Breathing is something most of us never think about. It happens automatically, adapting continuously to whatever we are doing. Your breathing changes when you climb the stairs, have a conversation, laugh with friends, exercise, become excited, or feel anxious. These changes are completely normal. Healthy breathing is flexible, constantly adjusting to meet the body's needs.
Sometimes, however, this flexibility changes. Instead of adapting smoothly, breathing can become less coordinated, less comfortable, or no longer well matched to the body's needs. When this altered pattern contributes to ongoing breathlessness or other symptoms, clinicians may describe it as a Breathing Pattern Disorder (BPD).
Although the name is unfamiliar to many people, breathing pattern disorders are increasingly recognised by respiratory clinicians, physiotherapists and researchers as an important cause of persistent breathlessness.
What is a breathing pattern?
A breathing pattern is the way you breathe, rather than simply how much you breathe.
It includes:
- how quickly you breathe
- how deeply you breathe
- how regularly you breathe
- how your chest and abdomen move together
- how your breathing changes during activity, rest and emotion
There is no single "correct" breathing pattern. Healthy breathing changes continuously throughout the day. A person sitting quietly breathes differently from someone climbing a hill or giving a presentation. Even laughing, singing and talking temporarily alter the normal rhythm of breathing.
The ability to adapt is one of the defining features of healthy breathing.
What is a Breathing Pattern Disorder?
A Breathing Pattern Disorder develops when breathing becomes less adaptable and begins to contribute to symptoms.
Researchers do not yet have a single universally accepted definition, and several different breathing patterns have been described. Rather than representing one disease, BPD is best thought of as a group of conditions in which the rhythm, depth, timing or coordination of breathing has changed in a way that contributes to breathlessness.
Some people develop breathing that is predominantly from the upper chest. Others breathe with frequent sighs or yawns, while some develop irregular breathing rhythms or poor coordination between the chest and abdomen. These patterns can occur on their own or alongside conditions such as asthma, COPD or Long COVID.
This is why two people with a breathing pattern disorder may have very different symptoms.
Why can a breathing pattern change?
Breathing patterns often change for a good reason.
A chest infection, an asthma flare-up, pain, surgery, prolonged breathlessness or a stressful life event may all temporarily alter the way we breathe. During these situations, changing our breathing is often an appropriate response.
For most people, breathing gradually returns to its usual pattern once the trigger has resolved.
For others, the altered pattern persists. The original illness may improve, but the breathing pattern remains changed. Over time, this altered pattern may itself contribute to breathlessness, chest discomfort and a feeling that breathing requires more effort than it should.
Researchers continue to investigate why this happens. It is likely that breathing pattern disorders develop through a combination of changes in breathing mechanics, nervous system control and learned breathing behaviours rather than a single cause.
Want to understand this in more detail? Read our article What Causes a Breathing Pattern Disorder?
What does a breathing pattern disorder feel like?
People describe a wide variety of symptoms.
The most common is breathlessness, but many people also report:
- feeling unable to take a satisfying breath
- air hunger
- chest tightness or discomfort
- frequent sighing or yawning
- feeling that breathing requires too much effort
- breathlessness that seems greater than expected for the activity being performed
Some people also experience dizziness, tingling, light-headedness or palpitations, particularly if they are breathing more rapidly or deeply than their body requires. These symptoms are not present in everyone and are more commonly associated with specific breathing patterns involving hyperventilation.
Symptoms often fluctuate. Some people notice them mainly during exercise, while others experience them during conversation, stressful situations or even while resting quietly.
Is it the same as hyperventilation?
No.
For many years the terms hyperventilation syndrome, dysfunctional breathing and breathing pattern disorder were often used interchangeably.
Our understanding has changed.
Hyperventilation syndrome is now considered one type of breathing pattern disorder rather than the whole condition. Some people with BPD hyperventilate and develop low carbon dioxide levels, while others have breathing patterns that appear altered despite having normal carbon dioxide levels.
This distinction is important because not everyone with a breathing pattern disorder is "over-breathing."
Is it "just anxiety"?
No.
This is one of the most common misconceptions.
A breathing pattern disorder is not an imaginary condition, nor does it mean your symptoms are "all in your head."
Stress, anxiety and emotional events can influence breathing in everyone. For some people they may contribute to the development or worsening of a breathing pattern disorder. Equally, living with persistent breathlessness can understandably increase anxiety.
The relationship works in both directions.
Current evidence suggests that breathing pattern disorders arise through interactions between breathing mechanics, nervous system control, physical health and psychological factors. Focusing on only one of these factors does not adequately explain the condition.
Most importantly, the breathlessness experienced by people with BPD is real.
Why can my tests be normal?
This is often one of the most confusing aspects of the condition.
Most hospital investigations are designed to identify structural disease, such as asthma, COPD, pulmonary fibrosis or heart disease.
A breathing pattern disorder is different.
The lungs, heart and oxygen levels may all appear normal while the way breathing is organised and controlled has changed.
A diagnosis of BPD should not simply be reached because other tests are normal. Instead, it should be made following a careful clinical assessment that considers your symptoms, breathing pattern and the contribution this may be making to your breathlessness.
We'll explain how clinicians make this diagnosis in our article How Do Clinicians Diagnose a Breathing Pattern Disorder?
How can it affect everyday life?
Breathing pattern disorders can have a significant impact on daily activities.
People often find themselves avoiding exercise, walking more slowly, limiting social activities or worrying about situations where breathlessness might occur. Some begin to monitor every breath they take, making breathing feel increasingly effortful and uncomfortable.
Over time, this can create a cycle in which breathlessness leads to reduced activity, loss of confidence and further worsening symptoms.
Breaking this cycle is an important part of treatment.
What happens next?
Receiving a diagnosis of a breathing pattern disorder can feel confusing, particularly if previous investigations have been reassuring.
The encouraging news is that breathing pattern disorders are increasingly recognised, and many people experience meaningful improvement with the right assessment, education and treatment.
Understanding what a breathing pattern disorder is is the first step.
In the next article, we explore why breathing patterns change in the first place and why they sometimes continue after the original trigger has resolved.
Key messages
- Healthy breathing is naturally flexible and changes throughout the day.
- A breathing pattern disorder occurs when the pattern of breathing contributes to breathlessness or other symptoms.
- BPD is not the same as hyperventilation, although hyperventilation can be one form of BPD.
- It may occur on its own or alongside conditions such as asthma, COPD or Long COVID.
- Symptoms are real, even when routine investigations are normal.
- A diagnosis is made through careful clinical assessment rather than one single test.
- Understanding the condition is the first step towards effective treatment.
Remember: If you develop new, severe or rapidly worsening breathlessness, chest pain, coughing up blood, or feel faint or unwell, seek urgent medical assessment.