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Breathing Pattern Disorders

Checked: 23-04-2023 by Rob Adams Next Review: 23-04-2024

Overview

Breathing pattern disorders are patterns of overbreathing, where the depth and rate of breath are in excess of the body’s needs. Approximately 6-12% of the population experience chronic breathing pattern disorders, but some people are more affected than others.

Common symptoms include:

Frequent sighing and yawning
Feeling breathless, even after relatively minor exercise
Difficulty co-ordinating breathing and talking and/or eating
Pins and needles in hands/arms/around mouth
The feeling of being unable to take a satisfying breath

Who to Refer

Patients with breathing problems will usually have initial tests in primary care to rule out cardio-respiratory or other causes (see 'red flag' and 'what to do before referral' sections below).

If a Breathing Pattern Disorder is suspected then reassurance, patient information and management of underlying anxiety may be all that is needed.

If there is diagnostic uncertainty then a referral to appropriate specialty should be considered.

Otherwise, if symptoms are not improving with management in primary care then a referral to the Breathing Disorder Clinic run by the physiotherapists at the BRI can be considered.

Red Flags

Consider other causes of breathing problems and if suspected then investigate or refer as appropriate:

What to do before referral

Exclude physical causes of breathlessness and investigate accordingly. Tests that may be considered include:

Bloods - to include FBC, NTproBNP - to exclude anaemia and heart failure.
CXR
Spirometry
FeNO testing - to exclude asthma
ECG

Manage underlying anxiety or depression.

Give patient information - The Physiotherapy for breathing pattern disorders website has useful resources for patients and clinicians:

There are also some downloadable leaflets on this site as below:

Referral

If management in primary care has not been successful then GPs are able to refer directly into the physio Breathing Pattern Disorder service at the BRI via email:

oprespiratoryphysiotherapy@uhbw.nhs.uk

(there is no open access service at Southmead).

The BPD physios kindly ask referrers to consider and address the following prior to referral:

If there is any diagnostic uncertainty as the cause of symptoms, patients need to be referred into the appropriate specialty to be fully evaluated.
Hospital based tests such as hospital spirometry, need to be completed and looked at before referring to the physio BPD service – this service cannot rule out other causes and patients who are inadequately screened will not be seen.
If the suspected breathing pattern disorder started after contracting Covid 19, then please refer to the Long Covid service instead.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.