This study aims to evaluate a clinical tool called the Breathing Pattern Assessment Tool (BPAT), which is used by physiotherapists to assess breathing pattern disorder (BPD). BPD is a condition where breathing is inefficient or out of sync with the body's needs, leading to symptoms such as breathlessness. The study will investigate whether the BPAT is a reliable and accurate way to identify and assess BPD, and whether it can be used to monitor changes over time, particularly following physiotherapy treatment. It will also compare BPAT scores with other commonly used questionnaires that measure breathlessness and breathing symptoms. Participants will include patients with BPD, patients with asthma, and healthy individuals. Patients with BPD will attend physiotherapy sessions as part of their usual care, during which their breathing will be assessed using the BPAT at different time points, including before and after treatment. Healthy participants will attend a single assessment visit, and asthma participants' data will be collected from routine clinical care. The study will also explore whether BPAT scores change following treatment and whether these changes reflect improvements reported by patients and clinicians. In addition, a small number of patients and physiotherapists will be invited to take part in interviews to share their experiences of the assessment process and treatment. This will help understand whether the BPAT is acceptable and useful in clinical practice. Overall, this study aims to improve how breathing pattern disorder is assessed and monitored, which may help guide better treatment for patients in the future.
This study will evaluate the measurement properties and clinical usefulness of the Breathing Pattern Assessment Tool (BPAT), a physiotherapist-completed assessment used to identify breathing pattern disorder (BPD). BPD is a condition in which breathing is inefficient or inappropriate for the body's needs and is associated with symptoms such as breathlessness. The study aims to determine whether the BPAT is a reliable and valid method for identifying and assessing BPD, and whether it can be used to monitor changes over time, particularly following physiotherapy treatment. BPAT scores will be compared with established questionnaires that measure breathing symptoms and breathlessness. The study will also assess whether changes in BPAT scores reflect changes reported by patients and clinicians. Participants will include patients with BPD (n=100), patients with asthma (n=25), and healthy controls (n=25). Patients with BPD will be recruited from physiotherapy outpatient services and will receive physiotherapy as part of usual care. Healthy controls will attend a single assessment visit, and asthma control data will be obtained from routine clinical assessments. At the initial assessment, two physiotherapists will independently complete BPAT scores for each participant. Patients with BPD will attend a follow-up assessment within approximately 4 weeks, where a repeat BPAT assessment will be completed. Those diagnosed with BPD will then undergo a course of physiotherapy treatment as part of usual care, typically consisting of four sessions. BPAT and other outcome measures will be repeated at the end of treatment (up to 6 months). Patients and clinicians will also provide ratings of change in symptoms following treatment. The study will evaluate the reliability of the BPAT between clinicians and across time, its validity through comparison with other commonly used outcome measures, and its responsiveness to change following treatment. In addition, a subgroup of patients and physiotherapists will take part in qualitative interviews to explore their experiences of the BPAT and its use in clinical practice. These interviews will help assess the acceptability and practicality of the tool. This mixed-methods study aims to improve the assessment and monitoring of breathing pattern disorder and to support more consistent and effective clinical care.
