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Dynamic Hyperinflation in Patients With Moderate-Severe Asthma: Relationship With Clinical Control and Small Airway

L E Saldaña-Pérez1,2, J Serrano Pariente1,3,4, C Cisneros Serrano1,5,6

  • 1Grupo Emergente de Asma (GEA) de SEPAR, Spain.

Journal of Investigational Allergology & Clinical Immunology
|July 30, 2025
PubMed
Summary

Dynamic hyperinflation (DH) in asthma patients is linked to poorer symptom control, according to GEMA guidelines. While not impacting ACT scores, DH correlates with increased breathlessness and fatigue, highlighting its clinical significance.

Keywords:
Asthma controlDynamic hyperinflationDyspneaOscillometryPrevalence

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Dynamic hyperinflation (DH) significantly impacts lung volumes during exercise, contributing to breathlessness and reduced exercise tolerance in asthma patients.
  • Understanding the link between DH and symptom control is crucial for managing moderate-to-severe asthma.

Purpose of the Study:

  • To investigate the association between dynamic hyperinflation (DH) and asthma control in individuals with moderate-to-severe asthma.
  • To explore the relationship between DH and various indicators of symptom control, quality of life, and physiological parameters.

Main Methods:

  • A cross-sectional, multicenter observational study involving patients with moderate-to-severe asthma.
  • DH was assessed by the decrease in inspiratory capacity post-6-minute walk test (6MWT). Asthma control was evaluated using the Asthma Control Test (ACT) and GEMA guidelines.
  • Secondary assessments included allergen sensitization, quality of life (miniAQLQ), anxiety/depression, dyspnea (mMRC), fatigue (Borg scale), and small airway dysfunction.

Main Results:

  • Dynamic hyperinflation (DH) was present in 63% of the 154 analyzed patients.
  • No significant difference in Asthma Control Test (ACT) scores was observed between patients with and without DH.
  • However, patients with DH showed a higher proportion of partially/poorly controlled asthma per GEMA guidelines (40.2% vs 24.6%), increased dyspnea, fatigue, depression, and higher respiratory reactance, alongside lower aeroallergen sensitization.

Conclusions:

  • Dynamic hyperinflation (DH) is not significantly associated with asthma control as measured by the ACT.
  • A higher proportion of patients with DH exhibited uncontrolled asthma based on GEMA criteria, indicating a clinically relevant link.
  • DH is associated with increased symptom burden, including dyspnea and fatigue, and physiological changes like small airway dysfunction.