Page 29 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 29
•anamnesis
DB •physical exam
suspected
Dg and •chest X-ray, lung function tests, arterial blood gasses, ECG, blood glucose, CBC,
treat other kidney and liver function tests, consult otorhinolaryngologist and psychologist
•most common differential dg: asthma, COPD, respiratory failure, heart failure,
causes neuromuscular diseases, panic disorder, anxiety, upper airway disorder
•assess functional respiratory complaints with observation-based tools and 29
Persistent questionnaires, i.e. NQ, BPAT, MARM etc.
symptoms
of DB
CPET •erratic ventilation; hyperventilation with frequent sighing present at rest/during dysfunctional breathing – view of pulmonologist
exercise; hypocapnia
•normal PaO2, alveolar-arterial pressure gradient of oxygen, dead space
volume/tidal volume and arterial-ETCO2 pressure gradient at end-exercise
exercise- •asthma or exercise-induced bronchoconstriction
induced •deconditioned - abnormal or normal physiological limit
dyspnea •exercise-induced arrhythmia, intracardiac shunting, exercise-induced anaphylaxis,
etc.
DB •dyspnea independent from bronchospasm and unresponsive to beta-agonists
•functional (disordered breathing pattern or paradoxal vocal fold motion disorder)
or structural (phrenic nerve palsy, repaired diaphragmatic hernia,
bronchomalacia, laryngomalacia, subglotic stenosis, etc.)
Figure 3. An example of diagnostic algorithm for DB
tives to the assessment of DB-related symp- ent aspects of breathing (i.e. rate, regularity).
toms because it is not oriented around the di- The most important part is to assess breath-
rect effects of hyperventilation, the trade-off ing pattern and the relative distribution of
may be reduced specificity, particularly for breathing motion between upper rib cage and
people with respiratory medical conditions lower rib cage and abdomen. The MARM is
such as asthma, for whom similar symptoms a practical and reliable tool for the breathing
might arise from pathological changes in air- pattern assessment with good agreement be-
ways rather than from disturbed biomechani- tween examiners. Moreover, one study com-
cal breathing patterns”. paring MARM with respiratory induction
pletizmography found that it can better dis-
The Manual Assessment of Respira- tinguish thoracic from abdominal breath-
tory Motion (MARM) is a palpation tech- ing.36
nique based on the examiner’s interpretation
and estimate of motion identified by hands at The Brompton Breathing Pattern As-
the posterior and lateral lower rib cage. The sessment Tool (BPAT) is, like MARM, a tool
MARM enables examiner to measure differ- used by the observer (i.e. physiotherapist).
DB •physical exam
suspected
Dg and •chest X-ray, lung function tests, arterial blood gasses, ECG, blood glucose, CBC,
treat other kidney and liver function tests, consult otorhinolaryngologist and psychologist
•most common differential dg: asthma, COPD, respiratory failure, heart failure,
causes neuromuscular diseases, panic disorder, anxiety, upper airway disorder
•assess functional respiratory complaints with observation-based tools and 29
Persistent questionnaires, i.e. NQ, BPAT, MARM etc.
symptoms
of DB
CPET •erratic ventilation; hyperventilation with frequent sighing present at rest/during dysfunctional breathing – view of pulmonologist
exercise; hypocapnia
•normal PaO2, alveolar-arterial pressure gradient of oxygen, dead space
volume/tidal volume and arterial-ETCO2 pressure gradient at end-exercise
exercise- •asthma or exercise-induced bronchoconstriction
induced •deconditioned - abnormal or normal physiological limit
dyspnea •exercise-induced arrhythmia, intracardiac shunting, exercise-induced anaphylaxis,
etc.
DB •dyspnea independent from bronchospasm and unresponsive to beta-agonists
•functional (disordered breathing pattern or paradoxal vocal fold motion disorder)
or structural (phrenic nerve palsy, repaired diaphragmatic hernia,
bronchomalacia, laryngomalacia, subglotic stenosis, etc.)
Figure 3. An example of diagnostic algorithm for DB
tives to the assessment of DB-related symp- ent aspects of breathing (i.e. rate, regularity).
toms because it is not oriented around the di- The most important part is to assess breath-
rect effects of hyperventilation, the trade-off ing pattern and the relative distribution of
may be reduced specificity, particularly for breathing motion between upper rib cage and
people with respiratory medical conditions lower rib cage and abdomen. The MARM is
such as asthma, for whom similar symptoms a practical and reliable tool for the breathing
might arise from pathological changes in air- pattern assessment with good agreement be-
ways rather than from disturbed biomechani- tween examiners. Moreover, one study com-
cal breathing patterns”. paring MARM with respiratory induction
pletizmography found that it can better dis-
The Manual Assessment of Respira- tinguish thoracic from abdominal breath-
tory Motion (MARM) is a palpation tech- ing.36
nique based on the examiner’s interpretation
and estimate of motion identified by hands at The Brompton Breathing Pattern As-
the posterior and lateral lower rib cage. The sessment Tool (BPAT) is, like MARM, a tool
MARM enables examiner to measure differ- used by the observer (i.e. physiotherapist).
