Optimal Treatment for Dysfunctional Breathing in Adults: An International Delphi Study

Dysfunctional breathing (DB) is common and impairs quality of life. Various non-pharmacological interventions have been identified, but there is a lack of agreement regarding essential treatment components and delivery methods. This study aimed to gain consensus from experts and people with DB regarding the critical components, optimal format and delivery methods of non-pharmacological DB interventions.

A two-round Delphi process was conducted involving international experts, with each round followed by a consumer focus group. Online surveys were distributed using the Qualtrics platform. Components were defined as essential (median ≥ 4 on a 5-point Likert scale, interquartile range [IQR] = 0), desirable (median = 5, IQR > 0), or optional (median = 4, IQR > 0). In the 2nd round, components with a median score ≤ 3 and IQR = 0 were eliminated, and components without consensus (IQR > 0) were rescored.

Participants in Round 1 included 46 experts and 5 focus group patients with DB, and in Round 2, 44 experts and 4 patients. Essential components for treating DB were a comprehensive assessment, breathing retraining with or without biofeedback, education, manual therapy, psychological therapy, and home practice of techniques. Desirable components were individualised home programs and information materials, and re-assessment. Optional components were individualised modes of treatment delivery and exercise therapy.

This study identified five essential interventions for treating DB, with assessment and home practice essential for treatment delivery. Individualisation of interventions and treatment format is suggested. The findings provide a basis for the development of treatment options for people with DB.