Farnam Barati Sedeh1, Anna Von Bülow2, Vibeke Backer2, Uffe Bodtger3, Ulrik Søes Petersen4, Susanne Vest5, James Hull6, Celeste Porsbjerg2. 1. Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. Electronic address: farnam.barati.sedeh@regionh.dk. 2. Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. 3. Department of Respiratory and Internal Medicine, Naestved Hospital, Institute for Regional Health Research, University of Southern, Denmark; Institute for Regional Health Research, University of Southern, Denmark; Department of Respiratory of and Internal Medicine, Roskilde Hospital, Denmark. 4. Department of Respiratory of and Internal Medicine, Roskilde Hospital, Denmark. 5. Department of Respiratory and Infection Medicine, Hilleroed Hospital, Denmark. 6. Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.
Abstract
BACKGROUND: Difficult asthma is defined as asthma requiring high dose treatment. However, systematic assessment is required to differentiate severe asthma from difficult-to-treat asthma. Dysfunctional breathing (DB) is a common comorbidity in difficult asthma, which may contribute to symptoms, but how it affects commonly used measures of symptom control is unclear. METHODS: All adult asthma patients seen in four respiratory clinics over one year were screened prospectively, and patients with possible severe asthma according to ERS/ATS criteria ('Difficult asthma': high-dose inhaled corticosteroids/oral corticosteroids), underwent systematic assessment. Symptoms of DB were assessed utilizing a symptom based subjective tool, Nijmegen questionnaire (NQ), and objective signs of DB with the Breathing Pattern Assessment Tool (BPAT). Asthma control and quality of life were evaluated with the Asthma Control Questionnaire (ACQ) and the mini Asthma Quality of Life Questionnaire (AQLQ). RESULTS: A total of 117 patients were included. Among these, 29.9% (35/117) had DB according to the NQ. Patients with DB had a poorer asthma control (ACQ: Mean (SD) 2.86 ± 1.05 vs. 1.46 ± 0.93) and lower quality of life (AQLQ score: Mean (SD) 4.2 ± 1.04 vs. 5.49 ± 0.85) compared to patients without DB. Similarly, patients with objective signs of DB according to the BPAT score had worse asthma control: BPAT >4 vs < 4: (ACQ: Mean (SD) 3.15 ± 0.93 vs 2.03 ± 1.15). CONCLUSION: DB is common among patients with difficult asthma, and is associated with significantly poorer asthma control and lower quality of life. Assessment and treatment of DB is an important part of the management of difficult asthma.
BACKGROUND:Difficult asthma is defined as asthma requiring high dose treatment. However, systematic assessment is required to differentiate severe asthma from difficult-to-treat asthma. Dysfunctional breathing (DB) is a common comorbidity in difficult asthma, which may contribute to symptoms, but how it affects commonly used measures of symptom control is unclear. METHODS: All adult asthma patients seen in four respiratory clinics over one year were screened prospectively, and patients with possible severe asthma according to ERS/ATS criteria ('Difficult asthma': high-dose inhaled corticosteroids/oral corticosteroids), underwent systematic assessment. Symptoms of DB were assessed utilizing a symptom based subjective tool, Nijmegen questionnaire (NQ), and objective signs of DB with the Breathing Pattern Assessment Tool (BPAT). Asthma control and quality of life were evaluated with the Asthma Control Questionnaire (ACQ) and the mini Asthma Quality of Life Questionnaire (AQLQ). RESULTS: A total of 117 patients were included. Among these, 29.9% (35/117) had DB according to the NQ. Patients with DB had a poorer asthma control (ACQ: Mean (SD) 2.86 ± 1.05 vs. 1.46 ± 0.93) and lower quality of life (AQLQ score: Mean (SD) 4.2 ± 1.04 vs. 5.49 ± 0.85) compared to patients without DB. Similarly, patients with objective signs of DB according to the BPAT score had worse asthma control: BPAT >4 vs < 4: (ACQ: Mean (SD) 3.15 ± 0.93 vs 2.03 ± 1.15). CONCLUSION:DB is common among patients with difficult asthma, and is associated with significantly poorer asthma control and lower quality of life. Assessment and treatment of DB is an important part of the management of difficult asthma.
Authors: Karen H Andreasson; Søren T Skou; Charlotte S Ulrik; Hanne Madsen; Kirsten Sidenius; Karin D Assing; Celeste Porsbjerg; Jannie Bloch-Nielsen; Mike Thomas; Uffe Bodtger Journal: Ann Am Thorac Soc Date: 2022-09
Authors: Valentina Fainardi; Lucrezia Passadore; Marialuisa Labate; Giovanna Pisi; Susanna Esposito Journal: Int J Environ Res Public Health Date: 2022-01-06 Impact factor: 3.390