Autonomic modulations in patients with bronchial asthma based on short-term heart rate variability

Mohamed F Lutfi, Mohamed F Lutfi

Abstract

Background: Although enhanced cholinergic activity of asthmatics has been established early on, little heart rate variability (HRV) studies were done on asthma patients. Previous HRV studies were based on 24-hour recordings and therefore have not considered the extremely labile activity of bronchial asthma.

Objective: To evaluate the pattern of autonomic modulations in asthmatic patients based on short-term HRV studies.

Materials and methods: The study involved 100 asthmatic patients with an age range of 20-40 years. Asthma activity was evaluated over the last month prior to patients' assessment using asthma control test (ACT). Allflow Spirometer was used for assessing pulmonary function, while Biocom 3000 electrocardiography recorder was used for studying 5-minute HRV. Data was analyzed using the Statistical Package for the Social Sciences Software. Heart rate and asthma medications were introduced as a covariate when studied variables were screened for significant correlation between measurements of asthma severity and heart rate variability indices using partial correlations.

Results: The level of asthma control correlate positively with both normalized low frequency (LF Norm) and the ratio of low frequency/high frequency (LF/HF) (CC = 0.302, 0.212 and P = 0.002, 0.036, respectively) and negatively with HF Norm (CC = -0.317, P = 0.001). Duration of asthma correlates positively with normalized high frequency (HF Norm) (CC = 0.235, P = 0.020) and negatively with LF Norm (CC = -0.250, P = 0.013).

Conclusion: Poor asthma control is associated with lower HRV, depressed sympathetic and enhanced parasympathetic modulations especially in those with longer asthma duration.

Keywords: Asthma control test; asthma; autonomic; heart rate variability.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
LF Norm and HF Norm of studied asthmatic patients
Figure 2
Figure 2
LF/HF Norm of studied asthmatic patients

References

    1. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability standards of measurement, physiological interpretation and clinical use. Circulation. 1996;93:65–1043.
    1. Lutfi MF. Review article: Heart rate variability. Sud JMS. 2011;6:43–50.
    1. Vanderlei LC, Pastre CM, Hoshi RA, Carvalho TD, Godoy MF. Basic notions of heart rate variability and its clinical applicability. Rev Bras Cir Cardiovasc. 2009;24:205–17.
    1. Ori Z, Monir G, Weiss J, Sayhouni X, Singer DH. Heart rate variability. Frequency domain analysis. Cardiol Clin. 1992;10:499–537.
    1. Moak JP, Goldstein DS, Eldadah BA, Saleem A, Holmes C, Pechnik S, et al. Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Cleve Clin J Med. 2009;76(Suppl 2):S51–9.
    1. Simonsson BG, Jacobs FM, Nadel JA. Role of autonomic nervous system and the cough reflex in the increased responsiveness of airways in patients with obstructive airway disease. J Clin Invest. 1967;46:1812–8.
    1. Molfino N, Slutsky A, Julia-Serda G, Hoffstein V, Szalai J, Chapman K, et al. Assessment of airway tone in asthma. Am Rev Respir Dis. 1993;148:1238–43.
    1. Du J, He J, Wang Y. A study of heart rate variability in asthma. Zhonghua Jie He He Hu Xi Za Zhi. 2001;24:744–5.
    1. Garrard C, Seidle A, McKibben A, McAlpine L, Gordon D. Spectral analysis of heart rate variability in bronchial asthma. Clin Auton Res. 1992;2:105–11.
    1. Kazuma N, Otsuka K, Matsuoka I, Murata M. Heart rate variability during 24 hours in asthmatic children. Chronobiol Int. 1997;14:597–606.
    1. Kazuma N, Shirase E, Matsuoka I, Hirakawa N, Otani T, Honjyo M, et al. Circadian rhythm of parasympathetic nervous function in asthmatic children. Arerugi. 1998;47:1248–51.
    1. Toungoussova O, Foschino B, Esposito L, Carpagnano G, Salerno F, Dal Negro R, et al. Brittle asthma. Monaldi Arch Chest Dis. 2007;67:102–5.
    1. Graziani E, Petroianni A, Terzano C. Brittle asthma. Eur Rev Med Pharmacol Sci. 2004;8:135–8.
    1. Hirsch J, Bishop B. Respiratory sinus arrhythmia in humans: How breathing pattern modulates heart rate. Am J Physiol. 1981;10:H620–9.
    1. Schroeder E, Liao D, Chambless L, Prineas R, Evans G, Heiss G. Hypertension, blood pressure, and heart rate variability. The Atherosclerosis Risk in Communities (ARIC) Study. Hypertension. 2003;42:1106–11.
    1. Lucini D, Mela G, Malliani A, Pagani M. Impairment in cardiac autonomic regulation preceding arterial hypertension in humans. Circulation. 2002;106:2673–9.
    1. Fagard R, Pardaens K, Staessen J. Relationships of heart rate and heart rate variability with conventional and ambulatory blood pressure in the population. J Hypertens. 2001;19:389–97.
    1. Min K, Min J, Paek D, Cho S, Son M. Is 5-minute heart rate variability a useful measure for monitoring the autonomic nervous system of workers? Int Heart J. 2008;49:175–81.
    1. Desok K, Yunhwan S, Sook-hyun K, Jung S. Short term analysis of long term patterns of heart rate variability in subjects under mental stress. BioMed Eng Inform. 2008;2:487–91.
    1. Bigger J, Fleiss J, Rolnitzky L, Steinman R. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation. 1993;88:927–34.
    1. Eleftherios Z, Oikonomidou E, Kainis E, Kokkala M, Petroheilou K, Gaga M. Review: Control of asthma. Ther Adv Respir Dis. 2008;2:141–8.
    1. Kennedy J, Jones S. Asthma Control Test: Reliability, validity, and responsiveness in patients not previously followed by asthma specialists. Pediatrics. 2007;120:S132–33.
    1. Schatz M, Mosen D, Kosinsk D, Marcus P, Murray J, Nathan R, et al. Validity of the Asthma Control Test™ Completed at Home. Am J Manag Care. 2007;13:661–7.
    1. Vollmer W, Markson L, O’Connor E, Sanocki L, Fitterman L, Berger M. Association of asthma control with health care utilization and quality of life. Am J Respir Crit Care Med. 1999;160:1647–52.
    1. Juniper E, O’Byrne P, Guyatt G, Ferrie P, King D. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999;14:902–7.
    1. Miller M, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.
    1. Vignola A, Chanez P, Campbell A, Riccobono L, Scichilone N, Spatafora M, et al. Airway inflammation in mild intermittent and in persistent asthma. Am J Respir Crit Care Med. 1998;157:403–9.
    1. Green F, Butt J, James A, Carroll N. Abnormalities of the bronchial arteries in asthma. Chest. 2006;130:1025–33.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner