{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T06:44:13Z","timestamp":1793774653255,"version":"4.6.1"},"reference-count":65,"publisher":"European Respiratory Society (ERS)","issue":"141","content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2016,3,17]]},"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:p>Dysfunctional breathing is a term describing breathing disorders where chronic changes in breathing pattern result in dyspnoea and other symptoms in the absence or in excess of the magnitude of physiological respiratory or cardiac disease. We reviewed the literature and propose a classification system for the common dysfunctional breathing patterns described. The literature was searched using the terms: dysfunctional breathing, hyperventilation, Nijmegen questionnaire and thoraco-abdominal asynchrony. We have summarised the presentation, assessment and treatment of dysfunctional breathing, and propose that the following system be used for classification. 1) Hyperventilation syndrome: associated with symptoms both related to respiratory alkalosis and independent of hypocapnia. 2) Periodic deep sighing: frequent sighing with an irregular breathing pattern. 3) Thoracic dominant breathing: can often manifest in somatic disease, if occurring without disease it may be considered dysfunctional and results in dyspnoea. 4) Forced abdominal expiration: these patients utilise inappropriate and excessive abdominal muscle contraction to aid expiration. 5) Thoraco-abdominal asynchrony: where there is delay between rib cage and abdominal contraction resulting in ineffective breathing mechanics.<\/jats:p><jats:p>This review highlights the common abnormalities, current diagnostic methods and therapeutic implications in dysfunctional breathing. Future work should aim to further investigate the prevalence, clinical associations and treatment of these presentations.<\/jats:p>","DOI":"10.1183\/16000617.0088-2015","type":"journal-article","created":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T01:06:50Z","timestamp":1472692010000},"page":"287-294","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":346,"title":["Dysfunctional breathing: a review of the literature and proposal for classification"],"prefix":"10.1183","volume":"25","author":[{"given":"Richard","family":"Boulding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Stacey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Niven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2016,8,31]]},"reference":[{"key":"2024102403223514000_25.141.287.1","first-page":"365","article-title":"The pathophysiology of hyperventilation syndrome","volume":"54","author":"Folgering","year":"1999","journal-title":"Monaldi Arch Chest Dis"},{"key":"2024102403223514000_25.141.287.2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.109.2.516"},{"key":"2024102403223514000_25.141.287.3","first-page":"II31","article-title":"Dysfunctional breathing in asthma: is it common, identifiable and correctable?","volume":"57","author":"Morgan","year":"2002","journal-title":"Thorax"},{"key":"2024102403223514000_25.141.287.4","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200207-720OC"},{"key":"2024102403223514000_25.141.287.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7294.1098"},{"key":"2024102403223514000_25.141.287.6","first-page":"12","article-title":"Physical phenomena associated with anxiety states: the hyperventilation syndrome","volume":"48","author":"Kerr","year":"1938","journal-title":"Cal West Med"},{"key":"2024102403223514000_25.141.287.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(96)00195-X"},{"key":"2024102403223514000_25.141.287.8","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.97.10010167"},{"key":"2024102403223514000_25.141.287.9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.6.1723"},{"key":"2024102403223514000_25.141.287.10","first-page":"90","article-title":"Hyperventilation and dysfunctional breathing","volume":"46","author":"van Dixhoorn","year":"1997","journal-title":"Biol Psychol"},{"key":"2024102403223514000_25.141.287.11","doi-asserted-by":"publisher","DOI":"10.3109\/02770903.2011.554942"},{"key":"2024102403223514000_25.141.287.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcrj.2004.10.007"},{"key":"2024102403223514000_25.141.287.13","doi-asserted-by":"publisher","DOI":"10.3109\/02770903.2014.922190"},{"key":"2024102403223514000_25.141.287.14","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.58.2.110"},{"key":"2024102403223514000_25.141.287.15","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(86)90393-1"},{"key":"2024102403223514000_25.141.287.16","doi-asserted-by":"publisher","DOI":"10.1186\/2045-7022-2-18"},{"key":"2024102403223514000_25.141.287.17","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00130212"},{"key":"2024102403223514000_25.141.287.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2011.03.006"},{"key":"2024102403223514000_25.141.287.19","doi-asserted-by":"publisher","DOI":"10.1080\/02770900802252093"},{"key":"2024102403223514000_25.141.287.20","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1136\/thx.52.2008.S30","article-title":"The hyperventilation syndrome: a syndrome under threat?","volume":"52: Suppl 3","author":"Howell","year":"1997","journal-title":"Thorax"},{"key":"2024102403223514000_25.141.287.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpsycho.2010.05.006"},{"key":"2024102403223514000_25.141.287.22","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200412-1669OC"},{"key":"2024102403223514000_25.141.287.23","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(94)90004-3"},{"key":"2024102403223514000_25.141.287.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-699X.2007.00036.x"},{"key":"2024102403223514000_25.141.287.25","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(85)90042-X"},{"key":"2024102403223514000_25.141.287.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)02024-7"},{"key":"2024102403223514000_25.141.287.27","doi-asserted-by":"publisher","DOI":"10.1007\/s10484-008-9052-3"},{"key":"2024102403223514000_25.141.287.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2009.01.005"},{"key":"2024102403223514000_25.141.287.29","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.55.12.1016"},{"key":"2024102403223514000_25.141.287.30","doi-asserted-by":"publisher","DOI":"10.1191\/1479972306cd116ed"},{"key":"2024102403223514000_25.141.287.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2010.06.004"},{"key":"2024102403223514000_25.141.287.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijosm.2009.02.001"},{"key":"2024102403223514000_25.141.287.33","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.3.679"},{"key":"2024102403223514000_25.141.287.34","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2007.7204"},{"key":"2024102403223514000_25.141.287.35","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/142.5.1009"},{"key":"2024102403223514000_25.141.287.36","doi-asserted-by":"publisher","DOI":"10.1590\/S1413-35552012005000061"},{"key":"2024102403223514000_25.141.287.37","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(85)90008-X"},{"key":"2024102403223514000_25.141.287.38","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2011-201054c.203"},{"key":"2024102403223514000_25.141.287.39","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2011-201054c.207"},{"key":"2024102403223514000_25.141.287.40","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2008.100867"},{"key":"2024102403223514000_25.141.287.41","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-14-184"},{"key":"2024102403223514000_25.141.287.42","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.58.8.674"},{"key":"2024102403223514000_25.141.287.43","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-14-160"},{"key":"2024102403223514000_25.141.287.44","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00005613"},{"key":"2024102403223514000_25.141.287.45","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1183\/09031936.93.01090846","article-title":"CO2 response and pattern of breathing in patients with symptomatic hyperventilation, compared to asthmatic and normal subjects","volume":"1","author":"Hormbrey","year":"1988","journal-title":"Eur Respir J"},{"key":"2024102403223514000_25.141.287.46","doi-asserted-by":"publisher","DOI":"10.1378\/chest.84.3.286"},{"key":"2024102403223514000_25.141.287.47","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(75)90017-3"},{"key":"2024102403223514000_25.141.287.48","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0272-5231(21)00502-5","article-title":"Respiratory muscles and dyspnea","volume":"9","author":"Killian","year":"1988","journal-title":"Clin Chest Med"},{"key":"2024102403223514000_25.141.287.49","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.4.1072"},{"key":"2024102403223514000_25.141.287.50","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.2.459"},{"key":"2024102403223514000_25.141.287.51","doi-asserted-by":"publisher","DOI":"10.1136\/thx.52.4.355"},{"key":"2024102403223514000_25.141.287.52","doi-asserted-by":"publisher","DOI":"10.3109\/02770903.2012.717658"},{"key":"2024102403223514000_25.141.287.53","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01522"},{"key":"2024102403223514000_25.141.287.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2009.02.004"},{"key":"2024102403223514000_25.141.287.55","doi-asserted-by":"publisher","DOI":"10.1016\/S1360-8592(98)80019-3"},{"key":"2024102403223514000_25.141.287.56","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-2977(96)00080-0"},{"key":"2024102403223514000_25.141.287.57","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijosm.2006.01.012"},{"key":"2024102403223514000_25.141.287.58","doi-asserted-by":"publisher","DOI":"10.1016\/S1081-1206(10)63169-9"},{"key":"2024102403223514000_25.141.287.59","doi-asserted-by":"publisher","DOI":"10.1016\/S0954-6111(96)90156-0"},{"key":"2024102403223514000_25.141.287.60","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.55.4.295"},{"key":"2024102403223514000_25.141.287.61","doi-asserted-by":"publisher","DOI":"10.1177\/0145445501254003"},{"key":"2024102403223514000_25.141.287.62","doi-asserted-by":"publisher","DOI":"10.1191\/1479972304cd020rs"},{"key":"2024102403223514000_25.141.287.63","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2013.04.017"},{"key":"2024102403223514000_25.141.287.64","doi-asserted-by":"publisher","DOI":"10.1155\/2006\/834786"},{"key":"2024102403223514000_25.141.287.65","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thx.2006.065144","article-title":"Recommendations for the management of cough in adults","volume":"61: Suppl 1","author":"Morice","year":"2006","journal-title":"Thorax"}],"container-title":["European Respiratory Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/16000617.0088-2015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T04:58:59Z","timestamp":1740373139000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/16000617.0088-2015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8,31]]},"references-count":65,"journal-issue":{"issue":"141","published-online":{"date-parts":[[2016,8,31]]},"published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.1183\/16000617.0088-2015"],"URL":"https:\/\/doi.org\/10.1183\/16000617.0088-2015","relation":{},"ISSN":["0905-9180","1600-0617"],"issn-type":[{"value":"0905-9180","type":"print"},{"value":"1600-0617","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8,31]]}}}