Tools

Nijmegen Questionnaire

Last reviewed

Breathing Pattern Disorder Screening

The Nijmegen questionnaire is a 16-item self-report screening tool for hyperventilation syndrome and breathing pattern disorder. It was developed in the Netherlands by van Doorn, Colla and Folgering, validated by van Dixhoorn and Duivenvoorden in 1985, and is still widely used in research and clinical practice. Each item asks how often you experience a particular symptom on a scale from 0 (never) to 4 (very often), producing a total score between 0 and 64.

Breathing pattern disorder can occur alongside post-viral conditions, POTS and ME/CFS. It can contribute to or worsen symptoms including breathlessness, dizziness, chest tightness, tingling in the hands and face, and brain fog. Because these symptoms overlap significantly with autonomic dysfunction and post-viral fatigue, breathing pattern disorder can be difficult to distinguish from other aspects of a post-viral condition without specific screening.

The Nijmegen questionnaire is not a definitive diagnostic test, but it is a useful first step. A score of 23 or above (more than 22) is the cut-off most often used to decide whether further assessment of breathing pattern is worthwhile. Because it was written for hyperventilation, it can miss the restricted, effortful, upper-chest breathing patterns; the Self-Evaluation of Breathing Questionnaire (SEBQ) asks only about breathing sensations and is often used alongside it.

This is a free, interactive version. Complete it below and receive your score immediately. No sign-up or email is required.

For each symptom, indicate how often you experience it:

1. Chest pain

2. Feeling tense

3. Blurred vision

4. Dizziness

5. Feeling confused or disoriented

6. Faster or deeper breathing than usual

7. Short of breath

8. Tight feelings in chest

9. Bloated feeling in the stomach

10. Tingling fingers

11. Unable to breathe deeply

12. Stiff fingers or arms

13. Tight feelings around the mouth

14. Cold hands or feet

15. Palpitations (heart pounding or racing)

16. Feelings of anxiety

Understanding your Nijmegen score

What the score measures

It measures how often you have 16 symptoms linked with over-breathing and stress, such as shortness of breath, dizziness, tingling fingers, a tight chest and anxiety. Each is scored from 0 (never) to 4 (very often), giving a total from 0 to 64. Its authors now describe the score as a measure of "functional respiratory complaints" rather than of hyperventilation itself.

In the 1985 validation it separated 75 patients diagnosed with hyperventilation syndrome from 80 health care workers with 91% sensitivity and 95% specificity (van Dixhoorn and Duivenvoorden 1985). It is free to use (van Dixhoorn and Folgering 2015).

Nijmegen score interpretation

People without breathing complaints usually average about 10 to 12. The cut-off most often used is more than 22, that is 23 or above: in the first validation study it best separated patients whose complaints were brought on by deliberate over-breathing from other patients. When the authors re-analysed their second study, 19 or above best separated people with these complaints from healthy people, so published cut-offs range from 19 to 23.

Nijmegen reference points from the authors' validation data
ScoreWhat it is
10 to 12Usual average without breathing complaints (English, Belgian and Dutch studies)
11.9Healthy controls, 1985 validation data
19 or aboveBest separated people with hyperventilation complaints from healthy people (1985 data)
19.5Patients without hyperventilation complaints, first validation study
23 or aboveMost-used cut-off: best separated patients with and without these complaints in the first study

It means you report more of these symptoms, more often, than is usual. It is a reasonable basis for asking to have your breathing pattern assessed, usually by a respiratory physiotherapist. It is not a diagnosis: the score cannot tell breathing pattern disorder apart from anxiety, asthma or other causes, and a 2026 review judged it inadequate as a stand-alone diagnostic test.

What a change in score means

No minimal important change has been published. The authors report that after successful breathing therapy, average scores fell back to around 12, and that scores which stay high after treatment deserve a closer look for other causes. Compare results taken a few weeks apart in similar circumstances, and look for a trend rather than a single result.

Researchers have asked for a minimal important change to be worked out (Thomas et al. 2015).

What it does not measure

No. It records symptoms, not how you breathe. It does not measure breathing mechanics such as upper-chest breathing, or carbon dioxide levels, and several of its symptoms, such as dizziness, palpitations and cold hands or feet, are also common in autonomic conditions such as POTS. A diagnosis needs a clinician to look at how you breathe as well as at your symptoms.

The SEBQ covers restricted, effortful breathing better. The breathing pattern disorder versus autonomic breathlessness explainer covers the overlap with POTS, and diaphragmatic breathing describes one approach to retraining.

Taking this to your GP or consultant

Bring the total, the date, which symptoms you scored 3 or 4, and the trend from your saved results. Describe it as a 16-item symptom questionnaire widely used in clinical practice to screen for breathing pattern disorder (Bondarenko et al. 2026). It can support a request for referral to respiratory physiotherapy. New, worsening or severe breathlessness, or breathlessness with chest pain, needs a medical assessment whatever the score. See preparing for a GP appointment.

This is not a diagnostic tool. A score above the threshold suggests that further clinical assessment of breathing pattern may be worthwhile; it does not establish a diagnosis. Breathing symptoms can have multiple causes. Discuss results with your doctor.
Sources and licence

Based on: van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res. 1985;29(2):199–206.

  • van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res 1985;29(2):199–206. Article
  • van Dixhoorn J, Folgering H. The Nijmegen Questionnaire and dysfunctional breathing. ERJ Open Res 2015;1:00001-2015. Full text
  • Thomas M, Bruton A, Ainsworth B. Use of the Nijmegen Questionnaire in asthma. ERJ Open Res 2015;1:00033-2015. Full text
  • Bondarenko J, Grillo L, Denton E, Button B, Hew M, Holland A. Breathing pattern disorder: assessment and diagnosis. ERJ Open Res 2026. Full text