[en] While studies have demonstrated the impact of asthma symptoms on quality of life, very few studies have investigated the relationship between detailed asthma symptoms, as reported by the patient, and lung function and inflammation. A cross-sectional study was conducted on treated (ICS/LABA) adult (> 18 years) asthma patients recruited from the Liege University Hospital Asthma Clinic (Belgium) between 2018 and 2023 (n = 505). The intensity of asthma symptoms (dyspnea, wheezing, chest tightness, cough, and airway secretion) was measured using five-point Likert scales (5 expressing the greatest intensity). Multiple linear regression models including all independent variables were carried out to evaluate whether lung function and inflammatory parameters were independently associated with distinct symptoms. Cough associated with female gender (p < 0.05), smoking (p < 0.01), low FeNO (p < 0.05) and FEV1% pred. (p < 0.05), and high blood and sputum eosinophils (p < 0.05 for both). Airway secretion associated with smoking (p < 0.05). Chest tightness associated with young age (p < 0.001), female gender (p < 0.05) and low FEV1% pred. (p < 0.01). Dyspnea associated with female gender (p < 0.001), high BMI (p < 0.05), low FEV1% pred. (p < 0.0001) and high FEV1/FVC % (p < 0.01). Wheezing associated with young age (p < 0.01), high BMI (p < 0.05), smoking (p < 0.01), low FEV1% pred. (p < 0.0001) and high FEV1/FVC % (p < 0.05). Different respiratory symptoms are associated with distinct demographic, functional and inflammatory features paving the way for personalized therapeutic interventions.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Louis, Gilles ; Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie
Pétré, Benoît ; Université de Liège - ULiège > Département des sciences de la santé publique > Education thérapeutique du patient au service des soins intégrés
Sousa-Pinto, Bernardo; Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Bousquet, Jean; University Hospital Montpellier, Montpellier, France
Van Ganse, Éric; Claude Bernard Université Lyon 1, Lyon, France
J.B. Soriano et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the global burden of Disease Study 2015 Lancet Respir. Med. 2017 5 9 691 706 10.1016/S2213-2600(17)30293-X
C. Nunes A.M. Pereira M. Morais-Almeida Asthma costs and social impact Asthma Res. Pract. 2017 3 1 10.1186/s40733-016-0029-3 28078100 5219738
A. Nocon T. Booth The social impact of asthma Fam. Pract. 1991 8 1 37 41 10.1093/fampra/8.1.37 2044870
S.M. Tarlo C. Lemiere Occupational asthma N Engl. J. Med. 2014 370 7 640 649 10.1056/NEJMra1301758 24521110
J. Bousquet P.J. Bousquet P. Godard J.P. Daures The public health implications of asthma Bull. World Health Organ. 2005 83 7 548 554 10.1590/S0042-96862005000700016 16175830 2626301
K.B. Weiss P.J. Gergen T.A. Hodgson An economic evaluation of asthma in the United States N. Engl. J. Med. 1992 326 13 862 866 10.1056/NEJM199203263261304 1542323
Global Strategy for Asthma Management and Prevention Updated 2020. http://www.ginasthma.org (Accessed 21 August 2020) (2020).
P. Demoly et al. Prevalence of asthma control among adults in France, Germany, Italy, Spain and the UK Eur. Respir. Rev. 2009 18 112 105 112 10.1183/09059180.00001209 20956130
P. Demoly K. Annunziata E. Gubba L. Adamek Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years Eur. Respir. Rev. 2012 21 123 66 74 10.1183/09059180.00008111 22379176 9487469
E.F. Juniper P.M. O’Byrne G.H. Guyatt P.J. Ferrie D.R. King Development and validation of a questionnaire to measure asthma control Eur. Respir. J. 1999 14 4 902 907 10.1034/j.1399-3003.1999.14d29.x 10573240
G. Louis et al. How respiratory symptoms impact asthma-related quality of life in mild asthmatics Respir. Med. 2023 207 107098 10.1016/j.rmed.2022.107098 36584792
Louis, G. et al. Back to the roots of medicine: It’s severe asthma patient-reported symptoms that matter! Pulmonology 29, S92–S95. https://doi.org/10.1016/J.PULMOE.2023.10.005 (2023).
