The Physiotherapy Assessment of Breathing Pattern Disorder (PHAB)

An Evaluation of Physiotherapy Assessment; A Mixed Methods Study to Evaluate the Physiotherapy Assessment of Breathing Pattern Disorder

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.

Study Overview

• Status: Recruiting
• Conditions: Breathlessness; Breathing Pattern Disorder
• Intervention / Treatment: Diagnostic test: Assessment of Breathing Pattern- Breathing Pattern Assessment Tool

Detailed Description

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 (Estimated): 150

Contacts and Locations

• Study Contact: Name: Lizzie Grillo JF Clinical Specialist Physiotherapist, BSc MSc; Phone Number: 07843203979; Email: lizzie.grillo1@nhs.net

Study Locations

• United Kingdom
  • London
    • London, London, United Kingdom, SW3 6NP
      • Recruiting
      • Royal Brompton Hospital
      • Contact: Lizzie JF Grillo, MSc; Phone Number: +447843203979; Email: l.grillo@imperial.ac.uk
      • Principal Investigator: Lizzie JF Grillo, MSc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Patients with BPD (n=100) A convenience sample of patients referred to physiotherapy outpatient services of Royal Brompton Hospitals for BPD or unexplained breathlessness, over a 22-month recruitment period will be recruited.

Healthy control (n=25) A convenience sample of healthy controls will be recruited from relative/significant other accompanying the study participant and/or hospital staff.

Asthma control patients (n=25) Patients will be recruited from the Systematic Assessment of Asthma Clinic and data used from their completed usual care assessment.

Description

Inclusion Criteria (Breathing Pattern Disorder group)

• Adults aged above 18 years
• Outpatient referrals for 'unexplained breathlessness' or possible breathing pattern disorder
• Primary BPD (no other significant respiratory or cardiology diagnosis)
• Secondary BPD (patients with a diagnosis of asthma)
• Able to complete up to four sessions of outpatient physiotherapy intervention Exclusion Criteria
• Patients with a respiratory diagnosis including COPD, ILD, Bronchiectasis and Cystic Fibrosis or structural heart disease
• Pregnancy
• Unable to give informed consent
• Anyone currently participating in pulmonary/cardiac rehabilitation
• Anyone receiving specialist ENT speech and language therapy for Upper airway symptoms

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Breathing Pattern Disorder; Patients referred to physiotherapy with a Breathing Pattern Disorder	Diagnostic test: Assessment of Breathing Pattern- Breathing Pattern Assessment Tool; 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
Healthy Control; Patients with no respiratory symptoms or disorders	Diagnostic test: Assessment of Breathing Pattern- Breathing Pattern Assessment Tool; 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
Asthma; Patients diagnosed with asthma but no concerns for breathing pattern disorder	Diagnostic test: Assessment of Breathing Pattern- Breathing Pattern Assessment Tool; 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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Breathing Pattern Assessment Tool BPAT	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.	Baseline for all participants; 4 weeks and through study completion (up to 6 months) for participants with Breathing Pattern Disorder

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	Baseline for all participants; 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 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.	Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Dyspnoea 12 (D-12) Questionnaire	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.	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 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.	Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
Breath Hold	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.	Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
End Tidal C02	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.	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 (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.	Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder

Collaborators and Investigators

• Sponsor: Royal Brompton & Harefield NHS Foundation Trust
• Investigators: Principal Investigator: Lizzie JF Grillo, BSc MSc, Royal Brompton and Harefield Hospital

Study record dates

Study Major Dates

• Study Start (Actual): December 10, 2024
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): May 1, 2026

Study Registration Dates

• First Submitted: February 11, 2026
• First Submitted That Met QC Criteria: April 15, 2026
• First Posted (Actual): April 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 5, 2026
• Last Update Submitted That Met QC Criteria: April 28, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Assessment; Physiotherapy; Breathlessness; Breathing Pattern Disorder
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Signs and Symptoms, Respiratory; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Dyspnea
• Other Study ID Numbers: 315897

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the results reported in publications, including baseline characteristics, outcome measures, and relevant covariates. All direct identifiers will be removed prior to sharing. Data will be made available for the IPD that underlie results in a publication. This will be available within the publication and anonymous data available on online repository
• IPD Sharing Time Frame: Start: 6 months after publication of primary results. End: Indefinitely
• IPD Sharing Access Criteria: Qualified researchers may request access to de-identified individual participant data. Requests will be reviewed by the study investigators. Approved data will be shared via a secure online repository or by direct data transfer. Data will be limited to de-identified datasets necessary to reproduce the reported analyses.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No