Dysfunctional Breathing

Sleep Apnea for Kids and Adults
Avoiding Mouth Breathing
Heart Rate Variability

Dr Roca started in July 2021 an intense integrative breathing class that lasts 6 months. She signed up for this class that meets weekly to learn exactly what dysfunctional breathing is, how to recognize it and how to correct it. She has found that teaching just one breathing method is not enough for all. Many medical conditions and patients require a specific breathing method for their symptoms. This class has been eye opening and Dr Roca is thrilled to be able to teach her patients how to correct their dysfunctional breathing that is 100 percent connected to our health and our sleep.

Defining Dysfunctional Breathing

The term ‘dysfunctional breathing’ (DB) started to be used as growing uncertainty of the link between hypocapnia and symptoms of the hyperventilation syndrome made the use of that term controversial [29, 41].
Initially the term dysfunctional breathing seemed to be used almost as a proxy for hyperventilation syndrome but it has now evolved to be umbrella term for any functional breathing disorder including hyperventilation, breathing pattern disorders, paradoxical vocal fold motion, inducible laryngeal obstruction, psychological breathing disorders and some inappropriate breathing behaviors such as chronic mouth breathing.
Despite vagueness of definition the term dysfunctional breathing was commonly used. The following table shows around 45 studies that mentioned dysfunctional breathing in the title between 2001 to 2020. Earliest reference was by Piani in 1961“Dysfunctional Respiratory Syndrome”.

Table 1- Literature Review-Term Dysfunctional Breathing

Title  Year First Author Ref.
Breathing pattern disorders (dysfunctional breathing) characteristics and outcomes of children and young people attending a secondary care respiratory clinic.  2020 Newson [42]
Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management 2020 Barker [43]
Disruption of Pathological Patterns in a Young Population with Dysfunctional Breathing 2020 OK and Park [44]
Exercise intervention for individuals with dysfunctional breathing: a matched controlled trial 2020 Kiesel [45]
Assessing the impact of breathing retraining on asthma symptoms and dysfunctional breathing in children. 2019 Hepworth  [46]

Dysfunctional breathing: what do we know?

2019 Vidotto [47]
Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma 2019 Denton [48]
Dysfunctional Breathing in Children and Adults With Asthma 2018 Connett [49]
Association of dysfunctional breathing with health-related quality of life: A cross-sectional study in a young population 2018 OK, Park and Park  [50]
Stop Thinking! I Can’t! Do Attentional Mechanisms Underlie Primary Dysfunctional Breathing? 2018 Vidotto [51]
Dysfunctional breathing is more frequent in chronic obstructive pulmonary disease than in asthma and in health 2018 Law [52]
Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach 2017 Courtney [53]
Development of a screening protocol to identify individuals with dysfunctional breathing 2017 Kiesel [54]
Dysfunctional breathing in children and adolescents 2017 Weinberger [55]
Therapeutic options for dysfunctional breathing in children and adolescents 2017 Niggermann [56]
Dysfunctional breathing in patients with asthma 2017 Andreasson [57]
The impact of dysfunctional breathing on the assessment of breathing control 2017 Veidal [58]
The impact of a dedicated physiotherapist clinic for children with dysfunctional breathing.


2016 Barker [59]
Dysfunctional breathing: a review of the literature and proposal for classification 2016 Boulding [60]
Dysfunctional breathing and reaching one’s physiological limit as causes of exercise-induced dyspnoea.


2016 Depiazzi [61]
Reliability and Determinants of Self-Evaluation of Breathing Questionnaire (SEBQ) Score: A Symptoms-Based Measure of Dysfunctional Breathing.


2016 Mitchell [62]
The Nijmegen Questionnaire and dysfunctional breathing 2015 van Dixhoorn [40]
Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial.


2015 Jones [63]
Breathing exercises for dysfunctional breathing/hyperventilation syndrome in children. 2013 Barker [64]
Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. 2013 Jones [65]
Dysfunctional breathing in children with asthma: a rare but relevant comorbidity


