Breathing Pattern Disorder: A Breathing MOT case study

Breathing pattern disorders don’t always show up at rest and they don’t always fit neatly into common diagnoses like asthma or EILO. This case study shows how a breathing assessment helped identify what was really going on when a young athlete’s breathing started limiting his performance, despite normal test results.

The background

“X” was a 16-year-old student training at a high level in competitive rowing, with the long-term aim of qualifying to represent his country. When he began to increase his training volume and intensity, he began to notice something wasn’t right.

When he significantly exerted himself, he experienced noisy breathing on both inhalation and exhalation, along with a sensation of tightness in his throat. As his heart rate climbed, it felt increasingly difficult to get air in and his training sessions were becoming limited by this breathing rather than fitness or strength.

Despite this, X was otherwise healthy. He had already been assessed by a consultant and undergone exercise testing, where his heart and lung function were monitored. These results came back normal and EILO was ruled out. That left an important unanswered question:

If my lungs and heart are fine why does my breathing feel so difficult?

Why a breathing assessment was needed

This is exactly the type of situation the Breathing MOT is designed for.

When someone feels breathless or restricted during activity, but investigations don’t show a clear medical cause, a breathing pattern disorder can often be overlooked. The MOT focuses on how someone breathes, not just what the tests say.

For X to be able to train more effectively he needed to understand whether his breathing mechanics and coordination were contributing to his symptoms.

What the assessment revealed

X’s breathing was assessed both at rest and during activity on a treadmill. This allowed us to observe how his breathing changed as physical demand increased.

The assessment showed that:

• His breathing was very shallow under load

• He was breathing predominantly from the upper chest

• His overall breathing volume was low for the intensity of exercise

• Tension was building rapidly through his neck, shoulders and upper body

These symptoms indicated that his breathing pattern wasn’t meeting the demands of high-intensity exercise, even though his lungs were healthy, and confirmed a breathing pattern disorder, rather than a structural airway problem.

What happened next

Once the breathing pattern disorder was identified, X was given clear guidance on his next steps. This included referral for targeted breathing pattern re-education, where treatment could focus on:

• Restoring more effective diaphragm-led breathing to ensure his volumes could adapt appropriately 

• Reducing unnecessary upper-body tension

• Improving coordination between breathing, core stability and movement

• Applying these changes specifically to the demands of rowing

Rather than guessing or trialling treatments blindly, X and his family now had clarity and a plan built on understanding the root cause.

The outcome

With appropriate breathing retraining and sport-specific work, X was able to regain control of his breathing during high-intensity rowing. His breathing felt more natural, less restrictive and no longer limited his performance.

He also left with the knowledge of how to recognise early warning signs and the tools to address them if symptoms returned.

Why this matters

This case highlights an important message: you can feel very breathless and still have normal lung and heart tests.

When breathing feels wrong but investigations are “clear,” a Breathing MOT can help bridge the gap between symptoms and answers by looking at the mechanics, pattern and coordination of breathing itself.

Is a Breathing MOT right for you?

You might benefit from a Breathing MOT if:

• Your breathing limits exercise or daily activity

• Tests have come back normal, but symptoms persist

• Inhalers or standard treatments haven’t helped

• You feel your breathing “doesn’t match” your fitness

The Breathing MOT is about understanding what’s going on, so the next step, whatever that is, is the right one.

Book here now or email us at enquiries@airphysiotherapy.co.uk or call 020 7971 1464 if you'd like to know more.