacerbations. The mechanism of action of corticosteroids is unknown and the assumption that their action is solely due to "anti-inflammatory" effects needs to be challenged. ASM, in evolutionary terms, dates to the earliest land dwelling creatures that required muscle to empty primitive lungs. ASM appears very early in embryonic development and active peristalsis is essential for the formation of the lungs. However, in post-natal life its only role appears to be to maintain airways in a configuration that minimizes resistance to airflow and dead space. In health, significant constriction is actively prevented, presumably through classic negative feedback loops. Disruption of this robust homeostatic control can develop at any age and results in asthma. In order to develop a cure, we need to move from our current focus on immunology and inflammatory pathways to work that will lead to an understanding of the mechanisms that contribute to ASM stability in health and how this is disrupted to cause asthma. This requires a radical change in the focus of most of "asthma research."
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Affiliation(s)
| | - Mark L. Everard
- Division of Paediatrics & Child Health, Perth Children's Hospital, University of Western Australia, Perth, WA, Australia
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26
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Barker N, Thevasagayam R, Ugonna K, Kirkby J. Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management. Front Pediatr 2020; 8:379. [PMID: 32766182 PMCID: PMC7378385 DOI: 10.3389/fped.2020.00379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
Dysfunctional breathing (DB) is an overarching term describing deviations in the normal biomechanical patterns of breathing which have a significant impact on quality of life, performance and functioning. Whilst it occurs in both children and adults, this article focuses specifically on children. DB can be viewed as having two components; breathing pattern disorder (BPD) and inducible laryngeal obstruction (ILO). They can be considered in isolation, however, are intricately related and often co-exist. When both are suspected, we propose both BPD and ILO be investigated within an all-encompassing multi-disciplinary dysfunctional breathing clinic. The MDT clinic can diagnose DB through expert history taking and a choice of appropriate tests/examinations which may include spirometry, breathing pattern analysis, exercise testing and laryngoscopic examination. Use of the proposed algorithm presented in this article will aid decision making regarding choosing the most appropriate tests and understanding the diagnostic implications of these tests. The most common symptoms of DB are shortness of breath and chest discomfort, often during exercise. Patients with DB typically present with normal spirometry and an altered breathing pattern at rest which is amplified during exercise. In pediatric ILO, abnormalities of the upper airway such as cobblestoning are commonly seen followed by abnormal activity of the upper airway structures provoked by exercise. This may be associated with a varying degree of stridor. The symptoms, however, are often misdiagnosed as asthma and the picture can be further complicated by the common co-presentation of DB and asthma. Associated conditions such as asthma, extra-esophageal reflux, rhinitis, and allergy must be treated appropriately and well controlled before any directed therapy for DB can be started if therapy is to be successful. DB in pediatrics is commonly treated with a course of non-pharmaceutical therapy. The therapy is provided by an experienced physiotherapist, speech and language therapist or psychologist depending on the dominant features of the DB presentation (i.e., BPD or ILO in combination or in isolation) and some patients will benefit from input from more than one of these disciplines. An individualized treatment program based on expert assessment and personalized goals will result in a return to normal function with reoccurrence being rare.
