Breathing pattern disorder: assessment and diagnosis

Breathing pattern disorder (BrPD) is an important and common cause of breathlessness; however, the approach to assessment and diagnosis is variable. Consequently, identification of BrPD is inconsistent, risks clinical underestimation and diagnostic delays, and may lead to inappropriate treatments and patient distress. This review aimed to explore the measurement properties of assessment instruments available for BrPD and proposes evidence-based frameworks for identification, assessment and diagnosis. A total of seven patient-reported outcomes and nine physical outcome measurements used in BrPD were identified, but validation in BrPD and evidence for clinometric properties was frequently not available. Comprehensive evaluation of BrPD requires assessment of both symptoms and breathing patterns, and we propose a framework for diagnosis of BrPD that includes three components: symptom screening using the Nijmegen questionnaire, physical assessment using the Breathing Pattern Assessment Tool, and excluding or optimising underlying conditions. A screening and assessment framework is proposed to facilitate a confident diagnosis of BrPD and underpin individualised treatment.