TY - JOUR
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 - 2019/5
Y1 - 2019/5
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
UR - http://www.scopus.com/inward/record.url?scp=85060336680&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2018.11.037
DO - 10.1016/j.jaip.2018.11.037
M3 - Article
AN - SCOPUS:85060336680
VL - 7
SP - 1471
EP - 1476
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
SN - 2213-2198
IS - 5
ER -