Introduction There are few controlled studies to prove the effectiveness of breathing retraining in the management of dysfunctional breathing (Cochrane 2013) and only one observational study which shows a reduction in Emergency Room attendance (Hagman 2011) as a measure of the efficacy widely reported in clinical practice.
Method Using all consecutive unselected patients referred to a single Respiratory Physiotherapy Unit with 2 experienced practitioners between April 2012 – April 2013, a historical control was used to examine the healthcare utilisation of this group. The incidence of all cause new Out Patient referrals, A+E visits, and admissions in the six month period prior to treatment was compared to the six months after the study period. Extraction of data was by review of notes and computerised search of hospital events with anonymised patient data. In addition to this information on baseline characteristics, response to treatment, and comorbidities were also examined.
Results 67 patients were recorded, 2 were duplicate referrals and excluded from further analysis. The majority were referred by the Respiratory Service, but 27 by General Practice and senior nurses. Mean age was 58 (SD 15.6) and male to female ratio 30 to 37 respectively. 93% had one or more comorbidities, the most frequent being asthma in 49%. 58 patients attended for breathing retraining with an average Nijmegen score of 26.31 (SD 10.28).
In the 6 months after physiotherapy, new outpatient referrals fell by 56% (from 70 to 31), A+E visits fell by 17% (30 to 25) but admissions rose by 35% (20 to 27). The overall reduction of secondary care visits was 31% (120 to 83). Exploratory analysis using Wilcoxon matched-pairs signed rank test showed statistical significance in the outpatient referral group only (p < 0.01).
Conclusion While this is crude data based on limited numbers in a single site, the size of effect is noteworthy, suggesting efficacy of intervention. Healthcare utilisationwasnot restricted to Respiratory presentation, in keeping with the multi-symptomatic nature of this condition. The rise in admissions is in contrast but did not relate to respiratory symptoms in this ageing population over a 24 month period. Further study is warranted.
References 1 Jones M, Harvey A, Marston L. et al. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database Syst Rev. 2013;5:CD009041
2 Hagman C, Janson C, Emtner M. et al. Breathing retraining - a five-year follow-up of patients with dysfunctional breathing. Respir Med. 2011;105:1153–9
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