Practice Matters Magazine

The magazine for Healthcare Professionals from The Wellington Hospital


Articles written by professionals from The Wellington Hospital for Healthcare Professionals.

Breathing Retraining

Respiratory Physiotherapist, Robin McNeils discusses the symptoms and treatments associated with breathing problems

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Many patients present to GPs and consultants with a collection of symptoms that, despite exhaustive investigations, do not seem to be attributed to any cardiac, respiratory or neurological condition. Often these patients have an unresolved breathing pattern disorder, which may be triggered by a period of ill-health, a life event or have an inconclusive cause.

Breathing pattern disorders fall into two main categories:

Dysfunctional breathing pattern refers to a biomechanical problem where the patient is breathing inefficiently by using shoulderand neck muscles to breathe rather than the diaphragm. This uses more energy and gives a greater sensation of breathlessness. Often these patients find practical tasks using their arms particularly challenging.

Hyperventilation Syndrome is when someone is physiologically over-breathing at rest or during exertion, resulting in various symptoms including:

• Faster breathing, shortness of breath, inability to breathe deeply, frequent yawning/sighing

• Chest pain, chest tightness, palpitations, cold hands/feet, stomach bloating

• Blurred vision, feeling confused, dizziness, numbness/tingling in fingers, tightness in fingers or around mouth

• Feeling tense or wound up, feelings of anxiety

*Most of these are mentioned in the Nijmegen Questionnaire

Many of these symptoms are down to the lowering of carbon dioxide experienced in both acute and chronic hyperventilation. This can initially present like asthma symptoms. Most patients will initially undertake the Nijmegen questionnaire in order to establish cause and severity. If someone scores 23 or above, or score 3 or 4 for three or more questions, they should be referred for breathing retraining. Individualised treatment can include:

• Patient education, explanation of symptoms and reassurance

• Trigger factor modification

• Correction of dysfunction breathing pattern at rest

• Breathing re-education to correct any element of hyperventilation

• Progression of activity whilst maintaining good breathing technique

Common benefits reported by patients include a decrease in the sensation of breathlessness, improvements in breathing pattern and breath hold time, with a reduction in ‘head fuzz’ and increased productivity. There are also often decreased anxiety levels and usage of reliever inhalers, whilst reports of increased activity levels and feelings of control over health, result in fewer GP visits.

Other respiratory physiotherapy services also offered at The Wellington Hospital include various lung clearance techniques and one-to-one pulmonary rehabilitation. We also offer the exercise prescription clinic for anyone with any relevant cardiac or respiratory complaints looking for guidance on progressing exercise.


Robin McNelis, Respiratory, breath, lung function,

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Mr Robin McNelis

Respiratory Physiotherapist

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