Breathing Pattern Disorders in Active People

Target audience: This article is for active adults, recreational athletes, runners, cyclists, gym users, coaches, and fitness professionals who want a clear explanation of breathing pattern disorders without a medical textbook parked on the kitchen table. It is also for people who train often yet still feel unexplained air hunger, chest tightness, throat tightness, frequent sighing, or a sense that their breathing “won’t settle” during exercise. The goal is not to turn every hard workout into a diagnosis. Normal exercise makes breathing faster. A steep hill can make anyone sound like a broken accordion. The issue begins when breathlessness feels out of proportion to the effort, appears at low workloads, keeps returning in the same pattern, or does not match the athlete’s usual fitness level.1

 

Key points covered: breathing pattern disorders in active people can involve inefficient breathing mechanics, overbreathing, upper-airway narrowing, anxiety-breathing feedback loops, or overlap with asthma and exercise-induced bronchoconstriction. The article explains common symptoms, why exercise exposes the problem, how screening works, what clinicians may test, where evidence is strong or limited, and what practical steps readers can take before guessing their way through symptoms. The main message is simple: a fit body can still have a messy breathing pattern, and symptoms deserve careful sorting rather than a lazy label.

 

Breathing pattern disorder is usually discussed under the wider term dysfunctional breathing. A 2016 review by Boulding, Stacey, Niven, and Fowler described dysfunctional breathing as breathing that causes breathlessness or related symptoms without being fully explained by disease severity.2 That wording matters. It does not say the symptoms are fake. It does not say the person is unfit. It says the breathing system may be producing symptoms through timing, rhythm, depth, muscle use, carbon dioxide handling, or upper-airway behavior. In active people, this can look confusing because the person may have a strong heart, good legs, and a training history that does not fit the distress they feel.

 

The British Thoracic Society clinical statement on respiratory problems in athletic individuals, published in Thorax in 2022, gives this topic a practical frame. It covers assessment and management of respiratory symptoms in athletic people, including asthma, exercise-induced bronchoconstriction, exercise-induced laryngeal obstruction, and breathing pattern disorder.1 That matters because exercise breathlessness has many possible causes. A runner who gasps during intervals may have exercise-induced bronchoconstriction. A swimmer who feels throat closing near race pace may have exercise-induced laryngeal obstruction. A lifter who braces hard and then cannot reset their breathing may have a breathing pattern issue, reflux irritation, anxiety, deconditioning, anemia, or a mix. Breath is not a single-lane road. It is more like rush-hour traffic with several ramps feeding into the same jam.

 

Common symptoms include air hunger, frequent sighing, difficulty getting a satisfying breath, chest tightness, throat tightness, dizziness, tingling in the fingers or lips, palpitations, and breathlessness that feels too strong for the workload.3 Some people describe it as “I can breathe, but it doesn’t feel like enough.” Others say they keep trying to take a deeper breath but cannot finish it. That detail can be clinically relevant. The American Thoracic Society statement on dyspnea defines dyspnea as a subjective experience of breathing discomfort with different qualities and intensities.4 In plain English, breathlessness is felt from the inside. A coach watching from the sideline may see normal movement while the athlete feels a red-alert signal in the chest or throat.

 

Exercise exposes these patterns because ventilation has to rise fast and stay coordinated. During easy walking, small inefficiencies may hide in the background. During a tempo run, hill repeat, rowing interval, or heavy circuit, the system has less slack. Breathing rate rises. Tidal volume, meaning the amount of air moved per breath, changes. The rib cage, diaphragm, abdominal wall, shoulders, neck, and upper airway all need to cooperate. If the pattern becomes rapid, shallow, chest-dominant, or irregular, the athlete may feel short of breath even when oxygen levels are not the main problem. A 2021 Frontiers in Physiology review by Ionescu and colleagues explained that cardiopulmonary exercise testing can reveal erratic breathing frequency and tidal volume, high breathing frequency, and symptoms such as chest tightness, dizziness, tingling, or breathlessness at low workload in dysfunctional breathing.5

 

Overbreathing is one part of the picture, but it is not the whole picture. Hyperventilation means ventilation is higher than needed for carbon dioxide production. That can lower carbon dioxide levels and contribute to dizziness, tingling, chest discomfort, and a sense of air hunger. In a 2019 PLOS One retrospective study titled “Cardiopulmonary exercise testing for identification of patients with hyperventilation syndrome,” Brat and colleagues compared 29 patients with hyperventilation syndrome with 29 healthy controls. At peak exercise, the hyperventilation group had a different breathing pattern, including higher breathing frequency and lower tidal volume. The study also reported that the absence of expected changes in ventilatory efficiency and end-tidal carbon dioxide during exercise was specific for hyperventilation syndrome, although the authors noted limitations because the design was retrospective and compared patients only with healthy controls.6 That is useful evidence, but it is not a home diagnostic kit.

