Published by Maney Publishing (c) W. S. Maney & Son Limited Discussion Paper Breathing pattern disorders and physiotherapy: inspiration for our profession Tania CliftonSmith, Janet Rowley Breathing Works Physiotherapy Clinic, Auckland, New Zealand Background: Breathing pattern disorders (BPDs), historically known as hyperventilation syndrome, are being increasingly recognized as an entity of their own. Breathing patterns reflect the functioning of the respiratory system and the biomechanical system as well as the cognitive state. Clinical relevance: It is essential, therefore, that physiotherapists from all areas of specialty consider the assessment and treatment of a patient’s breathing pattern. New literature is emerging which underpins the relevance of BPD in patients with lung disease, anxiety, and also in the comparatively new area of sport performance. Physiotherapists are well placed to treat people with disordered breathing because of their clinical skills and comprehensive knowledge base. Current treatment is briefly reviewed in this paper, and trends for future treatment are also addressed. Conclusion: The potential for improving the patient’s state, by optimizing their breathing pattern in all their activities, is an important development in physiotherapy. It is a developing area of knowledge which is pertinent to physiotherapy practice as it develops in a biopsychosocial model. Keywords: Breathing dysfunction, Breathing exercises, Breathing pattern disorders, Breathing retraining, Hyperventilation syndrome Introduction Breathing is a central aspect of our whole being and is one of our most vital functions. A disordered breathing pattern can be the first sign that all is not well, whether it be a mechanical, physiological or psychological dysfunction. It is essential, therefore, that breathing is considered in all physiotherapy assessments. Breathing practices historically span many centu- ries, philosophies and cultures. Since the turn of the century, Western medicine has been acknowledging the role of the breath in wellbeing, 1–3 and more recently research has been critically evaluating the role of the breath in both wellness and illness. 4–6 The concept of dysfunctional breathing, or breathing pattern disorders (BPDs) has developed, to describe the presentation of a poor breathing pattern that produces symptoms. 7 Defining BPD is an evolving process, and various disciplines are providing unique perspectives which give a multi-dimensional under- standing of the multi-faceted function that is breath- ing. 4,8,9 Research is providing new knowledge which underpins the comprehensive role physiotherapy can provide in optimizing the breathing pattern, redu- cing/eliminating symptoms and facilitating well- being. 10–12 To date the physiotherapy literature on the topic of breathing pattern disorders and breathing re-education is sparse. Breathing pattern disorders are fast becoming recognized within the speciality area of musculoskeletal and sports physiotherapy 11 and private practice, 13 whilst still having a significant role in the more likely areas of lung disease 5,6 and of anxiety. 9,14 A Developing Understanding of Breathing Pattern Disorders The symptoms of BPD first appeared in medical literature in 1871 when DaCosta, 1 noted a set of symptoms predominately in American civil war soldiers that were similar to those of heart disease: fatigue upon exertion, palpitations, sweating, chest pain and a disabling shortness of breath. DaCosta’s syndrome became known as Soldier’s Heart (chest pain). 15 As early as 1876 the suggestion of a mechanical origin was considered. Surgeon Arthur Davy attributed the symptoms to military drill where ‘over-expanding’ the chest caused dilatation of the heart, and so induced irritability. 16 Haldane and Poultons 2 produced a paper linking the symptoms to overbreathing. This gained further support when Solely and Shock 3 reported that symptoms could be relieved by increasing partial pressure of carbon dioxide (CO 2 ), reinforcing an underlying respiratory disorder as the cause. It was the discovery of the role of hypocapnia in hyperven- tilation syndrome (HVS), which placed it firmly in the Correspondence to: T CliftonSmith, Breathing Works, 122 Remuera Road, Remuera 1541, Auckland, New Zealand. Email: breathe@ihug.co.nz ß W. S. Maney & Son Ltd 2011 DOI 10.1179/1743288X10Y.0000000025 Physical Therapy Reviews 2011 VOL. 16 NO.1 75