Authors (including presenting author) :
Leung EYH(1), Fung BKY(1), Leung RWC(1), Tse DYH(1), Law WS(1), Chan CYY(1), Lam HT(1), Chan KT (2), Ng SCM (2), Kwok KL (2), Chan YT (2), Leung SY(2)
Affiliation :
Physiotherapy Department(1), Department of Paediatrics(2), 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. The prevalence of dysfunctional breathing was reported to be 8% adult population and 30% of adult with asthma. In asthmatic children, it was reported to be 5%.
Objectives :
To evaluate the use of the breathing re-education program on the asthmatic children with dysfunctional breathing to reduce exercise induced dyspnea.
Methodology :
It is a case series study to evaluated the effectiveness of the breathing re-education program for asthmatic children with dysfunctional breathing pattern. Data was retrieved from October 2020 to June 2022. 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 inclusion criteria were asthmatic children with no significant organ/ system insufficiency age 6-18 with dysfunctional breathing as defined above. 5 sessions of breathing re-education program were taught. Data was reported as median and interquartile range. Wilcoxon Signed Rank test was used for paired comparison. p<0.05 was regarded as significant.
Result & Outcome :
Twenty-three asthmatic children (Female: 5, Male:18) were included with 22 children (95.7%) having thoracic breathing and 1 having abdominal breathing. The duration of wake mouth breathing as reported by parents decreased from median of 50% (IQR 20%-70%) to 20% (IQR 10%-40%) (p= <0.001). The perceived dyspnea as judged by modified Borg scale after running improved from 5 (IQR 4-7) to 1 (IQR 0-5) (p= <0.001). The breath hold time increased from 23 seconds (IQR 19-27 seconds) to 33 seconds (IQR 28-38 seconds) (p= <0.001). The number of steps with breath hold increased from 34 steps (IQR 27-43 steps) to 57 steps (IQR 46-61 steps) (p= <0.001). The quality of life was judged by Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) improved from 0.9 (IQR 0.5-1.5) to 0.6 (IQR 0.2-0.8) (p=0.008). Thoracic breathing pattern was converted to abdominal breathing pattern in 12 out of 23 children. Conclusion: Breathing re-education program provided a treatment option for exercise induced dyspnea in asthmatic children with dysfunctional breathing. The breathing re-education program improved the breathing pattern, rate of perceived dyspnea and quality of life at rest and during exercise.