 

Breathing pattern disorder can also be mechanical. Boulding and colleagues proposed several recognizable patterns, including hyperventilation syndrome, periodic deep sighing, thoracic-dominant breathing, forced abdominal expiration, and thoracoabdominal asynchrony.2 These terms sound like a mechanic’s invoice, so here is the plain version. Some people breathe high in the chest and recruit the neck more than needed. Some keep taking deep sighs because the normal breath never feels complete. Some move the rib cage and abdomen out of sync. Some push the abdomen hard during exhalation and disturb the next inhalation. None of these observations alone proves disease. They are clues that need context.

 

The athlete trap is assuming capacity equals control. A person can squat heavy, run long, and still breathe with poor timing under stress. Fitness raises the ceiling, but coordination decides how smoothly the system works at any given moment. Think of a strong cyclist with a poorly adjusted gear shift. The engine is there. The transfer is messy. In breathing, that mess may show up when pace changes, when the athlete moves from nasal to mouth breathing, when bracing interrupts rhythm, or when race nerves turn breathing into a steering wheel gripped with white knuckles.

 

The biggest mistake is blaming every symptom on dysfunctional breathing. Exercise-induced bronchoconstriction, asthma, cardiac disease, anemia, infection, pulmonary vascular disease, reflux, vocal fold or supraglottic obstruction, medication effects, and anxiety disorders can all cause or worsen exercise breathlessness.1 Exercise-induced laryngeal obstruction deserves special attention. The 2017 European Respiratory Society and European Laryngological Society statement defines inducible laryngeal obstruction as inappropriate, transient, reversible narrowing of the larynx in response to triggers.7 When exercise triggers it, the term EILO is used. It often causes inspiratory symptoms, throat tightness, noisy breathing, or a feeling that air cannot get in. It can mimic asthma, and bronchodilators may not fix it if the main problem is in the larynx rather than the lower airways.1,7

 

This is where screening should stay humble. The Nijmegen Questionnaire is often used to screen symptoms associated with hyperventilation complaints. Van Dixhoorn and Folgering reviewed its history in ERJ Open Research in 2015 and emphasized that it was introduced as a screening tool, not a universal diagnostic stamp for every breathing pattern disorder.8 A questionnaire can organize symptoms. It cannot see the larynx. It cannot measure gas exchange during a ramp test. It cannot rule out heart disease. It should prompt better questions, not end the conversation.

 

A basic screen starts with the symptom story. Does the problem occur at rest, during easy effort, or only near high intensity? Is the main difficulty breathing in, breathing out, or both? Is there wheeze, stridor, cough, chest pain, dizziness, fainting, tingling, or palpitations? Does the symptom stop quickly when exercise stops? Does asthma medication help, partly help, or do nothing? Does the pattern change with stress, sleep loss, caffeine, illness, menstrual cycle, heat, cold air, or indoor pool exposure? A coach or clinician may also observe whether the person uses the neck and shoulders excessively, breathes mainly through the upper chest, sighs often, loses rhythm with movement, or switches into rapid shallow breathing before the workload justifies it.1

 

Professional testing depends on the suspected cause. Spirometry checks basic lung function. Bronchoprovocation testing can assess exercise-induced bronchoconstriction or asthma-like airway narrowing. Cardiopulmonary exercise testing measures ventilation, oxygen uptake, carbon dioxide output, heart response, workload, and symptom timing during graded exercise.5 Continuous laryngoscopy during exercise allows clinicians to observe the larynx while symptoms are being provoked, and pediatric dysfunctional breathing guidance describes continuous exercise laryngoscopy as a gold-standard approach for EILO when available and suitable.3 The point is not to test everyone with a smartwatch and a sigh. The point is to avoid guessing when symptoms are persistent, severe, unusual, or performance-limiting.

