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Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults

  1. Mandy Jones1,*,
  2. Alex Harvey1,
  3. Louise Marston2,
  4. Neil E O'Connell3

Editorial Group: Cochrane Airways Group

Published Online: 31 MAY 2013

Assessed as up-to-date: 26 FEB 2013

DOI: 10.1002/14651858.CD009041.pub2

How to Cite

Jones M, Harvey A, Marston L, O'Connell NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009041. DOI: 10.1002/14651858.CD009041.pub2.

Author Information

  1. 1

    Brunel University, School of Health Sciences and Social Care, Uxbridge, Middlesex, UK

  2. 2

    University College London, Research Department of Primary Care & Population Health, Division of Population Health, Faculty of Biomedical Sciences, London, UK

  3. 3

    Brunel University, Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Uxbridge, Middlesex, UK

*Mandy Jones, School of Health Sciences and Social Care, Brunel University, Kingston Lane, Uxbridge, Middlesex, UB8 3PH, UK.

Publication History

  1. Publication Status: New
  2. Published Online: 31 MAY 2013


Characteristics of included studies [ordered by study ID]
Lindeboom 1980

MethodsRandomised controlled trial

ParticipantsHyperventilation syndrome (n = 45). Co-morbidities not reported.

Inclusion/exclusion criteria, age and gender split not reported.

InterventionsBreathing exercises plus relaxation therapy (n = 15) versus relaxation therapy alone (n = 15) compared with a control group (n = 15).

Participants in both intervention groups underwent an assessment, followed by 8 x 1 hour training sessions twice weekly.

The breathing exercises and relaxation therapy was led by a physiotherapist. In addition, participants received one introductory and one debrief talk lasting a minimum of 1.5 hours from a psychologist.

Breathing exercises focused on reducing respiratory frequency and diaphragmatic breathing.

Relaxation therapy was a variation of the Jacobson method plus attention to body posture based on yoga principles.

All groups received additional written information.

Further details of the interventions were not reported.

OutcomesPrimary outcome measures were 1) the number and intensity of hyperventilation attacks and 2) the symptoms experienced. It was not specified how these were measured. 3) Muscle tone/tension was measured using EMG apparatus.

Outcomes were measured at baseline and on completion of the 10 treatment sessions.

A follow-up survey was conducted after 1 year (65% response rate) but no detail of the survey content or data collection was provided.

NotesMethodological detail inadequately described for data extraction.

Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskInsufficient methodological detail

Allocation concealment (selection bias)Unclear riskInsufficient methodological detail

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNo numerical data presented

Selective reporting (reporting bias)Unclear riskInsufficient detail provided

Other biasUnclear riskInsufficient detail provided

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInsufficient detail provided

Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Beumer 1971Narrative editorial

Monday 1995Control group could not be classed as a no-breathing exercises control group

Van Doorn 1982No control group

Weimann 1970Observational study

Summary of findings for the main comparison.

Breathing exercises compared with no intervention for dysfunctional breathing/hyperventilation syndrome

Patient or population: Participants with primary dysfunctional breathing/hyperventilation syndrome

Settings: Out patient setting

Intervention: Breathing exercises plus relaxation therapy

Comparison: Relaxation therapy alone

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
Quality of the evidence

Assumed riskCorresponding risk


Quality of lifeSee commentSee commentSee commentSee commentSee commentNot reported


(approx 4 weeks follow-up)
See commentSee commentSee comment41 (1 study)⊕⊝⊝⊝
very low1,2
The symptoms experienced by participants within each intervention group reduced but were described as non-significant.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio; [other abbreviations, e.g. OR, etc]

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1. (-1 limitations) The study was poorly reported so we were not able to determine its methodological quality
2. (-2 imprecision) There was only one very small study and data was not reported in a manner fit for meta-analysis