背景:呼吸模式障碍(BPD)反映了呼吸的生物力学模式改变,导致呼吸困难,通常伴有难以治疗的哮喘。BPD的诊断没有金标准,但Nijmegen问卷(NQ)>23是常用的。
目的:我们试图推进BPD的临床特征,更好地了解NQ在困难哮喘中的临床效用,WessexAsthmaCoHort难治性哮喘(WATCH)研究的患者。
方法:困难哮喘和BPD的人口统计学和临床因素之间的关联,通过临床诊断确定(是/否,n=476),通过NQ评分(≤23:正常(无BPD提示)和>23:异常(建议BPD),n=372,以及连续的原始NQ评分)在单变量模型中进行评估,以识别与三个BPD结果相关的重要风险因素。对于临床诊断和基于NQ的BPD,采用独立样本t检验或Mann-WhitneyU检验对数据分布进行评估,或采用Spearman相关检验进行评估.使用卡方检验评估二分关联。开发了多变量逻辑(二分结果)和线性回归模型(连续结果),以识别与临床医生诊断和基于NQ的BPD相关的预测因素。二分法和连续的。将具有NQ评分数据的患者分组为NQ四分位数(低,中度,高,并且非常高)。使用线性回归分析评估四分位数与四个健康相关问卷结果的关联模式。
结果:多变量回归确定临床诊断的BPD与女性相关(OR1.85;95%CI1.07,3.20),合并症(鼻炎(OR2.46;95%CI1.45,4.17),GORD(OR2.77;95%CI1.58,4.84),ILO(OR4.37;95%CI2.01,9.50)和任何心理合并症(OR1.86;95%CI1.13,3.07))和医疗保健使用(恶化(OR1.07;95%CI1.003,1.14)和以前的ICU入院(OR2.03;95%CI1.18,3.47))。基于NQ的BPD异常诊断与湿疹病史相关(OR1.83;95%CI1.07,3.14),多变量回归分析时,GORD(OR1.94;95%CI1.15,3.27)或任何心理合并症(OR4.29;95%CI2.64,6.95)。还发现了临床和基于NQ的BPD性状之间的差异,这些定义之间的BPD状态有42%的不一致。以NQ为连续结局的多变量线性回归分析显示,与哮喘预后较差(入住ICU,p=0.037),不同的表型特征(女性p=0.001,吸烟者,p=0.025))和更大的多浊度(GORD,p=0.002,睡眠呼吸暂停,p=0.040,任何心理合并症,p<0.0001)。
结论:在多疾病模型中,BPD与困难哮喘的不良健康结果和负面健康影响相关。因此,它值得更好的承认和及时的处理。临床诊断和NQ对BPD提供了不同的观点,因此,通过考虑临床特征和NQ的大小,可以最好地实现这一目标。
BACKGROUND: Breathing pattern disorder (BPD) reflects altered biomechanical patterns of breathing that drive breathing difficulty and commonly accompanies difficult-to-treat asthma. Diagnosis of BPD has no gold standard, but Nijmegen Questionnaire (NQ) >23 is commonly used.
OBJECTIVE: We sought to advance clinical characterization of BPD and better understand the clinical utility of NQ in difficult asthma in patients from the Wessex AsThma CoHort of difficult asthma (WATCH) study.
METHODS: Associations between demographic and clinical factors in difficult asthma and BPD, ascertained by clinical diagnosis (yes/no, n = 476), by NQ scores (≤23: normal [no suggestion of BPD] and >23: abnormal [suggested BPD], n = 372), as well as the continuous raw NQ scores were assessed in univariate models to identify significant risk factors associated with the 3 BPD outcomes. For the clinician-diagnosed and NQ-based BPD, associations of continuous factors were assessed using the independent samples t test or the Mann-Whitney U test as appropriate for the data distribution or by the Spearman correlation test. Dichotomous associations were evaluated using χ2 tests. Multivariable logistic (dichotomous outcomes) and linear regression models (continuous outcomes) were developed to identify predictive factors associated with clinician-diagnosed and NQ-based BPD, dichotomous and continuous. Patients with data on NQ scores were grouped into NQ quartiles (low, moderate, high, and very high). The patterns of association of the quartiles with 4 health-related questionnaire outcomes were assessed using linear regression analyses.
RESULTS: Multivariable regression identified that clinically diagnosed BPD was associated with female sex (odds ratio [OR]: 1.85; 95% confidence interval [CI]: 1.07, 3.20), comorbidities (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]), and health care usage (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]). Abnormal NQ-based BPD diagnosis was associated with 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) at multivariable regression. Differences between clinical and NQ-based BPD traits were also found with 42% discordance in BPD state between these definitions. Multivariable linear regression analysis with NQ as a continuous outcome showed positive association 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).
CONCLUSIONS: BPD is associated with worse health outcomes and negative health impacts in difficult asthma within a multimorbidity disease model. It therefore merits better recognition and prompt treatment. Clinical diagnosis and NQ offer different perspectives on BPD, so this goal may be best addressed by considering clinical features alongside the magnitude of NQ.