Breathing Pattern Assessment Tool

Original Editor - Lilian Ashraf

Top Contributors - Lilian Ashraf  

Objective

Breathing Pattern Assessment Tool (BPAT) is a structured tool for diagnosis of breathing pattern disorders. Dysfunctional breathing is defined as an ‘alteration in the normal biomechanical pattern of breathing, that results in intermittent/chronic symptoms, which may be both respiratory and non-respiratory and a propensity to hyperventilation with subjective and psychological impact.

Intended Population

BPAT was developed for diagnosis of breathing pattern disorders in patients with asthma.

Method of Use

The patient should be at rest (have sat still for 5 minutes prior to assessment) in sitting with their back rested.

Count respiratory rate and observe breathing pattern for one minute. Score features of breathing in table below:

	0	1	2
Abdominal or upper chest movement: Where is movement occurring in tidal volume breathing at rest?	Abdominal (Diaphragm level and below)	Combination (Movement in both upper chest and abdomen)	Apical (Upper chest rises and falls with each breath)
Inspiratory flow Do they have increased inspiratory flow? This would be indicated by an audible breath IN through either nose or mouth and includes any type of wheeze.	Silent	Audible	Loud
Expiratory flow Do they have increased expiratory flow? This would be indicated by an audible breath OUT through either nose or mouth and includes any type of wheeze.	Silent	Audible	Loud
Channel of inspiration and expiration Are they breathing through their; nose, mouth or a combination of both during the minute assessed?	Nose (with their mouth closed throughout the minute assessed)	Nose and mouth (During the minute some breaths are through their nose and some through their mouth)	Mouth (Breathing with mouth open throughout)
Air hunger During the minute assessed is the patient showing signs of air hunger. This includes yawning, sighing or taking a deeper breath than their tidal breaths?	None	Once per minute	Twice or more times per minute
Respiratory Rate What is their respiratory rate in the minute assessed? TOTAL RR___________	12 or less	13-25	25+
Rhythm Are their breaths evenly spaced throughout the minute? Do they appear regular and rhythmical?	Rhythmical		Erratic
Scoring	0	1	2
Score for each column
		TOTAL SCORE

Evidence

BPD is prevalent in treatment-refractory asthma and heightens symptom perception and impairs quality of life. The BPAT provides a simple and rapid way to characterize BPD in treatment-refractory asthma. The assessment is easy to complete and can prompt need for physiotherapy assessment ± intervention to optimize respiratory symptom management.

Sensitivity analysis indicated that a BPAT score of ≥4 corresponded to a sensitivity of 0.92 and a specificity of 0.75 for diagnosis of BPD in this cohort.

BPAT has high sensitivity and moderate specificity for BPD in patients with long COVID, with a sensitivity of 89.5% and specificity of 78.3% for diagnosing BPD in post-COVID breathlessness.