Nijmegen Questionnaire for Dysfunctional Breathing
Also known as: Nijmegen, Nijmegen Questionnaire, DBQ
The Nijmegen Questionnaire is a 16-item self-report instrument designed to identify dysfunctional breathing patterns, particularly hyperventilation syndrome, in patients presenting with respiratory or non-respiratory symptoms. Developed by van Beveren and colleagues in the Netherlands in 1994, it provides rapid assessment of symptoms attributable to chronic hyperventilation: dizziness, chest tightness, muscle tension, paresthesias, and anxiety. The Nijmegen Questionnaire is widely used in respiratory physiology clinics, pulmonary rehabilitation programs, and psychosomatic medicine to detect dysfunctional breathing phenotypes that may masquerade as asthma, anxiety disorders, or cardiopulmonary disease.
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When to use it
The Nijmegen Questionnaire is indicated when dysfunctional breathing is suspected as a contributing factor to respiratory symptoms (e.g., dyspnea disproportionate to spirometry findings) or non-respiratory symptoms attributable to hyperventilation (dizziness, paresthesias, syncope). It is particularly valuable in patients with asthma inadequately responsive to conventional therapy (may indicate concurrent dysfunctional breathing requiring breathing retraining), in panic disorder presentations (breathing dysfunction is a cardinal feature), and in patients with medically unexplained dyspnea. It is less useful as a standalone diagnostic tool (must be integrated with clinical assessment and physiological testing) or in acute dyspnea assessment.
Strengths & limitations
- Rapid screening: 16 items require <5 minutes, enabling high-volume screening in busy clinics
- Symptom-specific: Directly addresses hyperventilation manifestations (paresthesias, muscle tension, anxiety, dizziness) distinct from other dyspnea etiologies
- Psychometrically validated: Demonstrates adequate internal consistency (Cronbach's α 0.61–0.79), discriminates dysfunctional breathing from normal controls
- Bridges respiratory and psychological phenotypes: Captures overlap between respiratory and anxiety symptom presentations, facilitating integrated assessment
- Non-specific symptoms: Many Nijmegen items (anxiety, nervousness, trembling) also occur in panic disorder or generalized anxiety, limiting specificity for breathing dysfunction per se
- No subscale structure: Single total score obscures potential subdomains (physical vs. psychological symptoms); clinicians must interpret item clusters informally
- Modest psychometric properties: Internal consistency only moderate; sensitivity/specificity vary across populations and cutoff thresholds
- Absence of physiological validation: Questionnaire score correlates imperfectly with objective hyperventilation markers (end-tidal CO₂, capnography); clinical context essential
Frequently asked
Can the Nijmegen Questionnaire diagnose hyperventilation syndrome?
No, the questionnaire screens for dysfunctional breathing symptoms but does not diagnose hyperventilation syndrome. Diagnosis requires clinical presentation, breathing pattern observation (rapid, shallow breathing), and ideally physiological confirmation (end-tidal CO₂ <35 mmHg, venous bicarbonate <24 mEq/L). Use Nijmegen as a screening aid within comprehensive clinical assessment.
My asthma patient scored 25 on the Nijmegen. What does this mean?
A score of 25 indicates significant dysfunctional breathing symptom burden. In an asthma patient, this suggests concurrent breathing dysfunction (hyperventilation) contributing to symptom burden alongside asthma. Ensure asthma is well-controlled via spirometry and symptom assessment, then offer breathing retraining (physiotherapy, slow breathing exercises) to address dysfunctional pattern.
How does Nijmegen relate to panic disorder?
Hyperventilation is a cardinal feature of panic attacks; dysfunctional breathing (rapid, shallow) triggers paresthesias, dizziness, and chest tightness that reinforce panic. High Nijmegen scores in panic patients indicate breathing dysfunction as a maintaining mechanism. Cognitive-behavioral therapy incorporating breathing retraining is highly effective.
What should I do if a patient's Nijmegen score is borderline (17–23)?
Borderline scores suggest possible dysfunctional breathing. Consider a clinical breathing pattern assessment (observe respiratory rate, depth, sigh frequency, accessory muscle use). If clinical suspicion is high, offer breathing retraining trial (4–6 sessions) and repeat Nijmegen to assess response. Borderline cases often benefit from early intervention.
Sources
- Van Beveren, T. L., Fülöp, M., van Beek, H. G., & Zijlstra, F. J. (1994). Hyperventilation and panic panic attacks in a group of asthma patients. Respiration, 61(5), 282-287. link ↗
- Higgs, F., Donovan, G., Opdam, H., & Tiller, J. (2013). Hyperventilation and dysfunctional breathing: a tool for assessment and retraining. Breathe, 9(4), 284-293. link ↗
How to cite this page
ScholarGate. (2026, June 3). Nijmegen Questionnaire for Dysfunctional Breathing. ScholarGate. https://scholargate.app/en/pulmonology/dysfunctional-breathing-questionnaire
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