Work

Prevalence and factors associated with exertional dyspnea in severe asthma: data at inclusion from the French RAMSES cohort

Year: 2026

Type: article

Abstract: OBJECTIVES: To estimate the prevalence of exertional dyspnea in a French cohort of patients with severe asthma and to explore associated factors, with a focus on biologics. METHODS: RAMSES is a French, multicenter, prospective cohort of patients with severe asthma. The primary outcome was exertional dyspnea defined by a modified Medical Research Council (mMRC) score ≥2. Secondary outcomes were mMRC score ≥1 and ≥ 3. To study factors associated with exertional dyspnea, logistic regressions were performed. We hypothesized that the potential effect of biologics on exertional dyspnea relied on improved asthma control, and explored it through a mediation model. RESULTS: A total of 569 participants from the RAMSES cohort were included. Among them, 360 (65.5%) had uncontrolled asthma and 307 (54.1%) were treated with biologics. The prevalence of exertional dyspnea defined by an mMRC score ≥1, ≥2 and ≥ 3 was respectively 73.8 [70.2; 77.4] %, 48.5 [44.4; 52.6] % and 21.6 [18.2; 25] %. The Asthma Control Test (ACT) score was the factor most strongly associated with exertional dyspnea (mMRC score ≥2) (OR = 0.8 [0.74; 0.86] for 1-point increase). Biologic therapy was associated with a lower rate of exertional dyspnea (OR = 0.46 [0.25-0.84]), with the effect largely mediated by an improvement in the ACT score (mediation ratio: 63.4% [5.1-254.2]) CONCLUSION: Our results highlight the high prevalence of dyspnea-related disability in severe asthma, justifying considering this treatable trait as a priority therapeutic goal. Exertional dyspnea was associated with uncontrolled asthma and biologics, primarily through asthma control.

Source: Respiratory Medicine

DOI: 10.1016/j.rmed.2026.109239