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The following is a summary of “Associations of Breathing Pattern Disorder and Nijmegen Score With Clinical Outcomes in Difficult-to-Treat Asthma,” published in the April 2024 issue of Allergy & Immunology by Freeman, et al.
Breathing pattern disorder (BPD) characterizes altered breathing biomechanics, often accompanying difficult-to-treat asthma. Diagnosis lacks a gold standard, but the Nijmegen Questionnaire (NQ) is commonly used, with a score >23 indicating potential BPD. For a study, researchers sought to enhance clinical understanding of BPD and assess the clinical utility of the NQ in difficult asthma within the Wessex AsThma CoHort of difficult asthma (WATCH) study.
They conducted an analysis to evaluate associations between demographic and clinical factors in difficult asthma and breathing pattern disorder (BPD) using different assessment methods. BPD was determined by clinical diagnosis (yes/no, n = 476), Nijmegen Questionnaire (NQ) scores (≤23: normal, >23: abnormal, n = 372), and continuous raw NQ scores. Univariate models were employed to identify significant risk factors for the three BPD outcomes. Associations of continuous factors with clinician-diagnosed and NQ-based BPD were assessed using independent samples t-test or Mann-Whitney U test as appropriate or by Spearman correlation test. Dichotomous associations were evaluated using χ2 tests. Multivariable logistic and linear regression models were developed to identify the dichotomous and continuous predictive factors associated with clinician-diagnosed and NQ-based BPD. Patients with NQ score data were categorized into NQ quartiles (low, moderate, high, and very high), and the association patterns of these quartiles with four health-related questionnaire outcomes were assessed using linear regression analyses.
In the multivariable regression analysis, clinically diagnosed breathing pattern disorder (BPD) showed associations with several factors. Female sex was associated with higher odds of clinically diagnosed BPD (odds ratio [OR]: 1.85; 95% CI: 1.07, 3.20). Comorbidities such as rhinitis (OR: 2.46; 95% CI: 1.45, 4.17), gastroesophageal reflux disease (GORD) (OR: 2.77; 95% CI: 1.58, 4.84), inducible laryngeal obstruction (OR: 4.37; 95% CI: 2.01, 9.50), and any psychological comorbidity (OR: 1.86; 95% CI: 1.13, 3.07) were also associated with clinically diagnosed BPD. Additionally, healthcare usage factors such as exacerbations (OR: 1.07; 95% CI: 1.003, 1.14) and previous intensive care unit (ICU) admissions (OR: 2.03; 95% CI: 1.18, 3.47) were predictive of clinically diagnosed BPD. Abnormal NQ-based BPD diagnosis was associated with a history of eczema (OR: 1.83; 95% CI: 1.07, 3.14), GORD (OR: 1.94; 95% CI: 1.15, 3.27), or any psychological comorbidity (OR: 4.29; 95% CI: 2.64, 6.95) in multivariable regression analysis. They also observed differences between clinical and NQ-based BPD traits, with a 42% discordance in BPD state between these definitions. Furthermore, multivariable linear regression analysis with NQ as a continuous outcome revealed positive associations with worse asthma outcomes (admission to ICU, P = .037), different phenotypic traits (female sex, P = .001; ever smoker, P = .025), and greater multimorbidity (GORD, P = .002; sleep apnea, P = .04; and any psychological comorbidity, P < .0001).
BPD is associated with adverse health outcomes and negative health impacts in difficult asthma within a multimorbidity framework, warranting recognition and treatment. Clinical diagnosis and NQ offer complementary perspectives on BPD, suggesting that a comprehensive approach considering clinical features and NQ magnitude may be optimal for management.
Reference: jaci-inpractice.org/article/S2213-2198(23)01305-3/fulltext