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Affiliation(s)
- Nicki Barker
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Ravi Thevasagayam
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Kelechi Ugonna
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Jane Kirkby
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
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27
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Andreasson KH, Skou ST, Ulrik CS, Madsen H, Sidenius K, Jacobsen JS, Assing KD, Rasmussen KB, Porsbjerg C, Thomas M, Bodtger U. Protocol for a multicentre randomised controlled trial to investigate the effect on asthma-related quality of life from breathing retraining in patients with incomplete asthma control attending specialist care in Denmark. BMJ Open 2019; 9:e032984. [PMID: 31892661 PMCID: PMC6955530 DOI: 10.1136/bmjopen-2019-032984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION AND AIM Uncontrolled asthma is a global health challenge with substantial impact on quality of life (QoL) and overall healthcare costs. Unrecognised and/or unmanaged comorbidities often contribute to presence of uncontrolled asthma. Abnormalities in breathing pattern are termed dysfunctional breathing and are not only common in asthma but also lead to asthma-like symptoms and reduced QoL, and, in keeping with this, improvement with breathing normalisation. Evidence-based guidelines recommend breathing retraining interventions as an adjuvant treatment in uncontrolled asthma. Physiotherapy-based breathing pattern modification interventions incorporating relaxation have been shown to improve asthma-related QoL in primary care patients with impaired asthma control. Despite anecdotal reports, effectiveness of breathing retraining in patients referred to secondary care with incomplete asthma control has not been formally assessed in a randomised controlled trial (RCT). We aim to investigate the effect of breathing exercises on asthma-related QoL in patients with incomplete asthma control despite specialist care. METHODS AND ANALYSIS This two-armed assessor-blinded multicentre RCT will investigate the effect of physiotherapist-delivered breathing retraining on asthma QoL questionnaire (MiniAQLQ) in addition to usual specialist care, recruiting from seven outpatient departments and one specialised clinic representing all regions of Denmark during 2017-2019. We will include 190 consenting adults with incomplete asthma control, defined as Asthma Control Questionnaire 6-item score ≥0.8. Participants will randomly be allocated to either breathing exercise programme in addition to usual care (BrEX +UC) or UC alone. BrEX compiles three physiotherapy sessions and encouragement to perform home exercise daily. Both groups continue usual secondary care management. Primary outcome is between-group difference in MiniAQLQ at 6 months. Secondary outcomes include patient-reported outcome measures, spirometry and accelerometer. ETHICS AND DISSEMINATION Ethics Committee, Region Zealand (SJ-552) and Danish Data Protection Agency (REG-55-2016) approved the trial. Results will be reported in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT03127059; Pre-results.
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Affiliation(s)
- Karen Hjerrild Andreasson
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Naestved, Region Zealand, Denmark
- Department for Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Søren Thorgaard Skou
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Naestved, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Diseases, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Madsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Kirsten Sidenius
- Allergy & Lung Clinic, Elsinore, (private specialised clinic), Helsingør, Denmark
| | - Jannie Søndergaard Jacobsen
- Department of Physiotherapy and Occupational Therapy, and Pulmonary Disease Unit, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Midtjylland, Denmark
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Celeste Porsbjerg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
| | - Mike Thomas
- Primary Care, Department for Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Uffe Bodtger
- Department for Regional Health Research, Naestved Hospital, University of Southern Denmark, Naestved, Denmark
- Department of Respiratory Medicine, Naestved-Slagelse-Ringsted Hospitals, Naestved, Denmark
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28
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Hepworth C, Sinha I, Saint GL, Hawcutt DB. Assessing the impact of breathing retraining on asthma symptoms and dysfunctional breathing in children. Pediatr Pulmonol 2019; 54:706-712. [PMID: 30938089 DOI: 10.1002/ppul.24300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the impact of breathing retraining on asthma symptoms and dysfunctional breathing (DB) in children. Breathing retraining can improve DB but there is a lack of evidence in pediatrics. METHODS Participants attended outpatient physiotherapy appointments and received individually tailored interventions, particularly Buteyko breathing techniques. The primary outcome was the change in the Asthma Control Test (ACT) score or change in childhood ACT (CACT) score from first to final appointment. The ACT and CACT are validated in children more than or equal to 12 years and children aged 4 to 11, respectively. The secondary outcome measure was the change in Nijmegen Questionnaire (NQ) score from first to the final appointment (score range, 0-64) with a score of more than or equal to 23 indicating DB symptoms. RESULTS One hundred and sixty-nine children with asthma attended and completed a mean of six physiotherapy sessions, over a mean of 15 weeks. Patients were aged 2 to 18, mean 10 years. Fifty-five patients were more than or equal to 12 years old and 114 were less than or equal to 11 years. One hundred and seven patients were receiving BTS/SIGN asthma guideline step 1 to 3 therapy and 62 were on step 4 to 5 therapy. The mean ACT score improved by 4.4 (P < 0.0001), the mean CACT score improved by 4.9 (P < 0.0001), and the mean NQ score change improved by -9.3 points (P < 0.0001). CONCLUSION In addition to standard medical therapy, individually tailored physiotherapy interventions improved asthma control and DB in children on all levels of asthma treatment. A randomized controlled study is required to determine whether these improvements are due to the intervention.
