Laveneziana Pierantonio, Beurnier Antoine
Sorbonne Université, INSERM, UMRS 1158, neurophysiologie respiratoire expérimentale et clinique, 75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, service des explorations fonctionnelles de la respiration, de l'exercice et de la dyspnée, 75013 Paris, France.
Université Paris-Sud, faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; AP-HP, Hôpital Bicêtre, service de physiologie, 94270 Le Kremlin-Bicêtre, France.
Presse Med. 2019 Mar;48(3 Pt 1):274-281. doi: 10.1016/j.lpm.2019.01.008. Epub 2019 Mar 8.
Dyspnoea is a cardinal symptom of asthma and an essential part of assessing control of the disease. Its intensity is variable for the same level of bronchial obstruction, which suggests the involvement of other mechanisms. Therefore, it is extremely important to characterize and measure dyspnoea in asthmatic patients because its profile can be quantitatively and qualitatively modified by disease control, comorbidities and anxiety. Hence the value of using additional tools to ACT and ACQ because the latter do not characterize nor measure specifically dyspnoea in asthma. Different tools can be used in this regard, at rest as the subjective assessment of dyspnoea by scales such as the modified Medical Research Council (mMRC), the New York Heart Association (NYHA) and the Visual Analogue Scale (VAS) or more recently using the Dyspnea-12 and the Multidimensional Dyspnea Profile (MDP) questionnaire, which assesses the sensory and affective dimensions of dyspnoea; and during exercise testing such as the "modified" Borg scale, graduated from 0 to 10, or the VAS. Among the factors contributing to dyspnoea in asthmatic patients, probably bronchial obstruction, increased airway resistance and dynamic hyperinflation play an important role. Despite this, the asthmatic patient's description of dyspnoea may be masked by hyperventilation syndrome or other comorbidities that can easily be detected and treated through educational programs and targeted therapies.
呼吸困难是哮喘的主要症状，也是评估疾病控制情况的重要组成部分。对于相同程度的支气管阻塞，其严重程度存在差异，这表明还有其他机制参与其中。因此，对哮喘患者的呼吸困难进行特征描述和测量极为重要，因为疾病控制、合并症和焦虑会在数量和质量上改变其特征。因此，使用ACT和ACQ之外的其他工具具有重要价值，因为后者无法专门对哮喘中的呼吸困难进行特征描述和测量。在这方面可以使用不同的工具，在静息状态下，可通过改良医学研究委员会（mMRC）、纽约心脏协会（NYHA）和视觉模拟量表（VAS）等量表对呼吸困难进行主观评估，或者最近使用呼吸困难-12量表和多维呼吸困难量表（MDP）问卷，后者评估呼吸困难的感觉和情感维度；在运动测试期间，可使用“改良”的博格量表（从0到10分级）或VAS。在导致哮喘患者呼吸困难的因素中，支气管阻塞、气道阻力增加和动态肺过度充气可能起重要作用。尽管如此，哮喘患者对呼吸困难的描述可能会被过度通气综合征或其他合并症掩盖，而这些合并症可通过教育项目和针对性治疗轻易检测和治疗。
