Breathing Re-education Program for Asthmatic Children Complaining of Exercise Associated Dyspnea with Dysfunctional Breathing

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Authors (including presenting author) :
Leung RWC1, Fung BKY1, Chan MPY1, Chan CYY1, Lam KY1, KT Chan2 , SCM Ng2, KL Kwok2, EYT Chan2, Ng KK2, Li CM1, Leung SY2
Affiliation :
(1)Physiotherapy Department, (2)Department of Paediatrics, Kwong Wah Hospital, Hong Kong
Introduction :
Dysfunctional breathing (DB) is an alternation in normal biomechanical breathing pattern resulting in intermittent or chronic respiratory and/or non-respiratory symptoms. It is associated with thoracic breathing pattern and mouth breathing. The prevalence of dysfunctional breathing was reported to be 8% adult population and 30% of adult with asthma, 5.3% of children aged 5-18 with asthma experienced dysfunctional breathing.
Objectives :
To evaluate the use of the breathing re-education program on the asthmatic children with dysfunctional breathing.
Methodology :
It was a retrospective analysis of the effectiveness of the breathing re-education program in correcting the dysfunctional breathing pattern in asthmatic children. Data were retrieved from January 2017 to March 2019. The diagnostic criteria of dysfunctional breathing included: 1) complaint of shortness of breath during exercise and 2) absence of significant decrease in FEV-1 after exercise challenge and 3) normal VO2 max derived from Step test and 4) normal scores from Nijmegen score, i.e.< 23. The referral criteria were asthmatic children with no significant organ / system insufficiency aged 6-18 with dysfunctional breathing as per the above-mentioned diagnostic criteria. The breathing re-education program classified patients into thoracic breathing group and abdominal breathing group. This was followed by 6 sessions of breathing re-education program. Data were reported as median and interquartile range. Wilcoxon singed rank test was used for paired comparison. p< 0.05 was regarded as significant.
Result & Outcome :
Fourteen asthmatic children (Female: 8, Male: 6). Eleven children (78.6%) had thoracic breathing and 3 had abdominal breathing. The duration of wake mouth breathing as reported by parents decreased from median of 80% (IQR 38%-93%) to 20% (8%-35%) (p= 0.001). The perceived dyspnea as judged by modified Borg scale after running improved from 6 (IQR 5-8) to 3 (IQR 1-4) (p= 0.005). The breath hold time increased from 19 seconds (IQR 14-22 seconds) to 30 seconds (IQR 25-33 seconds)(p= 0.002). The number of steps in the pace test increased from 31 steps (IQR 26-36 steps) to 55 steps (IQR 43-64 steps) (p= 0.005). Thoracic breathing pattern was converted to abdominal breathing pattern in 7 out of 11 children. Breathing re-education program provides a treatment option for exercise induced dyspnea due to dysfunctional breathing pattern in asthmatic children.

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