Abstract
BackgroundBreathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components may provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control.MethodsOne hundred twenty-two asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-min. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model.ResultsFifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n = 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma.ConclusionThe within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing can be an indicator of poor asthma control.
Highlights
The goal of asthma management is to achieve optimal asthma control [1]
The within-subject variability of breathing pattern components is suggested as a better indicator of asthma control than their mean values when measured in a single occasion
This may be because the within-subject variability can efficiently reflect changes in the natural behaviour of tidal breathing occurred in relation to asthma control
Summary
The goal of asthma management is to achieve optimal asthma control [1]. To assess asthma control, symptom questionnaires are currently used in clinical practice [2]. Natural behaviour of breathing is assessed by quantifying breathing patterns with breathing pattern comprising components of volume, timing and thoracoabdominal (TA) movements [4] Breathing pattern components, such as tidal volume (Vt), timing parameters (inspiration and expiration duration or their ratio, respiratory rate (RR)) and TA motion, can be measured non-invasively over time without requiring patients’ cooperation compared to traditional lung function tests [5, 6]. The most commonly reported respiratory symptoms of dysfunctional breathing are predominant upper thoracic breathing, asynchrony between ribcage and abdominal motion, breathlessness, chest tightness, wheezing and deep sighing [9] Most of these have been described subjectively through clinicians’ observations or using symptom questionnaires, such as the Nijmegen Questionnaire (NQ) [10]. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control
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