Page 28 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 28
Associated conditions ity of 95%. The questionnaire consists of 16
items of which seven are linked with respira-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma DB can occur either in the absence of organic tory symptoms, four assess excessive ventila-
diseases (i.e., due to psychogenic causes such tion and five relate to central nervous system
as anxiety) or it may be coexisting with res- symptoms. Questions are answered in a few
piratory diseases (asthma, COPD, interstitial minutes on a five-point scale ranging from
lung diseases), cardiovascular disease, tho- ‘never’ (0 points) to ‘very often’ (4 points).34
racic wall abnormalities, hyperventilation in The score ranges from 0 to 64, with cut-off
anxiety related disorders and panic disorder. value of 23 and more points that best indi-
Symptoms of DB can mimic asthma, which cates HVS. However, elevated score is not di-
may influence the level of disease control and agnostic of a specific syndrome. The ques-
potentially lead to overtreatment, especially tionnaire has been increasingly used as an
in difficult-to-treat and severe asthma pheno- outcome measure in various clinical and re-
type, as illustrated in Figure 2.17,25,26 The ex- search settings for physiotherapists and other
pected treatment success with bronchodila- specialists. The cut-off value to detect DB and
tors and anti-inflammatory medicines may distinguish it from other abnormalities de-
be substantially reduced due to the presence pends on the context in which the NQ is used,
of disorder in breathing pattern. Among in- i.e. in poorly managed asthma, COPD, panic
dividuals with asthma, a positive diagnosis of disorder and anxiety, where its specificity may
DB is found in a third of women and a fifth be lower.6 Actually, the score measures “func-
of men.27 Also, DB may exacerbate myofas- tional respiratory complaints” meaning that
cial pain syndromes, such as temporomandib- it refers to ventilation, dyspnoea and breath-
ular joint disease 28, and other common condi- ing movement in relationship with stress and
tions such as headaches and migraines.29 DB anxiety. Van Dixhoon and group of authors34
is present in the so-called ‘long COVID’ syn- that developed the questionnaire comment
drome as part of a long-lasting dyspnoea asso- that “it detects transdiagnostic and probably
ciated with previous SARS-CoV-2 infection nonmedical abnormality”, “reflects a subjec-
persisting for months after acute infection. tive aspect of DB” and that “early detection
of these tension related complaints would pre-
Diagnostic methods vent unnecessary visits to medical specialists
and treatment”. The NQ is not copyrighted
Diagnosis of DB may be established only af- (free to use) but depends heavily on patients’
ter assessment, exclusion or adequate treat- understanding of questions and adequate
ment of other possible conditions. A gold self-assessment.
standard diagnostic method is yet to be es-
tablished. Several questionnaires and func- The Self-Evaluation of Breathing Ques-
tional tests have been used with less or more tionnaire (SEBQ) includes 25 questions
success. Tools should help multidimensional of which 23 refer to breathing or forms of
evaluation of breathing as it comprises three breath. Thus, it is complementary to NQ as
main functions: gas exchange (lung func- it evaluates more respiratory symptoms relat-
tion), change in posture and movement of the ed to the manual assessment measure.35 In a
trunk (biomechanical function)9 and a “sense study by Courtney R and Greenwood KM,
of self” (mental function).32,33 We offer a brief SEBQ demonstrated both very high test–re-
algorithm in assessment of DB (Figure 3). test reliability and internal consistency in a
group of adults from the general population.21
The Nijmegen Questionnaire (NQ) was However, as they concluded, “whilst SEBQ
introduced and validated in individuals with may bring a greater sensitivity than alterna-
exercise induced hyperventilation syndrome,
where it shows sensitivity of 91% and specific-
items of which seven are linked with respira-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma DB can occur either in the absence of organic tory symptoms, four assess excessive ventila-
diseases (i.e., due to psychogenic causes such tion and five relate to central nervous system
as anxiety) or it may be coexisting with res- symptoms. Questions are answered in a few
piratory diseases (asthma, COPD, interstitial minutes on a five-point scale ranging from
lung diseases), cardiovascular disease, tho- ‘never’ (0 points) to ‘very often’ (4 points).34
racic wall abnormalities, hyperventilation in The score ranges from 0 to 64, with cut-off
anxiety related disorders and panic disorder. value of 23 and more points that best indi-
Symptoms of DB can mimic asthma, which cates HVS. However, elevated score is not di-
may influence the level of disease control and agnostic of a specific syndrome. The ques-
potentially lead to overtreatment, especially tionnaire has been increasingly used as an
in difficult-to-treat and severe asthma pheno- outcome measure in various clinical and re-
type, as illustrated in Figure 2.17,25,26 The ex- search settings for physiotherapists and other
pected treatment success with bronchodila- specialists. The cut-off value to detect DB and
tors and anti-inflammatory medicines may distinguish it from other abnormalities de-
be substantially reduced due to the presence pends on the context in which the NQ is used,
of disorder in breathing pattern. Among in- i.e. in poorly managed asthma, COPD, panic
dividuals with asthma, a positive diagnosis of disorder and anxiety, where its specificity may
DB is found in a third of women and a fifth be lower.6 Actually, the score measures “func-
of men.27 Also, DB may exacerbate myofas- tional respiratory complaints” meaning that
cial pain syndromes, such as temporomandib- it refers to ventilation, dyspnoea and breath-
ular joint disease 28, and other common condi- ing movement in relationship with stress and
tions such as headaches and migraines.29 DB anxiety. Van Dixhoon and group of authors34
is present in the so-called ‘long COVID’ syn- that developed the questionnaire comment
drome as part of a long-lasting dyspnoea asso- that “it detects transdiagnostic and probably
ciated with previous SARS-CoV-2 infection nonmedical abnormality”, “reflects a subjec-
persisting for months after acute infection. tive aspect of DB” and that “early detection
of these tension related complaints would pre-
Diagnostic methods vent unnecessary visits to medical specialists
and treatment”. The NQ is not copyrighted
Diagnosis of DB may be established only af- (free to use) but depends heavily on patients’
ter assessment, exclusion or adequate treat- understanding of questions and adequate
ment of other possible conditions. A gold self-assessment.
standard diagnostic method is yet to be es-
tablished. Several questionnaires and func- The Self-Evaluation of Breathing Ques-
tional tests have been used with less or more tionnaire (SEBQ) includes 25 questions
success. Tools should help multidimensional of which 23 refer to breathing or forms of
evaluation of breathing as it comprises three breath. Thus, it is complementary to NQ as
main functions: gas exchange (lung func- it evaluates more respiratory symptoms relat-
tion), change in posture and movement of the ed to the manual assessment measure.35 In a
trunk (biomechanical function)9 and a “sense study by Courtney R and Greenwood KM,
of self” (mental function).32,33 We offer a brief SEBQ demonstrated both very high test–re-
algorithm in assessment of DB (Figure 3). test reliability and internal consistency in a
group of adults from the general population.21
The Nijmegen Questionnaire (NQ) was However, as they concluded, “whilst SEBQ
introduced and validated in individuals with may bring a greater sensitivity than alterna-
exercise induced hyperventilation syndrome,
where it shows sensitivity of 91% and specific-
