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[Dyspnoea in asthma: diagnostic approach].

Pierantonio Laveneziana1, Antoine Beurnier2

  • 1Sorbonne Université, INSERM, UMRS 1158, neurophysiologie respiratoire expérimentale et clinique, 75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, service des explorations fonctionnelles de la respiration, de l'exercice et de la dyspnée, 75013 Paris, France.

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Dyspnoea, a key asthma symptom, varies in intensity due to factors beyond bronchial obstruction. Measuring and characterizing dyspnoea using specific tools is crucial for effective asthma management.

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Area of Science:

  • Pulmonology
  • Respiratory Medicine
  • Clinical Assessment

Background:

  • Dyspnoea is a primary symptom of asthma, essential for disease control assessment.
  • Its variable intensity, even with similar bronchial obstruction, suggests multifactorial causes.
  • Asthma control, comorbidities, and anxiety significantly influence dyspnoea's profile.

Purpose of the Study:

  • To highlight the importance of characterizing and measuring dyspnoea in asthma.
  • To emphasize the limitations of Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) in specifically assessing dyspnoea.
  • To introduce various tools for quantifying dyspnoea at rest and during exercise.

Main Methods:

  • Review of subjective dyspnoea assessment scales at rest: modified Medical Research Council (mMRC), New York Heart Association (NYHA), Visual Analogue Scale (VAS), Dyspnea-12, and Multidimensional Dyspnea Profile (MDP).
  • Inclusion of exercise testing methods: modified Borg scale and VAS.
  • Discussion of contributing factors like bronchial obstruction, airway resistance, and dynamic hyperinflation.

Main Results:

  • Existing tools like ACT and ACQ do not specifically characterize or measure dyspnoea in asthma.
  • Various scales and questionnaires (mMRC, NYHA, VAS, Dyspnea-12, MDP) and exercise tests (Borg, VAS) can assess dyspnoea.
  • Bronchial obstruction, airway resistance, and dynamic hyperinflation are key contributors to asthma-related dyspnoea.

Conclusions:

  • Accurate characterization and measurement of dyspnoea are vital for comprehensive asthma management.
  • Additional tools beyond ACT and ACQ are necessary for a specific dyspnoea assessment.
  • Hyperventilation syndrome and comorbidities can mask dyspnoea, necessitating targeted therapies and education.