A three-round eDelphi involving 39 UK paediatric respiratory professionals - physiotherapists, nurses and doctors, with 29 completing all rounds - sought consensus on how breathing pattern disorder in children and young people is recognised.
The panel could not agree on what to call it, splitting between dysfunctional breathing and breathing pattern disorder. They did agree, at a 75% threshold, on ten clinical features consistent with the condition, six descriptive terms, twelve phrases children commonly use to describe it, and seven signs and symptoms.
The list of children's own phrases is the most immediately usable output, because this is a diagnosis that lives or dies on the history. There is no validated diagnostic tool, and the consensus is explicitly a foundation for building one rather than a tool itself. The clinical importance is elsewhere: a child labelled with poorly controlled asthma who keeps escalating inhaled therapy without objective evidence of airway obstruction may have a breathing pattern problem instead, and recognising it redirects care to physiotherapy rather than to another step up the asthma ladder. Twenty-nine UK specialists is a narrow base, and nothing here has been tested against any reference standard.
- Consider breathing pattern disorder in a child escalating asthma therapy without objective obstruction.
- Ask the child to describe the sensation in their own words and record the phrase they use.
- Confirm airway obstruction objectively before stepping up inhaled therapy again.
- Refer to respiratory physiotherapy where the pattern rather than the airway looks abnormal.
- No validated diagnostic tool exists; this is expert agreement on features, not a test.
Why it matters
The alternative to recognising this is another increment of inhaled corticosteroid in a child whose airways are not the problem.
Don't overread it
Expert consensus among 29 UK specialists, with no validation against any reference standard.
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