2013 De Groot [66]
Dissociation of dysfunctional breathing and odour intolerance among adults in a general-population study. 2013 Bonde [67]
Asthma: vocal cord dysfunction (VCD) and other dysfunctional breathing disorders. 2012 Balkissoon [68]
Dysfunctional breathing phenotype in adults with asthma – incidence and risk factors 2012 Agache [69]
Relationship between dysfunctional breathing patterns and ability to achieve target heart rate variability with features of “coherence” during biofeedback 2011 Courtney [70]
Breathing retraining – a five-year follow-up of patients with dysfunctional breathing 2011 Hagman [71]
Medically unexplained dyspnea: partly moderated by dysfunctional (thoracic dominant) breathing pattern 2011 Courtney [72]
Relationships between measures of dysfunctional breathing in a population with concerns about their breathing. 2011 Courtney [73]
An observational investigation of dysfunctional breathing and breathing control therapy in a problem asthma clinic 2008 Stanton [74]
Dysfunctional breathing in patients with asthma 2008 Prys-Picard [75]
A comparison between patients with dysfunctional breathing and patients with asthma. 2008 Hagman [76]
Evaluation of breathing pattern: comparison of a Manual Assessment of Respiratory Motion (MARM) and respiratory induction plethysmography. 2008 Courtney [77]
Investigating the claims of Konstantin Buteyko, M.D., Ph.D.: the relationship of breath holding time to end tidal CO2 and other proposed measures of dysfunctional breathing. 2008 Courtney [78]
Childhood Asthma Control Test in asthmatic children with dysfunctional breathing 2008 Peroni [79]
Recognizing dysfunctional breathing in asthma consultations.


2007 Henderson [80]
The prevalence of dysfunctional breathing in adults in the community with and without asthma. 2005 Thomas [81]
Dysfunctional breathing in COPD 2003 Connolly [82]
Breathing retraining for dysfunctional breathing in asthma: a randomised controlled trial. 2003 Morgan [83]
Dysfunctional breathing and asthma. Panic disorder needs to be considered 2001 Davies [84]
Dysfunctional breathing and asthma. Trial shows benefit of Buteyko breathing techniques.  2001 Kuiper [85]
Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey 2001 Thomas [86]
Dysfunctional breathing and asthma. Is it important to tell the difference. 2001 Keeley [87]
The respiratory dysfunctional syndrome in bronchial asthma 1961 Piane [88]


Dysfunctional breathing does not have a formal agreed definition or gold standard diagnostic method.

Dysfunctional Breathing, Breathing Patterns and The Biomechanical Dimension

Some recent definitions of dysfunctional breathing have put emphasis on breathing patterns and link symptoms to the biomechanical neuromuscular aspects of breathing.

Examples in the recent literature:
“Dysfunctional breathing is a term describing a group of breathing disorders in patients where chronic changes in breathing pattern result in dyspnoea and often non respiratory symptoms in the absence of, or in excess of, organic respiratory disease”[60].

“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. DB can be viewed as having two components; breathing pattern disorder (BPD) and inducible laryngeal obstruction (ILO)”[43].

“Dysfunctional Breathing can be defined as an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms. It can be subdivided into thoracic and extra thoracic forms. Thoracic DB is characterized by breathing patterns involving relatively inefficient, excessive upper chest wall activity with or without accessory muscle activity. This is frequently associated with increased residual volume, frequent sighing and an irregular pattern of respiratory effort. It may be accompanied by true hyperventilation in the minority of subjects. Extra thoracic forms include paradoxical vocal cord dysfunction and the increasingly recognised supra-glottic ‘laryngomalacia’ commonly seen in young sportsmen and women”[89].

Breathing Pattern Disorders

The term breathing pattern disorders first started appearing in the literature in papers discussing the impact of habitual breathing on muscular-skeletal pain, posture and movement patterns [90, 91]. Recently the term breathing pattern disorder has started to be used interchangeably with dysfunctional breathing [42, 92].

Definition of a breathing pattern disorder
A breathing pattern disorder is a form of dysfunctional breathing that occurs when the normal relaxed respiratory cycle is replaced either intermittently or habitually with abnormal breathing patterns . Attempts have been made to classify different types of abnormal breathing pattern in adult patients with five different patterns being identified; hyperventilation syndrome, periodic deep sighing, thoracic dominant breathing, forced abdominal expiration and thoraco-abdominal asynchrony. [43]

Table 2- Articles using terms Breathing Pattern Disorders

Article Title Author  Year Reference
Breathing pattern disorder in difficult asthma: characteristics and improvement in asthma control and quality of life after breathing retraining Denton 2018 [92]
A clinical guide to the assessment and treatment of breathing disorders in the physically active- part 1  Chapman 2016 [93]
A clinical guide to the assessment and treatment of breathing disorders in the physically active- part 2 a case series. Hansen-Honeycutt 2016 [91]


Breathing Basics #1 sequence

© Dr. Rosalba Courtney 2021