Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma

Eve Denton, Janet Bondarenko, TunnRen Tay, Joy Lee, Naghmeh Radhakrishna, Fiona Hore-Lacy, Catherine Martin, Ryan Hoy, Robyn O'Hehir, Eli Dabscheck, Mark Hew

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

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.

Original languageEnglish
Journal Journal of Allergy and Clinical Immunology: In Practice
DOIs
Publication statusAccepted/In press - 1 Jan 2019

Keywords

  • Anxiety
  • Asthma
  • Breathing pattern disorder
  • Chronic rhinosinusitis
  • Depression
  • Difficult asthma
  • Dysfunctional breathing
  • Severe asthma
  • Treatable trait

Cite this

@article{c834bbc92ac646b0b52f3d9f2e08fea4,
title = "Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma",
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.",
keywords = "Anxiety, Asthma, Breathing pattern disorder, Chronic rhinosinusitis, Depression, Difficult asthma, Dysfunctional breathing, Severe asthma, Treatable trait",
author = "Eve Denton and Janet Bondarenko and TunnRen Tay and Joy Lee and Naghmeh Radhakrishna and Fiona Hore-Lacy and Catherine Martin and Ryan Hoy and Robyn O'Hehir and Eli Dabscheck and Mark Hew",
year = "2019",
month = "1",
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doi = "10.1016/j.jaip.2018.11.037",
language = "English",
journal = "Journal of Allergy and Clinical Immunology: In Practice",
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Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma. / Denton, Eve; Bondarenko, Janet; Tay, TunnRen; Lee, Joy; Radhakrishna, Naghmeh; Hore-Lacy, Fiona; Martin, Catherine; Hoy, Ryan; O'Hehir, Robyn; Dabscheck, Eli; Hew, Mark.

In: Journal of Allergy and Clinical Immunology: In Practice, 01.01.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma

AU - Denton, Eve

AU - Bondarenko, Janet

AU - Tay, TunnRen

AU - Lee, Joy

AU - Radhakrishna, Naghmeh

AU - Hore-Lacy, Fiona

AU - Martin, Catherine

AU - Hoy, Ryan

AU - O'Hehir, Robyn

AU - Dabscheck, Eli

AU - Hew, Mark

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Anxiety

KW - Asthma

KW - Breathing pattern disorder

KW - Chronic rhinosinusitis

KW - Depression

KW - Difficult asthma

KW - Dysfunctional breathing

KW - Severe asthma

KW - Treatable trait

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DO - 10.1016/j.jaip.2018.11.037

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JO - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

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