Page 56 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 56
as difficult asthma. Nevertheless as we trav- demonstrate the efficacy of such methods in
erse an era of new biologic asthma therapies, difficult asthma.
severe asthma forum 1: severe asthma - basic and clinical views formal assessment of adherence to conven-
tional asthma therapy and optimisation has Dysfunctional breathing (or breath-
become a mandated prerequisite to access- ing pattern disorder) describes an aberrant
ing biologic therapies in many healthcare sys- breathing pattern which results in breathing
tems such as the UK.29 In such systems, the difficulty that is often accompanied by other
Asthma Specialist Pharmacist often assumes symptoms including palpitations, chest pain,
a central gatekeeping role. light-headedness, paraesthesia and anxiety.
It is commonplace among patients with diffi-
The Asthma Physiotherapist cult asthma, affecting nearly 50% of subjects
in some studies.22,83 Furthermore it may link
An Asthma Specialist Physiotherapist can de- with other detrimental comorbidities in diffi-
liver 3 important roles in the context of a dif- cult asthma including psychological comor-
ficult asthma MDT; chest clearance support, bidities and inducible laryngeal obstruction/
breathing control training and physical exer- vocal cord dysfunction.83,84 An Asthma Spe-
cise training. cialist Physiotherapist is central to addressing
this through breathing retraining techniques.
Asthma is a chronic inflammatory dis- These have shown benefit in the setting of
ease associated with airway epithelial goblet asthma in general, as well as in difficult asth-
cell hyperplasia and consequent potential for ma.85-88 The high burden of dysfunctional
mucus hypersecretion. Some difficult asth- breathing in difficult asthma has potential to
ma patients may show a hypersecretory pat- impose significant workload pressures on an
tern of airways disease with excessive mucus Asthma Specialist Physiotherapist. It is there-
production that is associated with airflow ob- fore encouraging that a digital self-guided
struction and worse asthma control.77 Fur- breathing retraining intervention has shown
thermore, it is increasingly recognised that equivalent beneficial impact compared to
overlap airway disease states may arise with face-to-face Physiotherapist delivered train-
features of dual asthma, COPD and bron- ing in incompletely controlled asthma.89
chiectasis. Much debate has focused on the
concept of an Asthma-COPD-Overlap-Syn- Physical deconditioning and weight gain
drome that may show bronchitic clinical fea- are recognised features of difficult asthma.
tures.78 Bronchiectasis, while complicating Exercise interventions have potential to im-
distinct asthma phenotypes such as allergic prove asthma control, fitness levels and quality
fungal airways disease is estimated to occur in of life.90,91 While the evidence base for Pulmo-
about 1/3 of asthma patients and align with
more severe asthma.79,80,81 Chest clearance nary Rehabilitation in COPD is well estab-
may be a helpful adjunct tool in the setting lished, that remains limited in asthma. How-
of such dual disease phenotypes. An Asth- ever, a recent study demonstrated positive
ma Specialist Physiotherapist may facilitate effects of such an approach in severe asthma
that by teaching patients techniques such as with respect to exercise capacity and symp-
active cycle of breathing approaches centred toms.92 An Asthma Specialist Physiotherapist
on core components of breath control, thorac- would be well placed to support these types of
ic expansion exercises and forced exhalation intervention. However, high perceived barri-
techniques augmented by use of Positive Ex- ers to exercise have been documented in dif-
piratory Pressure (PEP) devices where appro- ficult asthma in conjunction with associated
priate82. There is minimal formal evidence to comorbidities and airways disease status that
can make such management options chal-
lenging.93
erse an era of new biologic asthma therapies, difficult asthma.
severe asthma forum 1: severe asthma - basic and clinical views formal assessment of adherence to conven-
tional asthma therapy and optimisation has Dysfunctional breathing (or breath-
become a mandated prerequisite to access- ing pattern disorder) describes an aberrant
ing biologic therapies in many healthcare sys- breathing pattern which results in breathing
tems such as the UK.29 In such systems, the difficulty that is often accompanied by other
Asthma Specialist Pharmacist often assumes symptoms including palpitations, chest pain,
a central gatekeeping role. light-headedness, paraesthesia and anxiety.
It is commonplace among patients with diffi-
The Asthma Physiotherapist cult asthma, affecting nearly 50% of subjects
in some studies.22,83 Furthermore it may link
An Asthma Specialist Physiotherapist can de- with other detrimental comorbidities in diffi-
liver 3 important roles in the context of a dif- cult asthma including psychological comor-
ficult asthma MDT; chest clearance support, bidities and inducible laryngeal obstruction/
breathing control training and physical exer- vocal cord dysfunction.83,84 An Asthma Spe-
cise training. cialist Physiotherapist is central to addressing
this through breathing retraining techniques.
Asthma is a chronic inflammatory dis- These have shown benefit in the setting of
ease associated with airway epithelial goblet asthma in general, as well as in difficult asth-
cell hyperplasia and consequent potential for ma.85-88 The high burden of dysfunctional
mucus hypersecretion. Some difficult asth- breathing in difficult asthma has potential to
ma patients may show a hypersecretory pat- impose significant workload pressures on an
tern of airways disease with excessive mucus Asthma Specialist Physiotherapist. It is there-
production that is associated with airflow ob- fore encouraging that a digital self-guided
struction and worse asthma control.77 Fur- breathing retraining intervention has shown
thermore, it is increasingly recognised that equivalent beneficial impact compared to
overlap airway disease states may arise with face-to-face Physiotherapist delivered train-
features of dual asthma, COPD and bron- ing in incompletely controlled asthma.89
chiectasis. Much debate has focused on the
concept of an Asthma-COPD-Overlap-Syn- Physical deconditioning and weight gain
drome that may show bronchitic clinical fea- are recognised features of difficult asthma.
tures.78 Bronchiectasis, while complicating Exercise interventions have potential to im-
distinct asthma phenotypes such as allergic prove asthma control, fitness levels and quality
fungal airways disease is estimated to occur in of life.90,91 While the evidence base for Pulmo-
about 1/3 of asthma patients and align with
more severe asthma.79,80,81 Chest clearance nary Rehabilitation in COPD is well estab-
may be a helpful adjunct tool in the setting lished, that remains limited in asthma. How-
of such dual disease phenotypes. An Asth- ever, a recent study demonstrated positive
ma Specialist Physiotherapist may facilitate effects of such an approach in severe asthma
that by teaching patients techniques such as with respect to exercise capacity and symp-
active cycle of breathing approaches centred toms.92 An Asthma Specialist Physiotherapist
on core components of breath control, thorac- would be well placed to support these types of
ic expansion exercises and forced exhalation intervention. However, high perceived barri-
techniques augmented by use of Positive Ex- ers to exercise have been documented in dif-
piratory Pressure (PEP) devices where appro- ficult asthma in conjunction with associated
priate82. There is minimal formal evidence to comorbidities and airways disease status that
can make such management options chal-
lenging.93