 

The emotional side is not a footnote. Breath has a special place in the nervous system because it is both automatic and partly voluntary. You do not command every breath while reading this sentence, but the moment breathing feels wrong, attention snaps to it like a phone alarm at 3 a.m. That attention can tighten muscles, raise breathing rate, and make the next breath feel even less satisfying. This does not mean the problem is “all in the head.” It means physiology and perception can loop. The ATS dyspnea statement notes that breathing discomfort is shaped by physiological, psychological, social, and environmental factors.4 In the gym, that loop can look like a person panicking because they cannot inhale fully. On a run, it can look like someone checking their breathing every ten seconds until the whole workout becomes a negotiation with their rib cage.

 

Respiratory retraining tries to rebuild control without forcing the breath into a rigid script. Common elements include education, awareness of breathing pattern, relaxed lower-rib movement, reduced neck tension, slower recovery breathing after effort, better posture when it affects mechanics, and gradual practice from rest to walking to sport-specific movement.3 For upper-airway symptoms, speech and language therapy may focus on laryngeal control, trigger management, and techniques that help keep the airway open during exertion.3 This is not the same as telling everyone to “just breathe through the nose” or “always use the diaphragm.” During intense exercise, mouth breathing is normal. The diaphragm always participates in breathing unless there is serious impairment. The issue is not purity. The issue is matching the breath to the task.

 

Evidence for breathing retraining needs a clean reading. The Cochrane review “Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults,” by Jones, Harvey, Marston, and O’Connell, found only one eligible randomized controlled trial with 45 adults. The review concluded that reliable clinical conclusions could not be drawn from that limited evidence base.9 That does not prove breathing exercises are useless. It means the evidence for adults with dysfunctional breathing or hyperventilation syndrome is thin when strict trial standards are applied. A separate randomized controlled trial by Holloway and West studied the Papworth method in 85 adults with asthma in primary care. Participants received five treatment sessions, with outcomes assessed at 6 and 12 months. The intervention improved respiratory symptoms, dysfunctional breathing scores, and adverse mood compared with usual care, but objective lung function measures did not significantly improve.10 That pattern is important: symptoms may improve even when standard lung numbers do not change.

 

For athletes with EILO, treatment evidence is also mixed and still developing. A 2019 BMJ Open Sport & Exercise Medicine study by Sandnes and colleagues examined 28 athletes with EILO treated with inspiratory muscle training. Symptoms decreased in 22 of 28 participants, or 79%, after the treatment period, and mean continuous laryngoscopy exercise scores improved. The study was exploratory and did not prove that one method works for every EILO presentation.11 Later follow-up work has also suggested that full symptom resolution may be uncommon in some groups, so people should not expect one trick to erase every episode.12 This is the cold-water part of the discussion. Breathing work can help selected people, but the field does not support miracle claims.

 

A practical plan starts with tracking, not tinkering. Record when symptoms happen, what exercise you were doing, intensity, duration, environment, warm-up, caffeine intake, stress level, sleep, medication use, and how quickly symptoms stop after slowing down. Note whether the problem feels like air cannot get in, air cannot get out, or breathing is simply chaotic. During symptoms, reduce intensity rather than fighting the breath like it owes you rent. Let exhalation settle. Drop the shoulders. Unclench the jaw. Walk until the rhythm returns. If symptoms are mild and familiar, practice calm breathing at rest for several minutes each day, then during easy walking, then during low-intensity training. Keep the practice boring on purpose. Breath control learned only at rest often disappears when the treadmill gets spicy.

 

Training changes should be conservative. Use longer warm-ups when symptoms appear early. Avoid sudden jumps from rest to high intensity. Build intervals with clear recovery time rather than stacking chaos on chaos. During strength training, reset breathing between heavy sets instead of carrying a brace into the next movement. During running, test whether a steady cadence and relaxed exhalation reduce symptoms at easy pace before trying to apply cues during race pace. If the main symptom is throat tightness or noisy breathing on inhalation, do not assume more inspiratory muscle training is the answer. Upper-airway symptoms need assessment because adding resistance can be wrong for some presentations.

 

There are also red flags. Seek medical evaluation for fainting, chest pain, blue lips, severe wheezing, coughing blood, new breathlessness at rest, sudden decline in exercise capacity, symptoms after infection that do not resolve, palpitations with dizziness, or breathlessness with known heart or lung disease. The same applies if symptoms repeatedly stop you from training, do not respond to usual asthma treatment, or feel different from your normal exercise discomfort. Active people can be skilled at ignoring signals. That is useful for finishing a hill repeat. It is less useful when the body is asking for a differential diagnosis.

