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Published in: BMC Pulmonary Medicine 1/2021

Open Access 01-12-2021 | Fibromyalgia | Research article

Preliminary development of a questionnaire to measure the extra-pulmonary symptoms of severe asthma

Authors: Giulio de Felice, Michael E. Hyland, Joseph W. Lanario, Yuri Antonacci, Rupert C. Jones, Matthew Masoli

Published in: BMC Pulmonary Medicine | Issue 1/2021

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Abstract

Background

Research into the effects of asthma treatments on the extra-pulmonary symptoms of severe asthma is limited by the absence of a suitable questionnaire. The aim was to create a questionnaire suitable for intervention studies by selecting symptoms that are statistically associated with asthma pathology and therefore may improve when pathology is reduced.

Methods

Patients attending a specialist asthma clinic completed the 65-item General Symptom Questionnaire (GSQ-65), a questionnaire validated for assessing symptoms of people with multiple medically unexplained symptoms. Lung function (FEV1%) and cumulative oral corticosteroids (OCS) calculated from maintenance dose plus exacerbations were obtained from clinic records. Pathology was represented by the two components of a principal component analysis (PCA) of FEV1% and OCS. LASSO regression was used to select symptoms that had high coefficients with these two principal components and occurred frequently in severe asthma.

Results

100 patients provided data. PCA revealed two components, one where FEV1% and OCS were inversely related and another where they were directly related. LASSO regression revealed 39 symptoms with non-zero coefficients on one or more of the two principal components from which 16 symptoms were selected for the GSQ-A on the basis of magnitude of coefficient and frequency. Asthma symptoms measured by asthma control questionnaires were excluded. The GSQ-A correlated 0.33 and − 0.34 (p = 0.001) with the two principal components.

