TY - JOUR T1 - Use of the Nijmegen Questionnaire in asthma JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00037-2015 VL - 1 IS - 1 SP - 00037-2015 AU - Jan van Dixhoorn AU - Hans Folgering Y1 - 2015/05/01 UR - http://openres.ersjournals.com/content/1/1/00037-2015.abstract N2 - We, like M. Thomas and colleagues, prefer to see the meaning of Nijmegen Questionnaire within a broader conceptual framework than ventilation and hypocapnia. M. Thomas and colleagues refer to “the variety of drivers (physiological, inflammatory, environmental, psychological, perceptual, behavioural and comorbidity-related) that contribute to asthma control.” We want to stress that the Nijmegen Questionnaire was never intended to be used in asthmatic patients. Actually, asthmatics, as well as other patients with respiratory diseases, were explicitly excluded from the initial studies of the questionnaire. The fact that both hyperventilating patients and asthmatic patients may have similar sets of complaints is not really surprising, considering the pathophysiology of both afflictions. We agree that the Nijmegen Questionnaire is indicative of the level of stress that many asthma patients may experience, which decreases asthma control and may result in faulty breathing patterns. Given the multidimensional nature of asthma, it is not really surprising that the questionnaire does not predict the outcome of breathing retraining. The question remains, however, of how to assess a faulty breathing pattern and, more specifically, of whether a faulty breathing pattern is the result of increased stress or is an inherently dysfunctional breathing pattern. This question comes from the conceptual framework of the definition of functional breathing. For asthmatics, M. Thomas and colleagues, pragmatically, chose “providing breathing training in a convenient, accessible and affordable way”. However, both the definitions of functional breathing and of convenient breathing training are not fully clear and require further study. Given this lack of clarity, one of the authors (J. van Dixhoorn) developed a procedure of indirect breathing regulation [1] in which the goal is not a specific mode of “proper” breathing. Instead, awareness is promoted of one's breathing and its variable response to a more or less balanced posture and more or less focussed attention.It remains to be seen whether dysfunctional breathing will acquire the status of an illness per se http://ow.ly/P60J7 ER -