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

Publication date: Available online 7 December 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

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

Abstract

Background

Understanding of dysfunctional breathing in difficult asthma patients who remain symptomatic despite maximal inhaler therapy is limited.

Objective

We characterised 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). Demographics, 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 to patients without dysfunctional breathing, those with dysfunctional breathing experienced poorer asthma status [symptom control, quality of life (QOL) and exacerbation rates] and greater unemployment. Additionally, more frequently they had elevated sino-nasal outcome test (SNOT-22) scores, anxiety, depression, sleep apnoea and gastroesophageal reflux. On multivariate analysis, anxiety (OR=3.26, 95%CI 1.18-9.01, p=0.02), depression (OR=2.8. 95%CI 1.14-6.9, p=0.03) and SNOT-22 (OR 1.03 95% CI 1.003-1.05, p=0.03) were independent risk factors for dysfunctional breathing.

Conclusion

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.

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