Management of post-acute covid-19 in primary care

Dear Editor

I would like to comment on Box 2 Breathing techniques, in particular the 'breathing control' technique which is a suggested treatment programme in this Practice Pointer.

The article states that:

“The “breathing control” technique is aimed at normalising breathing patterns and increasing the efficiency of the respiratory muscles (including the diaphragm) resulting in less energy expenditure, less airway irritation, reduced fatigue, and improvement in breathlessness.”

My understanding is that one component of a normal breathing pattern is breathing both in and out through the nose, and keeping the mouth closed throughout.

However the 'breathing control' instructions in this article state:

“The patient should sit in a supported position and breathe in and out slowly, preferably in through the nose and out through the mouth, while relaxing the chest and shoulders and allowing the tummy to rise.’

According to Dr Sarah Todd’s recent paper (1), on the Brompton Breathing Pattern Assessment Tool, during normal breathing the mouth should remain closed.

The fourth component of this Breathing Pattern Assessment is “Channel of inspiration and expiration”, that is nose or mouth breathing. Each component is given a score of 0 to 2 based on features consistent with expected normal (0) versus that present in severe dysfunctional breathing (2).

For “Channel of inspiration and expiration” the expected normal is described as “Nose (with their mouth closed throughout the minute assessed).” Using this scoring system, breathing in through the nose and out through the mouth as suggested in this Practice Pointer would score (1) and be an indicator of a breathing pattern disorder - rather than a normal breathing pattern.

Kind regards

Janet Brindley

1. Todd S, Walsted ES, Grillo L, Livingston R, Menzies-Gow A, Hull JH.
Novel assessment tool to detect breathing pattern disorder in patients with refractory asthma. Respirology. 2018;23(3):284-290. doi:10.1111/resp.13173