Conclusion

The GSQ-A assesses the frequency of 16 heterogenous non-respiratory symptoms that are associated with asthma severity using the statistical combination of FEV1% and OCS.
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Literature
1.
go back to reference Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O’Brien PC, Low PA. The Autonomic Symptom Profile: a new instrument to assess autonomic symptoms. Neurology. 1999;52:523–8.CrossRef Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O’Brien PC, Low PA. The Autonomic Symptom Profile: a new instrument to assess autonomic symptoms. Neurology. 1999;52:523–8.CrossRef
2.
go back to reference Treister R, O’Neil K, Downs HM, Oaklander AL. Validation of the composite autonomic symptom scale 31 (COMPASS-31) in patients with and without small fiber polyneuropathy. Eur J Neurol. 2015;22:1124–30.CrossRef Treister R, O’Neil K, Downs HM, Oaklander AL. Validation of the composite autonomic symptom scale 31 (COMPASS-31) in patients with and without small fiber polyneuropathy. Eur J Neurol. 2015;22:1124–30.CrossRef
3.
go back to reference Pennebaker JW. The psychology of physical symptoms. Springer Science & Business Media; 2012. Pennebaker JW. The psychology of physical symptoms. Springer Science & Business Media; 2012.
4.
go back to reference Hyland ME, Bacon AM, Lanario JW, Davies AF. Symptom frequency and development of a generic functional disorder symptom scale suitable for use in studies of patients with irritable bowel syndrome, fibromyalgia syndrome or chronic fatigue syndrome. Chronic Dis Transl Med. 2019;5(2):129–38.PubMedPubMedCentral Hyland ME, Bacon AM, Lanario JW, Davies AF. Symptom frequency and development of a generic functional disorder symptom scale suitable for use in studies of patients with irritable bowel syndrome, fibromyalgia syndrome or chronic fatigue syndrome. Chronic Dis Transl Med. 2019;5(2):129–38.PubMedPubMedCentral
5.
go back to reference Hyland ME, Lanario JW, Wei Y, Jones RC, Masoli M. Evidence for similarity in symptoms and mechanism: the extra-pulmonary symptoms of severe asthma and the polysymptomatic presentation of fibromyalgia. Immun Inflamm Dis. 2019;7(4):239–49.CrossRef Hyland ME, Lanario JW, Wei Y, Jones RC, Masoli M. Evidence for similarity in symptoms and mechanism: the extra-pulmonary symptoms of severe asthma and the polysymptomatic presentation of fibromyalgia. Immun Inflamm Dis. 2019;7(4):239–49.CrossRef
7.
go back to reference Martinez-Moragon E, Plaza V, Torres I, Rosado A, Urrutia I, Casas X, Hinojosa B, Blanco-Aparicio M, Delgado J, Quirce S, Sabadell C. Fibromyalgia as a cause of uncontrolled asthma: a case–control multicenter study. Curr Med Res Opin. 2017;33(12):2181–6.CrossRef Martinez-Moragon E, Plaza V, Torres I, Rosado A, Urrutia I, Casas X, Hinojosa B, Blanco-Aparicio M, Delgado J, Quirce S, Sabadell C. Fibromyalgia as a cause of uncontrolled asthma: a case–control multicenter study. Curr Med Res Opin. 2017;33(12):2181–6.CrossRef
8.
go back to reference Panicker R, Arifhodzic N, Al Ahmad M, Ali SA. Association and symptom characteristics of irritable bowel syndrome among bronchial asthma patients in Kuwait. Ann Thorac Med. 2010;5(1):37.CrossRef Panicker R, Arifhodzic N, Al Ahmad M, Ali SA. Association and symptom characteristics of irritable bowel syndrome among bronchial asthma patients in Kuwait. Ann Thorac Med. 2010;5(1):37.CrossRef
9.
go back to reference Shen TC, Lin CL, Wei CC, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Kao CH. Bidirectional association between asthma and irritable bowel syndrome: two population-based retrospective cohort studies. PLoS ONE. 2016;11(4):e0153911.CrossRef Shen TC, Lin CL, Wei CC, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Kao CH. Bidirectional association between asthma and irritable bowel syndrome: two population-based retrospective cohort studies. PLoS ONE. 2016;11(4):e0153911.CrossRef
10.
go back to reference Roussos A, Koursarakos P, Patsopoulos D, Gerogianni I, Philippou N. Increased prevalence of irritable bowel syndrome in patients with bronchial asthma. Respir Med. 2003;97(1):75–9.CrossRef Roussos A, Koursarakos P, Patsopoulos D, Gerogianni I, Philippou N. Increased prevalence of irritable bowel syndrome in patients with bronchial asthma. Respir Med. 2003;97(1):75–9.CrossRef
11.
go back to reference Leggett JJ, Johnston BT, Mills M, Gamble J, Heaney LG. Prevalence of gastroesophageal reflux in difficult asthma. Chest. 2005;127(4):1227–31.PubMed Leggett JJ, Johnston BT, Mills M, Gamble J, Heaney LG. Prevalence of gastroesophageal reflux in difficult asthma. Chest. 2005;127(4):1227–31.PubMed
