Bernstein Allergy Group, Inc, Cincinnati, OH, USA.
Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA.
J Asthma. 2022 Apr;59(4):730-738. doi: 10.1080/02770903.2021.1871739. Epub 2021 Jan 25.
While asthma and exercise-induced bronchoconstriction (EIB) can explain some cases of exertional dyspnea, the differential diagnosis of dyspnea is extensive. Dysfunctional breathing (DB) is a condition that is often overlooked and underdiagnosed. Pharmacologic treatments are available and widely utilized by clinicians for exertional dyspnea, but a better understanding of the non-pharmacologic treatments as well as psychological factors that play a role in DB can provide professional, elite amateurs, and recreational athletes with more therapeutic options. Given the psychological components involved with these conditions, a tool to measure domains of sports mental toughness in athletes could help medical providers create a more comprehensive athlete profile which can be used in conjunction with standard pharmacologic therapy to provide a more effective treatment plan. While normal breathing mechanics help shape appropriate posture and spinal stabilization, DB has been shown to contribute to pain and motor control deficits resulting in dysfunctional movement patterns, which further contribute to DB. Most respiratory specialists are unaware of how to assess the role of faulty sports technique, especially running gait, in dysfunctional breathing patterns making it difficult to recommend appropriate treatment and offer referrals for relevant therapies. Three key components of proper running gait are reviewed and described in detail including trunk counter-rotation, extension of atlanto-occipital joint in conjunction with a forward tilted trunk, and ankle and hip joint range of motion. When underlying gait abnormalities and mental skills are addressed properly, they can disrupt poor breathing mechanics, facilitating a transition away from DB and toward healthier breathing patterns.KEY POINTS In summary, the following points should be considered when evaluating athletes who are having difficulty breathing even when compliant with their medications or if there is not an indication of asthma or EIB:Assess dysfunctional breathing (DB) with Nijmegen questionnaire (NQ).If DB is present, measure mental skills using the Sisu Quiz to determine an athlete's mental skills profile.Evaluate postural changes that may impact an athlete's ability to breathe.Using the three tools of the NQ, Sisu Quiz, and Postural assessments creates an athlete profile that is clinically useful to improve breathing technique.DB is often mistaken for other conditions for which medications are prescribed. By identifying DB early and making appropriate changes may negate or reduce the need for pharmacotherapy.Improving DB will improve athletic performance.
虽然哮喘和运动诱发的支气管收缩（EIB）可以解释一些运动性呼吸困难的病例，但呼吸困难的鉴别诊断范围很广。功能性呼吸困难（DB）是一种经常被忽视和诊断不足的情况。临床医生广泛使用药物治疗来治疗运动性呼吸困难，但更好地了解非药物治疗以及在 DB 中起作用的心理因素，可以为专业运动员、精英业余运动员和娱乐运动员提供更多的治疗选择。鉴于这些病症涉及到心理因素，一种用于测量运动员运动心理韧性的工具可以帮助医疗服务提供者创建更全面的运动员档案，该档案可以与标准药物治疗结合使用，以提供更有效的治疗方案。虽然正常的呼吸力学有助于塑造适当的姿势和脊柱稳定性，但 DB 已被证明会导致疼痛和运动控制缺陷，从而导致功能失调的运动模式，进一步导致 DB。大多数呼吸专家都不知道如何评估错误的运动技术（尤其是跑步步态）在功能失调的呼吸模式中的作用，这使得他们难以推荐适当的治疗方法，并为相关治疗提供转介。本文详细回顾和描述了适当的跑步步态的三个关键组成部分，包括躯干反向旋转、寰枢关节伸展与躯干前倾以及踝关节和髋关节的活动范围。当适当解决潜在的步态异常和心理技能问题时，它们可以打破不良的呼吸力学，促进从 DB 向更健康的呼吸模式的转变。关键点总结：在评估即使遵守药物治疗仍呼吸困难或没有哮喘或 EIB 迹象的运动员时，应考虑以下几点：使用奈梅亨问卷（NQ）评估功能性呼吸困难（DB）。如果存在 DB，请使用 Sisu 测验测量心理技能，以确定运动员的心理技能档案。评估可能影响运动员呼吸能力的姿势变化。使用 NQ、Sisu 测验和姿势评估的三个工具创建一个临床有用的运动员档案，以改善呼吸技术。DB 经常被误诊为其他需要药物治疗的病症。通过早期识别 DB 并进行适当的改变，可能会消除或减少对药物治疗的需求。改善 DB 将提高运动表现。
