Breathing pattern disorder: symptoms and breathing retraining

What is a breathing pattern disorder?

Normally you breathe without thinking about it: slowly, quietly, through your nose and low into your tummy. In a breathing pattern disorder, that automatic pattern changes. You might breathe too fast, too deeply, from the top of your chest, through your mouth, or with lots of sighs and breath-holds. The breathing is often more than your body needs, which lowers the carbon dioxide in your blood and causes many of the symptoms.

It used to be called hyperventilation syndrome, but not everyone with it over-breathes all the time, so the broader terms breathing pattern disorder and dysfunctional breathing are now used.

Symptoms

• Feeling you can’t get a satisfying breath, or “air hunger”
• Frequent sighing or yawning
• Breathlessness at rest or out of proportion to what you’re doing
• Chest tightness or chest wall pain
• Dizziness, light-headedness or feeling spaced out
• Tingling in your hands, feet or around your mouth
• Tiredness, poor concentration and anxiety

These symptoms can be caused by other conditions, so see your GP to rule them out, especially if they are new.

Who gets it?

It is common. A review estimated it affects about 9.5% of adults seen in UK general practice. It is especially common in people with asthma, affecting about a third of women and a fifth of men with asthma, where it can be mistaken for poorly controlled asthma. It can also follow a chest infection, COVID-19, a period of stress or anxiety, or a frightening breathing episode. See long COVID breathlessness and carbon dioxide and over-breathing.

Breathing retraining

The usual treatment is breathing retraining with a respiratory physiotherapist. It typically involves:

• Understanding what is happening, which takes away much of the fear.
• Breathing control: slow, gentle breathing through the nose, low into the tummy. See diaphragmatic breathing.
• Breathing less, not more. Softer, smaller breaths, and learning to swallow or hold back a sigh or yawn instead of taking a big gulp.
• Practising in everyday life: while talking, walking and at night, not only sitting still.
• Dealing with triggers such as stress, posture or a blocked nose.

What the research shows

The research is surprisingly thin for something so common. A Cochrane review in 2013 found only one small, poorly reported randomised trial of breathing exercises for dysfunctional breathing, and concluded there was no credible evidence either way. Since then, more evidence comes from people with asthma: in a UK trial, physiotherapist-taught breathing training reduced over-breathing symptoms on the Nijmegen questionnaire, as well as anxiety, and improved asthma quality of life. A Cochrane review of breathing exercises in asthma also found fewer over-breathing symptoms.

Breathing retraining is standard practice among UK respiratory physiotherapists and many people find it helps, but we grade the evidence as weak.

Getting help

Ask your GP about a referral to a respiratory physiotherapist, explaining that you think your breathing pattern may be part of the problem. If you have asthma and feel breathless even when your asthma seems well controlled, mention it to your asthma nurse.