Dysfunctional breathing interacts with other treatable traits in difficult asthma

Published online: December 7, 2018

Many patients with difficult and severe asthma remain symptomatic despite seemingly appropriate therapy, good compliance and inhaler technique. Dysfunctional breathing, a treatable disorder of breathing pattern, likely accounts for these symptoms in some patients but is poorly understood. Identifying and treating dysfunctional breathing may lead to symptomatic improvement in patients with difficult asthma and improved knowledge is needed about this condition.

In a recent study by Denton et al in The Journal of Allergy and Clinical Immunology: In Practice dysfunctional breathing was identified amongst consecutive patients referred by Pulmonologists and Allergists to the Severe Asthma Clinic at a University teaching hospital. This was diagnosed by an elevated Nijmegen Questionnaire >23, a questionnaire validated to detect hyperventilation, one form of dysfunctional breathing. Detailed information about these patients was obtained.

Of 157 patients with difficult asthma just under half (47%) had dysfunctional breathing. Those with dysfunctional breathing had more symptoms, worse quality of life, increased exacerbation rates and more unemployment. They also had more sino-nasal symptoms, anxiety, depression, obstructive sleep apnea and gastroesophageal reflux disease. Independent risk factors for the presence of dysfunctional breathing included the presence of anxiety, depression and sino-nasal symptoms.

Dysfunctional breathing is very common amongst those referred  to a Severe Asthma Clinic and is associated with worse asthma status and unemployment. Anxiety and depression are potentially treatable and were independently associated with dysfunctional breathing, a long suspected but unconfirmed association. There was also an independent association between dysfunctional breathing and presence of sino-nasal symptoms, another treatable comorbid trait. Sino-nasal symptoms are a potential cause of mouth breathing, one form of dysfunctional breathing.

This article highlights the important interactions between comorbid treatable traits in difficult asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.