Is breathing retraining useful in the treatment of children with dysfunctional breathing/hyperventilation syndrome?


Dysfunctional breathing/hyperventilation syndrome is a breathing problem that involves breathing using a poor pattern or breathing too deeply or too rapidly (or both) (hyperventilation). There are many possible causes of dysfunctional breathing and if left untreated it can lead to a variety of unpleasant symptoms such as breathlessness, dizziness, pins and needles and chest pain. Little is known about dysfunctional breathing in children. Preliminary data suggest that at least 5.3% of children with asthma have dysfunctional breathing but no accepted recommendations are available for the treatment of these children. Dysfunctional breathing is currently treated using breathing exercises where the overall aim is to teach the patient to breathe gently using the lower part of their chest at a rate that matches their activity level.

Review question
The aim of this review was to investigate whether breathing exercises are useful in the treatment of children with dysfunctional breathing.

Key results
We found no suitable trials that evaluated the use of breathing exercises in the management of children with dysfunctional breathing. Currently there is no evidence to support or refute the use of breathing exercises in children with dysfunctional breathing and randomised controlled trials are needed.

This Cochrane plain language summary is up to date as of October 2013.

Authors' conclusions: 

The results of this systematic review cannot inform clinical practice as no suitable trials were identified for inclusion. Therefore, it is currently unknown whether these interventions offer any added value in this patient group or whether specific types of breathing exercise demonstrate superiority over others. Given that breathing exercises are frequently used to treat dysfunctional breathing/hyperventilation syndrome, there is an urgent need for well-designed clinical trials in this area. Future trials should conform to the CONSORT statement for standards of reporting and use validated outcome measures. Trial reports should also ensure full disclosure of data for all important clinical outcomes.

Read the full abstract...

Dysfunctional breathing is described as chronic or recurrent changes in breathing pattern causing respiratory and non-respiratory symptoms. It is an umbrella term that encompasses hyperventilation syndrome and vocal cord dysfunction. Dysfunctional breathing affects 10% of the general population. Symptoms include dyspnoea, chest tightness, sighing and chest pain which arise secondary to alterations in respiratory pattern and rate. Little is known about dysfunctional breathing in children. Preliminary data suggest 5.3% or more of children with asthma have dysfunctional breathing and that, unlike in adults, it is associated with poorer asthma control. It is not known what proportion of the general paediatric population is affected. Breathing training is recommended as a first-line treatment for adults with dysfunctional breathing (with or without asthma) but no similar recommendations are available for the management of children. As such, breathing retraining is adapted from adult regimens based on the age and ability of the child.


To determine whether breathing retraining in children with dysfunctional breathing has beneficial effects as measured by quality of life indices.

To determine whether there are any adverse effects of breathing retraining in young people with dysfunctional breathing.

Search strategy: 

We identified trials for consideration using both electronic and manual search strategies. We searched CENTRAL, MEDLINE and EMBASE. We searched the National Research Register (NRR) Archive, Health Services Research Projects in Progress (HSRProj), Current Controlled Trials register (incorporating the metaRegister of Controlled Trials and the International Standard Randomised Controlled Trial Number (ISRCTN) to identify research in progress and unpublished research. The latest search was undertaken in October 2013.

Selection criteria: 

We planned to include randomised, quasi-randomised or cluster-randomised controlled trials. We excluded observational studies, case studies and studies utilising a cross-over design. The cross-over design was considered inappropriate due to the purported long-lasting effects of breathing retraining. Children up to the age of 18 years with a clinical diagnosis of dysfunctional breathing were eligible for inclusion. We planned to include children with a primary diagnosis of asthma with the intention of undertaking a subgroup analysis. Children with symptoms secondary to cardiac or metabolic disease were excluded.

We considered any type of breathing retraining exercise for inclusion in this review, such as breathing control, diaphragmatic breathing, yoga breathing, Buteyko breathing, biofeedback-guided breathing modification and yawn/sigh suppression. We considered programmes where exercises were either supervised (by parents or a health professional, or both) or unsupervised. We also considered relaxation techniques and acute episode management as long as it was clear that breathing exercises were a component of the intervention.

Any intervention without breathing exercises or where breathing exercises were not key to the intervention were excluded.

Data collection and analysis: 

We planned that two authors (NJB and MJ) would extract data independently using a standardised form. Any discrepancies would be resolved by consensus. Where agreement could not be reached a third review author (MLE) would have considered the paper.

Main results: 

We identified 264 potential trials and reviews from the search. Following removal of duplicates, we screened 224 papers based on title and abstract. We retrieved six full-text papers and further evaluated them but they did not meet the inclusion criteria. There were, therefore, no studies suitable for inclusion in this review.