R. Louis F. Schleich P.J. Barnes Corticosteroids: still at the frontline in asthma treatment? Clin. Chest Med. 2012 33 3 531 541 10.1016/J.CCM.2012.05.004 22929100
I.D. Pavord et al. After asthma: redefining airways diseases Lancet 2018 391 10118 350 400 10.1016/S0140-6736(17)30879-6 28911920
J. Domínguez-Ortega E. Phillips-Anglés P. Barranco S. Quirce Cost-effectiveness of asthma therapy: a comprehensive review J. Asthma 2015 52 6 529 537 10.3109/02770903.2014.999283 25539023
A. Wilkinson A. Woodcock The environmental impact of inhalers for asthma: a green challenge and a golden opportunity Br. J. Clin. Pharmacol. 2022 88 7 3016 3022 10.1111/BCP.15135 34719810
A. Gater et al. Assessing asthma symptoms in adolescents and adults: qualitative research supporting development of the asthma daily symptom diary Value Health 2016 19 4 440 450 10.1016/j.jval.2016.01.007 27325336
B.L. Graham et al. Standardization of spirometry 2019 update an official American Thoracic Society and European Respiratory Society technical statement Am. J. Respir. Crit. Care Med. 2019 200 8 E70 E88 10.1164/rccm.201908-1590ST 31613151 6794117
Demarche, S. F. et al. Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre. BMJ Open7(11). https://doi.org/10.1136/bmjopen-2017-018186 (2017).
G. Louis et al. Predictors of change in asthma-related quality of life: a longitudinal real-life study in adult asthmatics Qual. Life Res. 2023 1 3 10.1007/s11136-022-03339-0
G.W. Sun T.L. Shook G.L. Kay Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis J. Clin. Epidemiol. 1996 49 8 907 916 10.1016/0895-4356(96)00025-X 8699212
D.D. Sin R.L. Jones S.F. Paul Man Obesity is a risk factor for dyspnea but not for airflow obstruction Arch. Intern. Med. 2002 162 13 1477 1481 10.1001/ARCHINTE.162.13.1477 12090884
M.J. Kasteleyn et al. Pulmonary function, exhaled nitric oxide and symptoms in asthma patients with obesity: a cross-sectional study Respir. Res. 2017 18 1 205 10.1186/S12931-017-0684-9/TABLES/5 29212496 5719519
J. Zhang et al. Risk factors for chronic cough in adults: a systematic review and meta-analysis Respirology 2022 27 1 36 47 10.1111/RESP.14169 34658107
S. Battaglia A. Benfante M. Spatafora N. Scichilone Asthma in the elderly: a different disease? Breathe 2016 12 1 18 10.1183/20734735.002816 27064568 4818235
G. Tuch et al. Cognitive assessment tools recommended in geriatric oncology guidelines: a rapid review Curr. Oncol. 2021 28 5 3987 10.3390/CURRONCOL28050339 34677257 8534877
T.M.L. Eagan P.S. Bakke G.E. Eide A. Gulsvik Incidence of asthma and respiratory symptoms by sex, age and smoking in a community study Eur. Respir. J. 2002 19 4 599 605 10.1183/09031936.02.00247302 11998986
S.K. Chhabra P. Chhabra Gender differences in perception of dyspnea, assessment of control, and quality of life in asthma J. Asthma 2011 48 6 609 615 10.3109/02770903.2011.587577 21679098
Å. Neuman et al. Dyspnea in relation to symptoms of anxiety and depression: a prospective population study Respir. Med. 2006 100 10 1843 1849 10.1016/J.RMED.2006.01.016 16516455
C.P. McLean A. Asnaani B.T. Litz S.G. Hofmann Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness J. Psychiatr Res. 2011 45 8 1027 1035 10.1016/J.JPSYCHIRES.2011.03.006 21439576 3135672
T. Yamamoto et al. Management reality of female patients with COPD: a multicenter cross-sectional CAP study in Japan Int. J. Chron. Obstruct. Pulmon. Dis. 2024 19 1123 1130 10.2147/COPD.S455397 38803411 11129750
F.N. Schleich et al. Importance of concomitant local and systemic eosinophilia in uncontrolled asthma Eur. Respir. J. 2014 44 1 97 108 10.1183/09031936.00201813 24525441
M. Kraft et al. The role of small airway dysfunction in asthma control and exacerbations: a longitudinal, observational analysis using data from the ATLANTIS study Lancet Respir. Med. 2022 10 7 661 668 10.1016/S2213-2600(21)00536-1 35247313
