Severity and phenotypes of dyspnea in asthma: Impact of comorbidities

Awa Bousso; Celine Chuffart; Maxime Leroy; Alice Gicquello; Aurelie Cottereau; Florence Hennegrave; Antoine Beurnier; Thomas Stoup; Sophie Pereira; Capucine Morelot-Panzini; Camille Taille; Nathalie Bautin; Stephanie Fry; Thierry Perez; Gilles Garcia; Cecile Chenivesse

doi:10.1016/j.rmed.2023.107276

Severity and phenotypes of dyspnea in asthma: Impact of comorbidities

Respir Med. 2023 May 20:107276. doi: 10.1016/j.rmed.2023.107276. Online ahead of print.

Authors

Awa Bousso¹, Celine Chuffart², Maxime Leroy³, Alice Gicquello⁴, Aurelie Cottereau⁴, Florence Hennegrave⁵, Antoine Beurnier⁶, Thomas Stoup¹, Sophie Pereira¹, Capucine Morelot-Panzini⁷, Camille Taille⁸, Nathalie Bautin⁹, Stephanie Fry⁹, Thierry Perez⁹, Gilles Garcia¹⁰, Cecile Chenivesse¹¹

Affiliations

¹ Univ. Lille, CHU Lille, Service de Pneumologie et Immuno-Allergologie, Lille, France.
² Centre Hospitalier de Roubaix, Service de Pneumologie, Roubaix, France.
³ CHU Lille, Department of Biostatistics, F-59000, Lille, France.
⁴ Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Pneumologie, Lille, France.
⁵ Centre Hospitalier Dunkerque, Service de Pneumologie, Dunkerque, France.
⁶ Bicêtre Hospital, Department of Physiology - Lung Function Testing, DMU 5 Thorinno, France; AP-HP - Paris Saclay University, Inserm UMR_S999, Le Kremlin Bicêtre, France; CRISALIS, F-CRIN Inserm Network, France.
⁷ GHU APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Paris, France; UMRS 1158, Inserm-Sorbonne Université, Paris, France.
⁸ CRISALIS, F-CRIN Inserm Network, France; Bichat Hospital, Respiratory Diseases Department, Reference Center for Rare Pulmonary Diseases, France; AP-HP Nord - University of Paris Cité, Inserm 1152, 75018, Paris, France.
⁹ CRISALIS, F-CRIN Inserm Network, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France.
¹⁰ Hopital privé d'Antony, Service de Pneumologie, Antony, France.
¹¹ CRISALIS, F-CRIN Inserm Network, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France. Electronic address: cecile.chenivesse@chu-lille.fr.

PMID: 37217082
DOI: 10.1016/j.rmed.2023.107276

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Affective; Asthma control; Breathlessness; Multidimensional dyspnea profile; Nijmegen; Sensory.