Functional Respiratory Disorders

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Many patients with pulmonary complaints fail to improve despite physicians' best efforts. Sometimes, we ascribe this failure to lack of adherence with therapy, or to the severity of the condition. What we often fail to appreciate, however, is that sometimes the lack of improvement can be explained by the patients' psychological states. For example, some patients with genuine asthma can experience shortness of breath as a result of anxiety rather than from the physical exacerbation of their asthma. Treating this by racheting up asthma therapies is of little use, and can be harmful. Thus, the first section of this book will help clinicians recognize functional respiratory symptoms that can arise as a result of both organic and psychological causes. Another group of patients have respiratory complaints that many clinicians recognize as functional in nature, such as vocal cord dysfunction, habit cough, anxiety-related dyspnea, and stress-related chest pain. Further, treatment of patients with sleep disorders often involves addressing functional issues that complicate their management, e.g., learning to accept continuous positive airway pressure (CPAP) therapy, or psychosocial stressors that can underlie development of parasomnia. Thus, the second section of this book provides detailed discussions of such disorders, including case studies and quizzes. These should strengthen the clinician's confidence in identifying and treating such conditions. Finally, even when clinicians are comfortable in identifying patients with functional respiratory disorders, planning a treatment program can be a challenge. Some patients may be reluctant to see mental health providers, even when such competent providers are available. For this reason, the third section of the book will help the clinician differentiate the patients for whom referral to a mental health provider is mandatory from those for whom other approaches may be useful. For the latter group, the book will teach clinicians to empower themselves by learning how to incorporate various therapies for functional disorders into their practice, including biofeedback, breathing techniques, basic cognitive behavioral therapy techniques, and hypnosis. Practical strategies for obtaining training in these modalities are provided in the appendix. Our target readers will be practicing clinicians including pediatricians, family practitioners, internists, pulmonologists, sleep specialists, psychiatrists, psychologists and other mental health care providers. Other readers will include medical and behavioral sciences students, residents, and fellows. This book will be written by an international group of authors, in part, in order to promote international readership of this book. The authors will represent multiple that will broaden the market for the book, including pulmonology, sleep medicine, psychiatry, psychology, speech therapy, and practitioners of alternative medicine.