Bousso Awa, Chuffart Celine, Leroy Maxime, Gicquello Alice, Cottereau Aurelie, Hennegrave Florence, Beurnier Antoine, Stoup Thomas, Pereira Sophie, Morelot-Panzini Capucine, Taille Camille, Bautin Nathalie, Fry Stephanie, Perez Thierry, Garcia Gilles, Chenivesse Cecile
Univ. Lille, CHU Lille, Service de Pneumologie et Immuno-Allergologie, Lille, France.
Centre Hospitalier de Roubaix, Service de Pneumologie, Roubaix, France.
Respir Med. 2023 May 20:107276. doi: 10.1016/j.rmed.2023.107276.
Dyspnea is a common but non-specific symptom of asthma, which in particular may be related to anxiety and hyperventilation syndrome, two frequent comorbidities of asthma.
We conducted a prospective multicentric cohort study in dyspneic asthmatic adults. Dyspnea was assessed using the Multidimensional Dyspnea Profile questionnaire. We described the sensory (QS) and affective (A2) domains of dyspnea and investigated the effect of poor asthma control, hyperventilation and anxiety on each dimension at baseline and after 6 months.
We included 142 patients (65.5% women, age: 52 years). Dyspnea was severe and predominated on its sensory domain (median QS: 27/50; A2: 15/50). Uncontrolled asthma (ACQ≥1.5), hyperventilation symptoms (Nijmegen≥23) and anxiety (HAD-A≥10) were present in 75%, 45.7% and 39% of cases, respectively. Hyperventilation symptoms were associated with higher QS and A2 scores: QS at 28.4(10.7) vs. 21.7(12.8) (p = 0.001) and A2 at 24(14) vs. 11.3(11) (p < 0.001) in patients with vs. without hyperventilation symptoms. Anxiety was only associated with increased A2 (27(12.3) vs. 10.9(11), p < 0.001). At 6 months, QS and A2 decreased of 7 and 3 points, respectively, in relation with changes in ACQ-6 and Nijmegen scores as well as the HAD-A score for A2.
In breathless asthmatics, dyspnea is severe and worsened but differentially modulated by hyperventilation symptoms and anxiety. A multidimensional phenotyping of dyspnea in asthmatics could be useful to understand its origins and personalize treatment.
呼吸困难是哮喘常见但非特异性的症状，尤其可能与焦虑和过度通气综合征有关，这两种情况是哮喘常见的共病。
我们对有呼吸困难的成年哮喘患者进行了一项前瞻性多中心队列研究。使用多维呼吸困难量表问卷评估呼吸困难情况。我们描述了呼吸困难的感觉（QS）和情感（A2）维度，并在基线和6个月后研究了哮喘控制不佳、过度通气和焦虑对每个维度的影响。
我们纳入了142例患者（65.5%为女性，年龄：52岁）。呼吸困难严重，且在感觉维度上占主导（QS中位数：27/50；A2：15/50）。分别有75%、45.7%和39%的病例存在未控制的哮喘（ACQ≥1.5）、过度通气症状（奈梅亨量表≥23）和焦虑（医院焦虑抑郁量表-焦虑分量表≥10）。过度通气症状与更高的QS和A2评分相关：有过度通气症状的患者QS为28.4(10.7)，无过度通气症状的患者为21.7(12.8)（p = 0.001）；有过度通气症状的患者A2为24(14)，无过度通气症状的患者为11.3(11)（p < 0.001）。焦虑仅与A2升高相关（27(12.3)比10.9(11)，p < 0.001）。在6个月时，与ACQ-6、奈梅亨量表评分以及A2的医院焦虑抑郁量表-焦虑分量表评分的变化相关，QS和A2分别下降了7分和3分。
在气喘吁吁的哮喘患者中，呼吸困难严重，且因过度通气症状和焦虑而加重，但调节方式不同。对哮喘患者的呼吸困难进行多维度表型分析可能有助于了解其病因并实现个性化治疗。
