Symptoms characterize asthma, and therefore, if shortness of breath continues even with seemingly adequate treatment for asthma, a number of possibilities must be considered:

  • Is the medication being taken?
  • Is the medication being taken effectively (is inhaler technique correct)?
  • Is the patient’s asthma severe and therefore undertreated?
  • Is there another cause for the shortness of breath?

One of the most common causes for shortness of breath in asthma patients is dysfunctional breathing, in which a patient with asthma develops an abnormal pattern of breathing that causes shortness of breath. This has many forms but includes hyperventilation and thoracic-dominant breathing. When patients are on treatment and still experiencing shortness of breath, clinicians must assess adherence with medication, inhaler technique, lung function, and comorbidities, including dysfunctional breathing.

Because dysfunctional breathing is common and potentially treatable (with physical therapy to re-train the pattern of breathing), it should always be considered in asthma patients with shortness of breath.

For a study published in The Journal of Allergy and Clinical Immunology: In Practice, my colleagues and I examined the factors associated with dysfunctional breathing in a large cohort of patients with severe asthma. We found that those patients with dysfunctional breathing had worse symptom control and quality of life, had more asthma exacerbations, and were more likely to be unemployed when compared with those without dysfunctional breathing. The presence of dysfunctional breathing in these patients was independently associated with sinus symptoms, anxiety, and depression, factors that may in themselves lead to dysfunctional patterns of breathing. Our findings highlight the important interactions between treatable comorbidities among patients with severe asthma.


Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma