The purpose of this study was to investigate the prevalence of dysfunctional breathing with Nijmegen Questionnaire (NQ) in a cohort of patients with PCC and further to investigate correlations between dysfunctional breathing and self-rated respiratory symptoms and self-rated health.
A cross-sectional observational study was conducted. Adult patients at the post-covid outpatient clinic were enrolled in the study in connection to a first clinical assessment at Karolinska university hospital between June 2020 and December 2022. In 2024, an electronic follow-up survey including self-rated respiratory symptoms (chest tightness, difficulties to take deep breath, changed breathing pattern, dyspnea, yawning’s, pain when taking deep breath, cough), modified medical research council (mMRC) and self-rated health (EQ-VAS) was sent out to all participants (n=610). A cut of ≥23 on NQ (0-64) was used to identify patients with dysfunctional breathing.
Questionnaires were sent out to 610 patients, among which 324 patients responded (53%). Dysfunctional breathing was identified in 139 (43%) patients. They were more likely to be female (77%), at younger age (mean 48 ± 11) and not hospitalized during acute COVID-19 infection (78%).
There was a strong correlation between dysfunctional breathing and chest tightness (r=0.55) and a moderate correlation between dysfunctional breathing and following symptoms “difficulties to take deep breath” (r=0.46), changed breathing pattern (forgotten how to breath, need to think of my breathing) (r=0.46), dyspnea (r=0.40), yawing’s (r=0.33) and “pain when taking deep breath” (r=0.30). A low correlation was seen between dysfunctional breathing and cough (r=0.17).
There was a strong correlation between dysfunctional breathing and breathlessness (high mMRC score) (r=0.57) and a strong correlation between dysfunctional breathing and a low EQ-VAS score (r=-0.59).
This study highlights that dysfunctional breathing is prevalent in patients with post-COVID-19 condition, especially younger, non-hospitalized females. Dysfunctional breathing correlates strongly with respiratory symptom (chest tightness, high mMRC score) and low self-rated health (EQ-VAS).
It is important for physiotherapist to assess respiratory symptoms such as chest tightness and dyspnea in this group of patients and a useful questionnaire to identify for dysfunctional breathing is the Nijmegen Questionnaire. In the next step more objectively measurements could be used for diagnostics and to offer individualized tailored rehabilitation.
Post COVID-19 condition
Assessment