C.E. Brightling R. Ward K.L. Goh A.J. Wardlaw I.D. Pavord Eosinophilic bronchitis is an important cause of chronic cough Am. J. Respir. Crit. Care Med. 1999 160 2 406 410 10.1164/AJRCCM.160.2.9810100 10430705
F.N. Schleich et al. Exhaled nitric oxide thresholds associated with a sputum eosinophil count ≥ 3% in a cohort of unselected patients with asthma Thorax 2010 65 12 1039 1044 10.1136/thx.2009.124925 20671307
G.M. Verleden L.J. Dupont A.C. Verpeut M.G. Demedts The effect of cigarette smoking on exhaled nitric oxide in mild steroid-naive asthmatics Chest 1999 116 1 59 64 10.1378/CHEST.116.1.59 10424504
M.A. Berry et al. The use of exhaled nitric oxide concentration to identify eosinophilic airway inflammation: an observational study in adults with asthma Clin. Exp. Allergy 2005 35 9 1175 1179 10.1111/J.1365-2222.2005.02314.X 16164444
S. Couillard et al. Derivation of a prototype asthma attack risk scale centred on blood eosinophils and exhaled nitric oxide Thorax 2022 77 2 199 202 10.1136/THORAXJNL-2021-217325 34362839
A. Bjerregaard et al. High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus-induced exacerbations: a prospective cohort study Clin. Exp. Allergy 2017 47 8 1007 10.1111/CEA.12935 28390083 7162064
G. Louis et al. Predictors of asthma-related quality of life in a large cohort of asthmatics: a cross‐sectional study in a secondary care center Clin. Transl Allergy 2021 11 7 e12054 10.1002/clt2.12054 34504679 8414513
F. Schleich et al. Real-world experience with mepolizumab: does it deliver what it has promised? Clin. Exp. Allergy 2020 50 6 687 695 10.1111/CEA.13601 32198794
F. Schleich et al. Benralizumab in severe eosinophilic asthma in real life: confirmed effectiveness and contrasted effect on sputum eosinophilia versus exhaled nitric oxide fraction—PROMISE ERJ Open Res. 2023 9 6 10.1183/23120541.00383-2023
D.J. Jackson et al. Reduction of daily maintenance inhaled corticosteroids in patients with severe eosinophilic asthma treated with benralizumab (SHAMAL): a randomised, multicentre, open-label, phase 4 study Lancet 2024 403 10423 271 281 10.1016/S0140-6736(23)02284-5 38071986
D. Cella L. Wagner Re-personalizing precision medicine: is there a role for patient-reported outcomes? J. Community Support. Oncol. 2015 275 7 10.12788/jcso.0161
D. Alemayehu J.C. Cappelleri Conceptual and analytical considerations toward the use of patient-reported outcomes in personalized medicine Am. Health Drug Benefits 2012 5 5 310 24991329 4046457
S. Díaz-Lobato S. Mayoradas J. Buffels Underuse of spirometry in primary care [4] (multiple letters) Chest 2004 126 5 1712 1713 10.1378/chest.126.5.1712 15539755
W.C. Yu et al. Spirometry is underused in the diagnosis and monitoring of patients with chronic obstructive pulmonary disease (COPD) Int. J. Chron. Obstruct. Pulmon. Dis. 2013 8 389 395 10.2147/COPD.S48659 24009418 3762609
B. Sousa-Pinto et al. Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: a MASK-air study Pulmonology 2023 10.1016/J.PULMOE.2023.07.004 37953211
S.C. Lazarus et al. Mometasone or tiotropium in mild asthma with a low sputum eosinophil level N. Engl. J. Med. 2019 380 21 2009 2019 10.1056/NEJMoa1814917 31112384 6711475
R. Louis et al. European Respiratory Society Guidelines for the diagnosis of asthma in adults Eur. Respir. J. 2022 1 2101585 10.1183/13993003.01585-2021
R. Vermeulen D. Heederik H. Kromhout H.A. Smit Respiratory symptoms and occupation: a cross-sectional study of the general population Environ. Health 2002 1 1 1 7 10.1186/1476-069X-1-5
P. Rogliani R. Laitano J. Ora R. Beasley L. Calzetta Strength of association between comorbidities and asthma: a meta-analysis Eur. Respir. Rev. 2023 32 167 10.1183/16000617.0202-2022
