Abstract：
BACKGROUND: Breathlessness is a disabling symptom, with complexity that is often under-recognized and undertreated in asthma.
OBJECTIVE: To highlight the burden of breathlessness in people with severe compared with mild-to-moderate asthma and identify psychophysiological correlates of breathlessness.
METHODS: This was a cross-sectional study of people with mild-to-severe asthma, who attended 2 in-person visits to complete a multidimensional assessment. The proportion of people with mild-to-moderate versus severe asthma who reported physically limiting breathlessness (modified Medical Research Council [mMRC] dyspnea score ≥2) was compared. Psychophysiological factors associated with breathlessness in people with asthma were identified via a directed acyclic graph and explored with multivariate logistic regression to predict breathlessness.
RESULTS: A total of 144 participants were included, of whom, 74 (51%) had mild-to-moderate asthma and 70 (49%) severe asthma. Participants were predominantly female (n = 103, 72%) with a median (quartile 1, quartile 3) age of 63.4 (50.5, 69.5) years and body mass index (BMI) of 31.3 (26.2, 36.0) kg/m2. The proportion of people reporting mMRC ≥2 was significantly higher in those with severe- (n = 37, 53%) than those with mild-to-moderate (n = 21, 31%) asthma (P = .013). Dyspnoea-12 Total (8.00 [4.75, 17.00] vs 5.00 [2.00, 11.00], P = .037) score was also significantly higher in the severe asthma group. Significant predictors of physically limiting breathlessness were BMI, asthma control, exercise capacity, and hyperventilation symptoms. Airflow limitation and type 2 inflammation were poor breathlessness predictors.
CONCLUSIONS: Over half of people with severe asthma experience physically limiting breathlessness despite treatment. Targeting psychophysiological factors, or traits, associated with breathlessness may help relieve this distressing symptom, which is of high priority to people with asthma.
OBJECTIVE: To highlight the burden of breathlessness in people with severe compared with mild-to-moderate asthma and identify psychophysiological correlates of breathlessness.
METHODS: This was a cross-sectional study of people with mild-to-severe asthma, who attended 2 in-person visits to complete a multidimensional assessment. The proportion of people with mild-to-moderate versus severe asthma who reported physically limiting breathlessness (modified Medical Research Council [mMRC] dyspnea score ≥2) was compared. Psychophysiological factors associated with breathlessness in people with asthma were identified via a directed acyclic graph and explored with multivariate logistic regression to predict breathlessness.
RESULTS: A total of 144 participants were included, of whom, 74 (51%) had mild-to-moderate asthma and 70 (49%) severe asthma. Participants were predominantly female (n = 103, 72%) with a median (quartile 1, quartile 3) age of 63.4 (50.5, 69.5) years and body mass index (BMI) of 31.3 (26.2, 36.0) kg/m2. The proportion of people reporting mMRC ≥2 was significantly higher in those with severe- (n = 37, 53%) than those with mild-to-moderate (n = 21, 31%) asthma (P = .013). Dyspnoea-12 Total (8.00 [4.75, 17.00] vs 5.00 [2.00, 11.00], P = .037) score was also significantly higher in the severe asthma group. Significant predictors of physically limiting breathlessness were BMI, asthma control, exercise capacity, and hyperventilation symptoms. Airflow limitation and type 2 inflammation were poor breathlessness predictors.
CONCLUSIONS: Over half of people with severe asthma experience physically limiting breathlessness despite treatment. Targeting psychophysiological factors, or traits, associated with breathlessness may help relieve this distressing symptom, which is of high priority to people with asthma.
摘要：
背景：呼吸困难是一种致残症状，其复杂性在哮喘中经常被认识和治疗不足。
目的：强调重度哮喘患者与轻度至中度哮喘患者的呼吸困难负担，并确定呼吸困难的心理生理相关性。
方法：这是一项针对轻度至重度哮喘患者的横断面研究，他参加了两次亲自访问，以完成多维评估。比较了轻度至中度哮喘与重度哮喘患者报告身体呼吸困难（改良医学研究委员会[mMRC]呼吸困难评分≥2）的比例。通过有向无环图确定与哮喘患者呼吸困难相关的心理生理因素，并通过多变量逻辑回归进行探索以预测呼吸困难。
结果：包括144名参与者，其中，74（51％）患有轻度至中度哮喘和70（49％）重度哮喘。参与者主要是女性（n=103，72％），中位（四分位数1，四分位数3）年龄为63.4（50.5，69.5）岁，体重指数（BMI）为31.3（26.2，36.0）kg/m2。与轻度至中度（n=21，31％）哮喘（p=0.013）相比，重度哮喘患者（n=37，53％）报告mMRC≥2的比例明显更高。总呼吸困难-12（8.00[4.75，17.00]对5.00[2.00，11.00]，p=0.037)评分在重度哮喘组中也显著较高。身体限制呼吸困难的重要预测因素是：BMI，哮喘控制,锻炼能力,和过度通气的症状.气流受限和2型炎症是呼吸困难的不良预测因子。
结论：超过一半的重度哮喘患者尽管接受了治疗，但在身体上出现呼吸困难。针对心理生理因素，或特征，与呼吸困难相关的可能有助于缓解这种痛苦的症状，这是哮喘患者的优先事项。
目的：强调重度哮喘患者与轻度至中度哮喘患者的呼吸困难负担，并确定呼吸困难的心理生理相关性。
方法：这是一项针对轻度至重度哮喘患者的横断面研究，他参加了两次亲自访问，以完成多维评估。比较了轻度至中度哮喘与重度哮喘患者报告身体呼吸困难（改良医学研究委员会[mMRC]呼吸困难评分≥2）的比例。通过有向无环图确定与哮喘患者呼吸困难相关的心理生理因素，并通过多变量逻辑回归进行探索以预测呼吸困难。
结果：包括144名参与者，其中，74（51％）患有轻度至中度哮喘和70（49％）重度哮喘。参与者主要是女性（n=103，72％），中位（四分位数1，四分位数3）年龄为63.4（50.5，69.5）岁，体重指数（BMI）为31.3（26.2，36.0）kg/m2。与轻度至中度（n=21，31％）哮喘（p=0.013）相比，重度哮喘患者（n=37，53％）报告mMRC≥2的比例明显更高。总呼吸困难-12（8.00[4.75，17.00]对5.00[2.00，11.00]，p=0.037)评分在重度哮喘组中也显著较高。身体限制呼吸困难的重要预测因素是：BMI，哮喘控制,锻炼能力,和过度通气的症状.气流受限和2型炎症是呼吸困难的不良预测因子。
结论：超过一半的重度哮喘患者尽管接受了治疗，但在身体上出现呼吸困难。针对心理生理因素，或特征，与呼吸困难相关的可能有助于缓解这种痛苦的症状，这是哮喘患者的优先事项。
