UK experts agree on the features of dysfunctional breathing in children, but not its name

Design

Modified three-stage eDelphi consensus study, UK paediatric respiratory centres

Population

39 health professionals in round 1; 29 completed round 3

Primary outcome

Consensus (75% agreement) on name, symptoms, signs and characteristics

Effect

Ten clinical features agreed; no consensus between the names dysfunctional breathing and breathing pattern disorder

This three-round eDelphi study gathered opinions from UK paediatric respiratory professionals (physiotherapists, nurses and doctors) on what dysfunctional breathing, also called breathing pattern disorder, looks like in children and young people. Of 39 who took part in round 1, 29 completed round 3. Consensus was set at 75% agreement or more on a 7-point scale.

There was no clear agreement between the two popular names. There was strong consensus on the clinical picture: ten clinical features, six descriptive terms, twelve phrases that young people commonly use and seven signs and symptoms were agreed. The authors note that no validated diagnostic tool exists, and the consensus is meant as a basis for building and testing one.

A Delphi consensus reflects expert opinion in a small UK sample, and the paper gives no list of features in its abstract, so clinicians should consult the full paper. It is a starting point for assessment, not a diagnostic rule, and it should not replace excluding asthma and other organic causes of breathlessness.

• Dysfunctional breathing in children has no validated diagnostic tool.
• Experts agreed on a set of common features but not on the name, so use a descriptive term in your notes.
• Exclude asthma and other organic causes before attributing breathlessness to a breathing pattern disorder.
• Read the full paper for the agreed features before using it to structure an assessment.

Why it matters

A condition without a name or a test is easily missed or treated as asthma that will not respond.

Don't overread it

This is a consensus from 29 to 39 UK professionals; it is not a validated diagnostic criterion.

The statistics, in plain English

A consensus threshold of 75% means three in four panellists at least somewhat agreed. It shows what experts believe, not what is true, and the panel was small.

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