Study Type
OBSERVATIONAL
Enrollment
150
Patients who have Breathing Pattern Disorder will be assessed with the Breathing Pattern Assessment Tool and then will undergo Physiotherapy intervention. This includes up to 4 sessions of physiotherapy treatments which include biomechanical, biochemical and psychopathological interventions for breathing pattern
Royal Brompton Hospital
London, London, United Kingdom
RECRUITINGBreathing Pattern Assessment Tool BPAT
A Clinician completed tool to look at components of breathing pattern assessment. The BPAT is a tabulated means of collating data obtained at respiratory physiotherapy assessment (appendix 1). Assessment components include (i) evaluation of chest/abdominal wall movement, noise of (ii) inspiratory and (iii) expiratory flow, (iv) channel of inspiration and expiration, (v) signs of air hunger (yawning, sighing and deeper breaths), (vi) RR and (vii) rhythm. Each component is given a score from 0 to 2, based on features consistent with expected normal (0) versus that present in severe DB (2), giving a total score of between 0 and 14. The BPAT is completed with a patient positioned, as per the standard assessment of resting breathing pattern (i.e. sat comfortably in a supported seat for at least 5 min) and takes approximately 1 min to collate. Each item is scored and summed for a total score, with higher scores indicating greater deviation from normal breathing patterns
Time frame: Baseline for all participants; 4 weeks and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Nijmegen Questionnaire
The Nijmegen Questionnaire is a 16-item patient-reported outcome measure assessing symptoms associated with dysfunctional breathing and hyperventilation. Each item is scored on a 5-point Likert scale from 0 ("never") to 4 ("very often"), yielding a total score range of 0 to 64. Higher scores indicate greater symptom burden and more severe breathing pattern issues. Scores ≥19-23 are commonly considered indicative of clinically significant breathing symptoms. A reduction in score over time reflects improvement.
Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Dyspnoea 12
The Dyspnoea-12 is a 12-item patient-reported questionnaire assessing the severity of breathlessness, including both physical and affective components. Each item is rated from 0 ("none") to 3 ("severe"), with a total score range of 0 to 36. Higher scores indicate more severe dyspnoea. Lower scores indicate minimal or no breathlessness. Changes in score over time reflect changes in dyspnoea severity.
Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L)
The EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) is a standardized measure of health-related quality of life comprising two components: a descriptive system and a visual analogue scale (VAS). The descriptive system assesses five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each rated on five levels from 1 ("no problems") to 5 ("extreme problems"), generating a 5-digit health state that can be converted into a utility index score using country-specific value sets. The EQ VAS records self-rated health on a scale from 0 ("worst imaginable health") to 100 ("best imaginable health"). Higher index and VAS scores indicate better health-related quality of life, while lower scores indicate poorer health status.
Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Breath Hold
Breath-hold time is a simple functional measure of respiratory control and tolerance to rising carbon dioxide levels. It is typically assessed as the duration (in seconds) that a participant can comfortably hold their breath following a normal exhalation. Shorter breath-hold times are associated with reduced carbon dioxide tolerance and may indicate dysfunctional breathing or hyperventilation tendencies. Longer breath-hold times indicate improved tolerance to carbon dioxide and more stable breathing control. Increases in breath-hold time over time reflect improvement.
Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
End Tidal C02
Measures end today C02 via a side stream device via nasal cannula. End-tidal carbon dioxide (EtCO₂) is an objective physiological measure of the partial pressure of carbon dioxide at the end of expiration, typically assessed using capnography. EtCO₂ is commonly used as an indicator of ventilatory status and to assess for hyperventilation. Lower EtCO₂ values indicate relative hypocapnia and are suggestive of hyperventilation. Increases in EtCO₂ toward the normal range over time reflect improvement in ventilatory regulation.
Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Breathing Vigilance Questionnaire
The Breathing Vigilance Questionnaire (Breathe-VQ) is a 6-item patient-reported measure assessing the degree of conscious monitoring and attentional focus on breathing. Each item is rated on a Likert scale, with total scores ranging from 6 to 30. Higher scores indicate greater breathing vigilance or hyper-awareness of breathing, which is associated with dysfunctional breathing patterns. Lower scores indicate less conscious monitoring of breathing. Changes in score over time reflect changes in breathing-related vigilance.
Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Self evaluation of breathing questionnaire
The Self-Evaluation of Breathing Questionnaire is a patient-reported measure assessing subjective breathing experiences and symptoms associated with dysfunctional breathing. It consists of multiple items rated on a Likert scale, with responses summed to produce a total score (higher scores indicate greater perceived breathing dysfunction). A total score greater than 11 has been suggested as indicative of possible dysfunctional breathing. Reductions in score over time reflect improvement in breathing perception.
Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Lizzie Grillo JF Clinical Specialist Physiotherapist, BSc MSc
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