12.
go back to reference Mahdavinia M, Bishehsari F, Hayat W, Codispoti CD, Sarrafi S, Husain I, Mehta A, Benhammuda M, Tobin MC, Bandi S, LoSavio PS. Prevalence of allergic rhinitis and asthma in patients with chronic rhinosinusitis and gastroesophageal reflux disease. Ann Allergy Asthma Immunol. 2016;117(2):158–62.CrossRef Mahdavinia M, Bishehsari F, Hayat W, Codispoti CD, Sarrafi S, Husain I, Mehta A, Benhammuda M, Tobin MC, Bandi S, LoSavio PS. Prevalence of allergic rhinitis and asthma in patients with chronic rhinosinusitis and gastroesophageal reflux disease. Ann Allergy Asthma Immunol. 2016;117(2):158–62.CrossRef
13.
go back to reference Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, Adcock IM, Bateman ED, Bel EH, Bleecker ER, Boulet LP. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343–73.CrossRef Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, Adcock IM, Bateman ED, Bel EH, Bleecker ER, Boulet LP. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343–73.CrossRef
16.
go back to reference Giuliani A. The application of principal component analysis to drug discovery and biomedical data. Drug Discov Today. 2017;22(7):1069–76.CrossRef Giuliani A. The application of principal component analysis to drug discovery and biomedical data. Drug Discov Today. 2017;22(7):1069–76.CrossRef
17.
go back to reference de Felice G, Giuliani A, Halfon S, Andreassi S, Paoloni G, Orsucci FF. The misleading Dodo Bird verdict. How much of the outcome variance is explained by common and specific factors? New Ideas Psychol. 2019;54:50–5.CrossRef de Felice G, Giuliani A, Halfon S, Andreassi S, Paoloni G, Orsucci FF. The misleading Dodo Bird verdict. How much of the outcome variance is explained by common and specific factors? New Ideas Psychol. 2019;54:50–5.CrossRef
18.
go back to reference James G, Witten D, Hastie T, Tibshirani R. An introduction to statistical learning, vol. 112. New York: Springer; 2013. p. 18.CrossRef James G, Witten D, Hastie T, Tibshirani R. An introduction to statistical learning, vol. 112. New York: Springer; 2013. p. 18.CrossRef
19.
go back to reference Antonacci Y, Astolfi L, Nollo G, Faes L. Information transfer in linear multivariate processes assessed through penalized regression techniques: validation and application to physiological networks. Entropy. 2020;22(7):732.CrossRef Antonacci Y, Astolfi L, Nollo G, Faes L. Information transfer in linear multivariate processes assessed through penalized regression techniques: validation and application to physiological networks. Entropy. 2020;22(7):732.CrossRef
20.
go back to reference Zou H, Hastie T. Regularization and variable selection via the elastic net. J R Stat Soc Ser B (Stat Methodol). 2005;67(2):301–20.CrossRef Zou H, Hastie T. Regularization and variable selection via the elastic net. J R Stat Soc Ser B (Stat Methodol). 2005;67(2):301–20.CrossRef
21.
go back to reference Chong IG, Jun CH. Performance of some variable selection methods when multicollinearity is present. Chemom Intell Lab Syst. 2005;78(1–2):103–12.CrossRef Chong IG, Jun CH. Performance of some variable selection methods when multicollinearity is present. Chemom Intell Lab Syst. 2005;78(1–2):103–12.CrossRef
22.
go back to reference Rish I, Grabarnik G. Sparse modeling: theory, algorithms, and applications. Boca Raton: CRC Press; 2014.CrossRef Rish I, Grabarnik G. Sparse modeling: theory, algorithms, and applications. Boca Raton: CRC Press; 2014.CrossRef
23.
go back to reference Mansfield LE, Hameister HH, Spaudling HS, Smith NJ. The role of the vagus nerve in airway narrowing caused by intraesophageal hydrochloric acid provocation and esophageal distension. Ann Allergy. 1981;47:431–4.PubMed Mansfield LE, Hameister HH, Spaudling HS, Smith NJ. The role of the vagus nerve in airway narrowing caused by intraesophageal hydrochloric acid provocation and esophageal distension. Ann Allergy. 1981;47:431–4.PubMed
24.
go back to reference Herve P, Denjean A, Jian R, Simonneau G, Duroux P. Intraesophageal perfusion of acid increases the bronchomotor response to methacholine and to isocapnic hyperventilation in asthmatic subjects. Am Rev Respir Dis. 1986;134(5):986–9.CrossRef Herve P, Denjean A, Jian R, Simonneau G, Duroux P. Intraesophageal perfusion of acid increases the bronchomotor response to methacholine and to isocapnic hyperventilation in asthmatic subjects. Am Rev Respir Dis. 1986;134(5):986–9.CrossRef
25.
