Courtney Rosalba, van Dixhoorn Jan, Greenwood Kenneth Mark, Anthonissen Els L M
School of Health Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia.
J Asthma. 2011 Apr;48(3):259-65. doi: 10.3109/02770903.2011.554942. Epub 2011 Feb 22.
Dysfunctional breathing (DB) may contribute to disproportionate dyspnea and other medically unexplained symptoms. The extent of dysfunctional breathing is often evaluated using the Nijmegen Questionnaire (NQ) or by the presence of abnormal breathing patterns. The NQ was originally devised to evaluate one form of dysfunctional breathing - hyperventilation syndrome. However, the symptoms identified by the NQ are not primarily due to hypocapnia and may be due to other causes including breathing pattern dysfunction.
The relationships between breathing pattern abnormalities and the various categories of NQ symptoms including respiratory or dyspnea symptoms have not been investigated. This study investigates these relationships.
62 patients with medically unexplained complaints, that seemed to be associated with tension and breathing dysfunction, were referred, or self-referred, for breathing and relaxation therapy. Dysfunctional breathing symptoms and breathing patterns were assessed at the beginning and end of treatments using the NQ for assessment of DB symptoms, and the Manual Assessment of Respiratory Motion (MARM) to quantify the extent of thoracic dominant breathing. Subscales for the NQ were created in 4 categories, tension, central neurovascular, peripheral neurovascular and dyspnea. Relationships between the NQ (sum scores and subscales) and the MARM were explored.
Mean NQ scores were elevated and mean MARM values for thoracic breathing were also elevated. There was a small correlation pre-treatment between MARM and NQ (r=0.26, p<0.05), but classification of subjects as normal/abnormal on both measurements agreed in 74% (p < 0.001) of patients. From the sub scores of NQ only the respiratory or 'dyspnea' items correlated with the MARM values. Dyspnea was only elevated for subjects with abnormal MARM. After treatment, both MARM and NQ returned to normal values (p< 0.0001). Changes in NQ were largest for subjects with abnormal MARM pre-treatment. There was a large interaction between the change in the NQ sub score dyspnea and initial MARM values. (p<0.001).
功能性呼吸障碍（DB）可能导致不成比例的呼吸困难及其他医学上无法解释的症状。功能性呼吸障碍的程度通常使用奈梅亨问卷（NQ）或通过异常呼吸模式的存在来评估。NQ最初设计用于评估一种功能性呼吸障碍形式——过度通气综合征。然而，NQ所识别的症状并非主要由低碳酸血症引起，可能是由其他原因导致，包括呼吸模式功能障碍。
呼吸模式异常与NQ各类症状（包括呼吸或呼吸困难症状）之间的关系尚未得到研究。本研究对这些关系进行调查。
62例有医学上无法解释的主诉、似乎与紧张和呼吸功能障碍相关的患者被转诊或自行转诊接受呼吸和放松治疗。在治疗开始和结束时，使用NQ评估DB症状，使用呼吸运动手动评估（MARM）量化胸式主导呼吸的程度，以此来评估功能性呼吸障碍症状和呼吸模式。NQ的分量表分为4类：紧张、中枢神经血管、外周神经血管和呼吸困难。探讨了NQ（总分和分量表）与MARM之间的关系。
NQ平均得分升高，胸式呼吸的MARM平均值也升高。治疗前MARM与NQ之间存在微弱相关性（r = 0.26，p < 0.05），但两项测量中受试者正常/异常的分类在74%的患者中一致（p < 0.001）。从NQ的子得分来看，只有呼吸或“呼吸困难”项目与MARM值相关。只有MARM异常的受试者呼吸困难才会加重。治疗后，MARM和NQ均恢复到正常值（p < 0.0001）。治疗前MARM异常的受试者NQ变化最大。NQ子得分呼吸困难的变化与初始MARM值之间存在很大的交互作用（p < 0.001）。
