Eve Denton1, Janet Bondarenko2, TunnRen Tay3, Joy Lee3, Naghmeh Radhakrishna3, Fiona Hore-Lacy3, Catherine Martin4, Ryan Hoy5, Robyn O'Hehir6, Eli Dabscheck3, Mark Hew5. 1. Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: e.denton@alfred.org.au. 2. Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia. 3. Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia. 4. Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 5. Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 6. Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Understanding of dysfunctional breathing in patients with difficult asthma who remain symptomatic despite maximal inhaler therapy is limited. OBJECTIVE: We characterized the pattern of dysfunctional breathing in patients with difficult asthma and identified possible contributory factors. METHODS: Dysfunctional breathing was identified in patients with difficult asthma using the Nijmegen Questionnaire (score >23). Demographic characteristics, asthma variables, and comorbidities were assessed. Multivariate logistic regression was performed for dysfunctional breathing, adjusted for age, sex, body mass index, and airflow obstruction. RESULTS: Of 157 patients with difficult asthma, 73 (47%) had dysfunctional breathing. Compared with patients without dysfunctional breathing, those with dysfunctional breathing experienced poorer asthma status (symptom control, quality of life, and exacerbation rates) and greater unemployment. In addition, more frequently they had elevated sino-nasal outcome test scores, anxiety, depression, sleep apnea, and gastroesophageal reflux. On multivariate analysis, anxiety (odds ratio [OR], 3.26; 95% CI, 1.18-9.01; P = .02), depression (OR, 2.8; 95% CI, 1.14-6.9; P = .03), and 22-item sino-nasal outcome test score (OR, 1.03; 95% CI, 1.003-1.05; P = .03) were independent risk factors for dysfunctional breathing. CONCLUSIONS: Dysfunctional breathing is common in difficult asthma and associated with worse asthma status and unemployment. The independent association with psychological disorders and nasal obstruction highlight an important interaction between comorbid treatable traits in difficult asthma.
BACKGROUND: Understanding of dysfunctional breathing in patients with difficult asthma who remain symptomatic despite maximal inhaler therapy is limited. OBJECTIVE: We characterized the pattern of dysfunctional breathing in patients with difficult asthma and identified possible contributory factors. METHODS:Dysfunctional breathing was identified in patients with difficult asthma using the Nijmegen Questionnaire (score >23). Demographic characteristics, asthma variables, and comorbidities were assessed. Multivariate logistic regression was performed for dysfunctional breathing, adjusted for age, sex, body mass index, and airflow obstruction. RESULTS: Of 157 patients with difficult asthma, 73 (47%) had dysfunctional breathing. Compared with patients without dysfunctional breathing, those with dysfunctional breathing experienced poorer asthma status (symptom control, quality of life, and exacerbation rates) and greater unemployment. In addition, more frequently they had elevated sino-nasal outcome test scores, anxiety, depression, sleep apnea, and gastroesophageal reflux. On multivariate analysis, anxiety (odds ratio [OR], 3.26; 95% CI, 1.18-9.01; P = .02), depression (OR, 2.8; 95% CI, 1.14-6.9; P = .03), and 22-item sino-nasal outcome test score (OR, 1.03; 95% CI, 1.003-1.05; P = .03) were independent risk factors for dysfunctional breathing. CONCLUSIONS:Dysfunctional breathing is common in difficult asthma and associated with worse asthma status and unemployment. The independent association with psychological disorders and nasal obstruction highlight an important interaction between comorbid treatable traits in difficult asthma.
Authors: Cindy Thamrin; Mark Hew; Joy Lee; Jacqueline Huvanandana; Juliet M Foster; Helen K Reddel; Michael J Abramson Journal: Sci Rep Date: 2021-07-19 Impact factor: 4.379