title: Dysfunctional breathing phenotype in adults with asthma - incidence and risk factors.
abstract: BACKGROUND
  Abnormal breathing patterns may cause characteristic symptoms and impair quality of life. In a cross-sectional survey 29% of adults treated for asthma in primary care had symptoms suggestive of dysfunctional breathing (DB), more likely to be female and younger, with no differences for severity of asthma. No clear risk factors were demonstrated for DB in asthma, nor the impact of asthma medication was evaluated. The objective of this study was to describe the DB phenotype in adults with asthma treated in a specialised asthma centre.
  
  
  METHODS
  Adult patients aged 17-65 with diagnosed asthma were screened for DB using the Nijmegen questionnaire (positive predictive score >23) and confirmed by progressive exercise testing. The following were evaluated as independent risk factors for DB in the multiple regression analysis: female sex; atopy, obesity, active smoker, moderate/severe rhinitis, psychopathology, GERD, arterial hypertension; severe asthma, asthma duration > 5 years, lack of asthma control, fixed airway obstruction, fast lung function decline, frequent exacerbator and brittle asthma phenotypes; lack of ICS, use of LABA or LTRA.
  
  
  RESULTS
  91 adults with asthma, mean age 35.04 ±1.19 years, 47(51.65%) females were evaluated. 27 (29.67%) subjects had a positive screening score on Nijmegen questionnaire and 16(17.58%) were confirmed by progressive exercise testing as having DB. Independent risk factors for DB were psychopathology (p = 0.000002), frequent exacerbator asthma phenotype (p = 0.01) and uncontrolled asthma (p < 0.000001).
  
  
  CONCLUSIONS
  Dysfunctional breathing is not infrequent in asthma patients and should be evaluated in asthma patients presenting with psychopathology, frequent severe asthma exacerbations or uncontrolled asthma. Asthma medication (ICS, LABA or LTRA) had no significant relation with dysfunctional breathing.
authors.affiliation: Department of Allergy and Clinical Immunology, Transylvania University, Faculty of Medicine, 56 Nicolae Balcescu, Brasov, Romania. ibrumaru@unitbv.ro.
authors.forename: Ioana
authors.initials: I
authors.lastname: Agache
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciobanu
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paul
authors.forename: Liliana
authors.initials: L
authors.lastname: Rogozea