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Affiliation(s)
- Claire Hepworth
- Department of Physiotherapy, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ian Sinha
- Department of Respiratory, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Gemma L Saint
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Daniel B Hawcutt
- Medical & Research department, NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Trust, Liverpool, UK
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29
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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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30
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Booth S, Chin C, Spathis A, Maddocks M, Yorke J, Burkin J, Moffat C, Farquhar M, Bausewein C. Non-pharmacological interventions for breathlessness in people with cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1524708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sara Booth
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | - Chloe Chin
- Consultant in Palliative Medicine, Camden, Islington, ELiPSE and UCLH & HCA
| | | | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Julie Burkin
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | | | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, München, Germany
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31
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Stewart JM, Pianosi P, Shaban MA, Terilli C, Svistunova M, Visintainer P, Medow MS. Postural Hyperventilation as a Cause of Postural Tachycardia Syndrome: Increased Systemic Vascular Resistance and Decreased Cardiac Output When Upright in All Postural Tachycardia Syndrome Variants. J Am Heart Assoc 2018; 7:e008854. [PMID: 29960989 PMCID: PMC6064900 DOI: 10.1161/jaha.118.008854] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postural tachycardia syndrome (POTS) is a heterogeneous condition. We stratified patients previously evaluated for POTS on the basis of supine resting cardiac output (CO) or with the complaint of platypnea or "shortness of breath" during orthostasis. We hypothesize that postural hyperventilation is one cause of POTS and that hyperventilation-associated POTS occurs when initial reduction in CO is sufficiently large. We also propose that circulatory abnormalities normalize with restoration of CO2. METHODS AND RESULTS Fifty-eight enrollees with POTS were compared with 16 healthy volunteer controls. Low CO in POTS was defined by a resting supine CO <4 L/min. Patients with shortness of breath had hyperventilation with end tidal CO2 <30 Torr during head-up tilt table testing. There were no differences in height or weight between control patients and patients with POTS or differences between the POTS groups. Beat-to-beat blood pressure was measured by photoplethysmography, and CO was measured by ModelFlow. Systemic vascular resistance was defined as mean arterial blood pressure/CO. End tidal CO2 and cerebral blood flow velocity of the middle cerebral artery were only reduced during head-up tilt in the hyperventilation group, whereas blood pressure was increased compared with control. We corrected the reduced end tidal CO2 in hyperventilation by addition of exogenous CO2 into a rebreathing apparatus. With added CO2, heart rate, blood pressure, CO, and systemic vascular resistance in hyperventilation became similar to control. CONCLUSIONS We conclude that all POTS is related to decreased CO, decreased central blood volume, and increased systemic vascular resistance and that a variant of POTS is consequent to postural hyperventilation.
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Affiliation(s)
- Julian M Stewart
- Department of Pediatrics, New York Medical College, Valhalla, NY
- Department of Physiology, New York Medical College, Valhalla, NY
| | - Paul Pianosi
- Paediatric Respiratory Medicine, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Mohamed A Shaban
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Courtney Terilli
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Maria Svistunova
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Paul Visintainer
- Epidemiology and Biostatistics, Baystate Medical Center, University of Massachusetts School of Medicine, Worcester, MA
| | - Marvin S Medow
- Department of Pediatrics, New York Medical College, Valhalla, NY
- Department of Physiology, New York Medical College, Valhalla, NY
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32
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Courtney R. Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach. ERJ Open Res 2017; 3:00065-2017. [PMID: 29234673 PMCID: PMC5721258 DOI: 10.1183/23120541.00065-2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/05/2017] [Indexed: 11/05/2022] Open
Abstract
Various breathing training programmes may be helpful for adults with asthma. The main therapeutic aim for many of these programmes is the correction of dysfunctional breathing. Dysfunctional breathing can be viewed practically as a multidimensional entity with the three key dimensions being biochemical, biomechanical and psychophysiological. The objectives of this review are to explore how each of these dimensions might impact on asthma sufferers, to review how various breathing therapy protocols target these dimensions and to determine if there is evidence suggesting how breathing therapy protocols might be optimised. Databases and reference lists of articles were searched for peer-reviewed English language studies that discussed asthma or dysfunctional breathing and various breathing therapies. Biochemical, biomechanical and psychophysiological aspects of dysfunctional breathing can all potentially impact on asthma symptoms and breathing control. There is significant variation in breathing training protocols and the extent to which they evaluate and improve function in these three dimensions. The various dimensions of dysfunctional breathing may be of greater or lesser importance in different cases and the effectiveness of breathing training protocols is likely to be improved when all three dimensions are considered. Outcomes for breathing training for dysfunctional breathing in asthma may be most successful when the three key dimensions of dysfunctional breathing are evaluated at the start of treatment and monitored during treatment. This allows breathing training protocols to be adjusted as appropriate to ensure that treatment is sufficiently comprehensive and intensive to produce measurable improvements where necessary.
