Page 33 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 33
Combining different tools possibly could costeroids or that requires such treatment to 33
be the best choice as it may increase diagnostic maintain good symptom control and reduce
accuracy. For example, in the recent studies the risk of exacerbations.26 The aforemen- dysfunctional breathing – view of pulmonologist
the NQ was used to evaluate symptoms relat- tioned findings reinforce the idea to routinely
ed to DB, and supplemented with the BPAT to search for DB in the patients referred for spe-
objectively assess breathing pattern in patients cialist management of asthma.25,54 Further in-
with difficult-to-treat asthma.17,25 Identify- vestigations are necessary to determine a pos-
ing DB as a co-morbidity in difficult-to-treat sible benefit of physiotherapeutic treatment in
asthma is of a special interest, to avoid poten- reduction of inhaled corticosteroids use in pa-
tially harmful or costly overtreatments such tients with concomitant asthma and DB.
as oral steroids, or biological treatments. One
group of researchers found that almost quar- Treatment
ter of patients referred to severe asthma clin-
ic had only DB.17 In comparison, Sedeh and Patient education about the condition, reassurance
colleagues25 firstly comprehensively and sys-
tematically verified asthma diagnosis in all Abdominal breathing retraining
participants, then assessed disease severity ac-
cording to international recommendations26 Breathing rate and depth control
and, at last, applied the NQ, BPAT, as well
as Asthma Control Questionnaire (ACQ ) Breathing retraining in progressively taxing postures such as
and Asthma Quality of Life Questionnaire walking
(AQLQ ). The researchers found that patients
with uncontrolled asthma and DB were most- Recognition of triggers
ly female (74%), had higher body mass index
(BMI), had significantly poorer asthma con- Control of symptoms during an episode of DB and manual
trol and lower quality of life compared to pa- therapy
tients without DB. After adjusting for BMI
the relationship between DB and poor asthma Various modes of breathing retraining pro-
control, did not change, meaning that symp- grams guided by a qualified professional (e.g.
toms of DB were not induced by obesity. Also, physiotherapist) are recommended, such as
DB alone, the NQ score as well as the BPAT breathing control, diaphragmatic breath-
were an independent determinants of ACQ- ing, yoga breathing, Buteyko breathing, bio-
score meaning that the adverse impact of DB feedback-guided breathing modification, and
on asthma control could not be explained yawn/sigh suppression.55,56
by other factors such as more bronchial hy-
per-responsiveness or lower lung function in Educating patients about DB is the key
patients with DB. Moreover, patients with a and the first step in the program. Helping pa-
low NQ, but high BPAT (objective signs of tients differentiate symptoms of DB from the
DB), had a significantly poorer asthma con- associated conditions, such as asthma, is an
trol, compared to patients with both low NQ important goal. For instance, DB would not
and low BPAT. Similar results were found in respond to targeted treatments for asthma.
one study on asthma patients using the NQ
and ACQ-score.54 Difficult-to-treat asthma is One randomized controlled trial by
asthma that is uncontrolled despite medium/ Lindeboom and colleagues compared re-
high dose inhaled corticosteroids with a sec- laxation therapy versus relaxation thera-
ond controller, or on maintenance oral corti- py and breathing exercises.57 According to a
Cochrane review58, the results of this study
“describe a significant reduction in frequen-
cy and severity of h yperventilation attacks in
the breathing exercise group compared with
the control group, which demonstrated an
increase in the frequency and severity of at-
tacks. In addition, a significant difference in
frequency and severity of h yperventilation at-
be the best choice as it may increase diagnostic maintain good symptom control and reduce
accuracy. For example, in the recent studies the risk of exacerbations.26 The aforemen- dysfunctional breathing – view of pulmonologist
the NQ was used to evaluate symptoms relat- tioned findings reinforce the idea to routinely
ed to DB, and supplemented with the BPAT to search for DB in the patients referred for spe-
objectively assess breathing pattern in patients cialist management of asthma.25,54 Further in-
with difficult-to-treat asthma.17,25 Identify- vestigations are necessary to determine a pos-
ing DB as a co-morbidity in difficult-to-treat sible benefit of physiotherapeutic treatment in
asthma is of a special interest, to avoid poten- reduction of inhaled corticosteroids use in pa-
tially harmful or costly overtreatments such tients with concomitant asthma and DB.
as oral steroids, or biological treatments. One
group of researchers found that almost quar- Treatment
ter of patients referred to severe asthma clin-
ic had only DB.17 In comparison, Sedeh and Patient education about the condition, reassurance
colleagues25 firstly comprehensively and sys-
tematically verified asthma diagnosis in all Abdominal breathing retraining
participants, then assessed disease severity ac-
cording to international recommendations26 Breathing rate and depth control
and, at last, applied the NQ, BPAT, as well
as Asthma Control Questionnaire (ACQ ) Breathing retraining in progressively taxing postures such as
and Asthma Quality of Life Questionnaire walking
(AQLQ ). The researchers found that patients
with uncontrolled asthma and DB were most- Recognition of triggers
ly female (74%), had higher body mass index
(BMI), had significantly poorer asthma con- Control of symptoms during an episode of DB and manual
trol and lower quality of life compared to pa- therapy
tients without DB. After adjusting for BMI
the relationship between DB and poor asthma Various modes of breathing retraining pro-
control, did not change, meaning that symp- grams guided by a qualified professional (e.g.
toms of DB were not induced by obesity. Also, physiotherapist) are recommended, such as
DB alone, the NQ score as well as the BPAT breathing control, diaphragmatic breath-
were an independent determinants of ACQ- ing, yoga breathing, Buteyko breathing, bio-
score meaning that the adverse impact of DB feedback-guided breathing modification, and
on asthma control could not be explained yawn/sigh suppression.55,56
by other factors such as more bronchial hy-
per-responsiveness or lower lung function in Educating patients about DB is the key
patients with DB. Moreover, patients with a and the first step in the program. Helping pa-
low NQ, but high BPAT (objective signs of tients differentiate symptoms of DB from the
DB), had a significantly poorer asthma con- associated conditions, such as asthma, is an
trol, compared to patients with both low NQ important goal. For instance, DB would not
and low BPAT. Similar results were found in respond to targeted treatments for asthma.
one study on asthma patients using the NQ
and ACQ-score.54 Difficult-to-treat asthma is One randomized controlled trial by
asthma that is uncontrolled despite medium/ Lindeboom and colleagues compared re-
high dose inhaled corticosteroids with a sec- laxation therapy versus relaxation thera-
ond controller, or on maintenance oral corti- py and breathing exercises.57 According to a
Cochrane review58, the results of this study
“describe a significant reduction in frequen-
cy and severity of h yperventilation attacks in
the breathing exercise group compared with
the control group, which demonstrated an
increase in the frequency and severity of at-
tacks. In addition, a significant difference in
frequency and severity of h yperventilation at-