go back to reference Houghton LA, Lee AS, Badri H, DeVault KR, Smith JA. Respiratory disease and the oesophagus: reflux, reflexes and microaspiration. Nat Rev Gastroenterol Hepatol. 2016;13(8):445–60.CrossRef Houghton LA, Lee AS, Badri H, DeVault KR, Smith JA. Respiratory disease and the oesophagus: reflux, reflexes and microaspiration. Nat Rev Gastroenterol Hepatol. 2016;13(8):445–60.CrossRef
26.
go back to reference Coughlan JL, Gibson PG, Henry RL. Medical treatment for reflux oesophagitis does not consistently improve asthma control: a systematic review. Thorax. 2001;56(3):198–204.CrossRef Coughlan JL, Gibson PG, Henry RL. Medical treatment for reflux oesophagitis does not consistently improve asthma control: a systematic review. Thorax. 2001;56(3):198–204.CrossRef
27.
go back to reference Kiljander TO, Harding SM, Field SK, Stein MR, Nelson HS, Ekelund J, Illueca M, Beckman O, Sostek MB. Effects of esomeprazole 40 mg twice daily on asthma: a randomized placebo-controlled trial. Am J Respir Crit Care Med. 2006;173(10):1091–7.CrossRef Kiljander TO, Harding SM, Field SK, Stein MR, Nelson HS, Ekelund J, Illueca M, Beckman O, Sostek MB. Effects of esomeprazole 40 mg twice daily on asthma: a randomized placebo-controlled trial. Am J Respir Crit Care Med. 2006;173(10):1091–7.CrossRef
28.
go back to reference Tay TR, Hew M. Comorbid, “treatable traits” in difficult asthma: current evidence and clinical evaluation. Allergy. 2018;73(7):1369–82.CrossRef Tay TR, Hew M. Comorbid, “treatable traits” in difficult asthma: current evidence and clinical evaluation. Allergy. 2018;73(7):1369–82.CrossRef
29.
go back to reference Boomershine CS. Fibromyalgia: the prototypical central sensitivity syndrome. Curr Rheumatol Rev. 2015;11(2):131–45.CrossRef Boomershine CS. Fibromyalgia: the prototypical central sensitivity syndrome. Curr Rheumatol Rev. 2015;11(2):131–45.CrossRef
30.
go back to reference Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F, Ciapparelli A, Dell Osso L, Bombardieri S. Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol. 2007;25(2):225–30.PubMed Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F, Ciapparelli A, Dell Osso L, Bombardieri S. Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol. 2007;25(2):225–30.PubMed
31.
go back to reference Öhman L, Simrén M. Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions. Nat Rev Gastroenterol Hepatol. 2010;7(3):163–73.CrossRef Öhman L, Simrén M. Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions. Nat Rev Gastroenterol Hepatol. 2010;7(3):163–73.CrossRef
32.
go back to reference Bantulà M, Roca-Ferrer J, Arismendi E, Picado C. Asthma and obesity: two diseases on the rise and bridged by inflammation. J Clin Med. 2021;10(2):169.CrossRef Bantulà M, Roca-Ferrer J, Arismendi E, Picado C. Asthma and obesity: two diseases on the rise and bridged by inflammation. J Clin Med. 2021;10(2):169.CrossRef
33.
go back to reference Silvestri M, et al. High serum levels of tumour necrosis factor-α and interleukin-8 in severe asthma: markers of systemic inflammation? Clin Exp Allergy. 2006;36:1373–81.CrossRef Silvestri M, et al. High serum levels of tumour necrosis factor-α and interleukin-8 in severe asthma: markers of systemic inflammation? Clin Exp Allergy. 2006;36:1373–81.CrossRef
34.
go back to reference Rastogi D, Jung M, Strizich G, Shaw PA, Davis SM, Klein OL, Penedo FJ, Ries AL, Daviglus ML, Moreiras JJ, Salathe MA. Association of systemic inflammation, adiposity, and metabolic dysregulation with asthma burden among Hispanic adults. Respir Med. 2017;1(125):72–81.CrossRef Rastogi D, Jung M, Strizich G, Shaw PA, Davis SM, Klein OL, Penedo FJ, Ries AL, Daviglus ML, Moreiras JJ, Salathe MA. Association of systemic inflammation, adiposity, and metabolic dysregulation with asthma burden among Hispanic adults. Respir Med. 2017;1(125):72–81.CrossRef
35.
go back to reference Melidis C, Denham SL, Hyland ME. A test of the adaptive network explanation of functional disorders using a machine learning analysis of symptoms. Biosystems. 2018;1(165):22–30.CrossRef Melidis C, Denham SL, Hyland ME. A test of the adaptive network explanation of functional disorders using a machine learning analysis of symptoms. Biosystems. 2018;1(165):22–30.CrossRef
Metadata
Title
Preliminary development of a questionnaire to measure the extra-pulmonary symptoms of severe asthma
Authors
Giulio de Felice
Michael E. Hyland
Joseph W. Lanario
Yuri Antonacci
Rupert C. Jones
Matthew Masoli
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2021
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-021-01730-0

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