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Affiliation(s)
- Rosalba Courtney
- School of Health Science, Southern Cross University, Lismore, Australia
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33
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Barker NJ, Elphick H, Everard ML. The impact of a dedicated physiotherapist clinic for children with dysfunctional breathing. ERJ Open Res 2016; 2:00103-2015. [PMID: 27957485 PMCID: PMC5140018 DOI: 10.1183/23120541.00103-2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/25/2016] [Indexed: 11/05/2022] Open
Abstract
Dysfunctional breathing is a significant cause of morbidity, adversely affecting an individual's quality of life. There is currently no data from paediatric centres on the impact of breathing retraining for dysfunctional breathing. Symptoms and quality of life were measured in 34 subjects referred sequentially for breathing retraining to the first dedicated paediatric dysfunctional breathing clinic in the UK. Data were obtained prior to the first intervention (time point 1), at discharge (time point 2) and by post 6 months later (time point 3). The mean (interquartile range) age of participants was 13.3 (9.1-16.3) years, with 52% female. Data were obtained at time points 2 and 3 in 23 and 13 subjects, respectively. Statistically significant improvements were observed in symptom scores, child quality of life and parental proxy quality of life between time points 1 and 2 (p<0.0001), while there was no significant difference in the data at time point 3 as compared with time point 2. This study suggests that physiotherapist-led breathing retraining offers significant benefit to young people with dysfunctional breathing which is maintained for at least 6 months after treatment is completed. Future studies will provide more information on the long-term effects of interventions for dysfunctional breathing.
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Affiliation(s)
- Nicola J Barker
- Dept of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Heather Elphick
- Dept of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, TelethonKids Institute, Princess Margaret Hospital for Children, Subiaco, Australia
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34
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Depiazzi J, Everard ML. Dysfunctional breathing and reaching one's physiological limit as causes of exercise-induced dyspnoea. Breathe (Sheff) 2016; 12:120-9. [PMID: 27408630 PMCID: PMC4933621 DOI: 10.1183/20734735.007216] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Key points This review provides an overview of the spectrum of conditions that can present as exercise-induced breathlessness experienced by young subjects participating in sport and aims to promote understanding of the need for accurate assessment of an individual’s symptoms. We will highlight the high incidence of nonasthmatic causes, which simply require reassurance or simple interventions from respiratory physiotherapists or speech pathologists. Breathlessness: accurate assessment and diagnosis is essential in order to provide correct advice and assistancehttp://ow.ly/4nrW8z
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Affiliation(s)
- Julie Depiazzi
- Physiotherapy Dept, Princess Margaret Hospital, Subiaco, Australia
| | - Mark L Everard
- Dept of Respiratory Medicine, Princess Margaret Hospital, Subiaco, Australia; University of Western Australia, Crawley, Australia
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35
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Reliability and Determinants of Self-Evaluation of Breathing Questionnaire (SEBQ) Score: A Symptoms-Based Measure of Dysfunctional Breathing. Appl Psychophysiol Biofeedback 2015; 41:111-20. [DOI: 10.1007/s10484-015-9316-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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van Dixhoorn J, Folgering H. The Nijmegen Questionnaire and dysfunctional breathing. ERJ Open Res 2015; 1:00001-2015. [PMID: 27730128 PMCID: PMC5005127 DOI: 10.1183/23120541.00001-2015] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/06/2015] [Indexed: 11/10/2022] Open
Abstract
The Nijmegen Questionnaire is useful to quantify and assess the normality of subjective sensations http://ow.ly/MBJj1.
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Affiliation(s)
- Jan van Dixhoorn
- Centre for Breathing Therapy, Amersfoort, The Netherlands
- Science Bureau, Linneaus Institure, Haarlem, The Netherlands
| | - Hans Folgering
- Emeritus Professor of Respiratory Physiology, Nijmegen, The Netherlands
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