 

Coaches and fitness professionals can play a practical role without crossing into diagnosis. They can notice symptom timing, suggest a lower intensity, document patterns, encourage warm-up changes, and refer out when symptoms are recurrent or severe. They can avoid shaming the athlete. They can also avoid pretending to be a pulmonologist with a stopwatch. A coach who says “this looks like something to assess” is doing more good than one who says “you just need more grit.” Grit has its place. It is not a spirometer.

 

The critical perspective is necessary because breathing pattern disorder is real but not neatly boxed. Definitions vary. Screening tools differ. Some studies focus on hyperventilation, others on breathing mechanics, others on inducible laryngeal obstruction, and others on asthma overlap. The 2021 CPET review notes that there is no gold-standard diagnosis or classification system, which helps explain why recognition remains uneven.5 The topic is also vulnerable to overclaiming because breathing is easy to market. A simple cue can sound scientific even when it has not been tested in the group being targeted. Readers should be alert to claims that one breathing method fixes performance, anxiety, posture, sleep, and metabolism in one sweep. That kind of claim usually tells you more about the sales page than the respiratory system.

 

The better view is narrower and more useful. Breathing pattern disorders in active people are not a character flaw. They are not proof of poor conditioning. They are also not a diagnosis to apply casually after one rough workout. They sit at the intersection of respiratory mechanics, perception, exercise demand, upper-airway behavior, medical screening, and learned response. If your breathing repeatedly feels wrong for the workload, the next step is not panic, blame, or a random viral breathing hack. The next step is pattern recognition, sensible training adjustment, and medical assessment when symptoms are persistent or concerning.

 

Disclaimer: This article is for general education only and is not medical advice, diagnosis, or treatment. Breathing symptoms can come from conditions that require professional care, including asthma, exercise-induced bronchoconstriction, exercise-induced laryngeal obstruction, heart disease, anemia, infection, and other disorders. Anyone with severe, new, recurrent, or exercise-limiting symptoms should consult a qualified clinician. If this topic matches your experience, share the article with a coach, clinician, or training partner, explore related evidence-based respiratory health content, and keep notes on your symptoms before changing your training plan. Breath is basic, but unexplained breathlessness is not something to freestyle.

 

References

 

Hull JH, Burns P, Carre J, et al. BTS clinical statement for the assessment and management of respiratory problems in athletic individuals. Thorax. 2022;77(6):540-551. doi:10.1136/thoraxjnl-2021-217904

 

Boulding R, Stacey R, Niven R, Fowler SJ. Dysfunctional breathing: a review of the literature and proposal for classification. Eur Respir Rev. 2016;25(141):287-294. doi:10.1183/16000617.0088-2015

 

Barker N, Thevasagayam R, Ugonna K, Kirkby J. Pediatric dysfunctional breathing: proposed components, mechanisms, diagnosis, and management. Front Pediatr. 2020;8:379. doi:10.3389/fped.2020.00379

 

Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435-452. doi:10.1164/rccm.201111-2042ST

 

Ionescu MF, Mani-Babu S, Degani-Costa LH, et al. Cardiopulmonary exercise testing in the assessment of dysfunctional breathing. Front Physiol. 2021;11:620955. doi:10.3389/fphys.2020.620955

 

Brat K, Stastna N, Merta Z, Olson LJ, Johnson BD, Cundrle I Jr. Cardiopulmonary exercise testing for identification of patients with hyperventilation syndrome. PLoS One. 2019;14(4):e0215997. doi:10.1371/journal.pone.0215997

 

Halvorsen T, Walsted ES, Bucca C, et al. Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement. Eur Respir J. 2017;50(3):1602221. doi:10.1183/13993003.02221-2016

 

van Dixhoorn J, Folgering H. The Nijmegen Questionnaire and dysfunctional breathing. ERJ Open Res. 2015;1(1):00001-2015. doi:10.1183/23120541.00001-2015

 

Jones M, Harvey A, Marston L, O’Connell NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database Syst Rev. 2013;(5):CD009041. doi:10.1002/14651858.CD009041.pub2

 

Holloway EA, West RJ. Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial. Thorax. 2007;62(12):1039-1042. doi:10.1136/thx.2006.076430

 

Sandnes A, Andersen T, Clemm HH, et al. Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training. BMJ Open Sport Exerc Med. 2019;5(1):e000436. doi:10.1136/bmjsem-2018-000436

 

Sandnes A, Andersen T, Clemm HH, et al. Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol. 2022;279(5):2511-2522. doi:10.1007/s00405-021-07214-5