The Physiotherapy Assessment of Breathing Pattern Disorder

The Breathing Pattern Assessment Tool (BPAT) is a clinician-completed assessment of breathing pattern. 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 scored from 0 (normal) to 2 (severely abnormal), with a total score ranging from 0 to 14. Higher scores indicate greater deviation from normal breathing patterns. Changes in score over time reflect changes in breathing pattern.

The Nijmegen Questionnaire is a 16-item patient-reported outcome measure assessing symptoms associated with breathing pattern disorder and hyperventilation. Each item is scored from 0 ("never") to 4 ("very often"), with a total score ranging from 0 to 64. Higher scores indicate greater symptom severity. Scores of 19 or above are commonly considered indicative of clinically significant symptoms. Changes in score over time reflect changes in symptom severity.

The Dyspnoea-12 Questionnaire is a 12-item patient-reported outcome measure assessing the severity of breathlessness, including both physical and affective components. Each item is scored from 0 ("none") to 3 ("severe"), with a total score ranging from 0 to 36. Higher scores indicate worse breathlessness (greater dyspnoea severity). Changes in score over time reflect changes in symptom severity.

The EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) is a standardized measure of health-related quality of life comprising a descriptive system and a visual analogue scale (EQ 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"), which can be converted into a single index score. The descriptive system responses are converted into a single index score using established value sets, typically ranging from less than 0 (worse than death) to 1 (full health). The EQ VAS records self-rated health on a scale from 0 ("worst imaginable health") to 100 ("best imaginable health"). Higher scores indicate better health-related quality of life, while lower scores indicate poorer health status.

Breath-Hold Time (seconds) is a functional measure of respiratory control and tolerance to carbon dioxide. It is assessed as the duration, in seconds, that a participant can comfortably hold their breath following a normal exhalation. Typical values in healthy adults are approximately 20 to 40 seconds. Higher values indicate better respiratory control and greater tolerance to carbon dioxide, while lower values indicate poorer tolerance and potential breathing pattern disorder (hyperventilation). Changes in breath-hold time over time reflect changes in respiratory function. There is no fixed upper limit; values are recorded in seconds.

End-Tidal Carbon Dioxide (EtCO₂, mmHg) is an objective physiological measure of the partial pressure of carbon dioxide at the end of expiration, assessed using capnography via a nasal cannula. EtCO₂ is used as an indicator of ventilatory status. Lower values indicate relative hypocapnia and potential hyperventilation, while higher values within the normal physiological range indicate improved ventilatory regulation. Changes in EtCO₂ over time reflect changes in respiratory function. Normal values are typically approximately 35-45 mmHg or 4.7 to 6.0 kPa.

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.

The Self-Evaluation of Breathing Questionnaire (SEBQ) is a patient-reported outcome measure assessing symptoms associated with dysfunctional breathing. It consists of 25 items, each scored on a Likert scale, with a total score ranging from 0 to 75. Higher scores indicate worse breathing pattern disorder/dysfunctional breathing. A total score greater than 11 has been suggested as indicative of possible dysfunctional breathing. Changes in score over time reflect changes in symptom severity.