Characterisation of a paediatric population referred for a dysfunctional breathing assessment

Abstract

Dysfunctional breathing (DB) is recognised as a modifiable factor in asthma management, and a differential diagnosis for exercise induced breathlessness (EIB). Recognition of DB can prevent excessive use of drug therapy. Further characterisation of this population seeks to assist clinicians in guiding referral for breathing retraining.

Consecutive referrals to a dysfunctional breathing physiotherapy clinic were audited between 06/18 and 05/20. Patients with incomplete data sets were omitted. 77 referrals were included (7-17y (median 12y)). 24 (31%) had a confirmed asthma diagnosis, and asthma had been investigated and excluded in 38 (49%). Of that 38, 18 had continued their asthma medication. 17 (22%) had attended A&E with shortness of breath and 19 (25%) referrals mentioned induced laryngeal obstruction (ILO). 59 CYP (77%) presented with exercise induced symptoms, only 14/59 (25%) with breathlessness alone and 38/59 (49%) with breathlessness plus other symptoms including chest tightness, and chest pain. 18/77 referrals did not report exercise induced symptoms and of these 8 presented with anxiety and 5 with suspected habit cough. 28 (36%) of referrals mentioned anxiety. 23 (30%) participated in competitive sport or regular training reporting reduced performance and participation.

Onset of breathing difficulty appears to occur in early or pre-adolescence. This may be accounted for by the pubertal growth spurt or changes in exercise habits or symptom awareness.

Breathing retraining for DB has an important role in restoring participation in physical activity at a pivotal age. Breathing patterns should be considered as part of a asthma assessment.