Psychological stress and Dysfunctional Breathing in children

ABSTRACT Background: Dysfunctional Breathing (DB) is a pathological entity which describes the deviations in the normal biomechanical patterns of breathing. It is recognized in both adults and children. The article focuses on children visiting the pediatric pulmonology clinic without a prior diagnosis. Diagnosis is based on medical history and psychometric tools, such as questionnaires. Spirometry and plethysmography aid in identifying dysfunctional breathing. These children often experience increased anxiety, affecting both their quality of life and that of their families. Aim: The present systematic review aimed to summarize the available scientific evidence in DB in children. Methodology: The relevant literature was searched in the PubMed database. The internationally recognized PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used, with the following keywords: dysfunctional breathing, psychological stress in children, and dysfunctional breathing and stress in children. Only nine studies met the inclusion criteria and were included in this systematic review. Results: A total of 1,016 articles were initially identified. Subsequently, 968 articles were excluded based on their titles. The remaining 48 were further evaluated. Of these, 39 were excluded after a careful review of their abstracts. Nine studies were included in the systematic review. According to the included articles, DB coexists with childhood asthma and often confuses the final diagnosis. All articles agree on the existence of different patterns in breathing which affects the psychological state of children in their daily routine. The important role of the correct history is also emphasized as well as the importance of additional auxiliary diagnostic tools in the final diagnosis. Regarding the therapeutic approach, all studies recommend the participation of children in physiotherapy programs by specialists, which train breathing patterns and improve them. In addition, support from psychologists is needed. Conclusions: It is a fact that DB concerns the pediatric medical community and a significant effort has been made to codify it, both diagnostically and therapeutically. Also, while it is mentioned that many times it can hide a pathological background in children and that it affects their psyche by adding more stress, there is not a significant amount of research that focuses only on the stress caused by dysfunctional breathing in children. Further well-designed worldwide studies are necessary to clarify this complex issue.