Acute Bronchial Asthma

McFadden, E. R.; Kiser, Roger; deGroot, William J.

doi:10.1056/nejm197302012880501

Cited by 423 publications

(36 citation statements)

References 28 publications

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“…WOOLF and SAMAD [13] found a good match between the intensity of breath sounds over the chest-wall with the darkness of the corresponding lung regions in chest radiograms. MCFADDEN et al [14] used auscultation and physiological measurements to follow the progress of resolution of an acute asthma attack. The presence of wheezes was most persistent, and extended well after subjective improvement was reported by the patient.…”

Section: Discussionmentioning

confidence: 99%

Respiratory health screening using pulmonary function tests and lung sound analysis

et al. 1994

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Lung sounds (LS) analysis is a potential source of additional objective, noninvasive and quantitative information on the status of the pulmonary system. We have examined the hypothesis that the addition of lung sounds analysis to spirometry increases the sensitivity of objective population screening, as compared to the use of spirometry alone. Questionnaires, spirometry and lung sounds were obtained in 493 active workers. Lung sounds analysis consisted of the averaged power spectra of breath sounds, measured separately during inspiration and expiration at four standard locations over the trachea and the chest-wall. Of the 493 subjects, 91 had an obstructive lung disease, including 27 with chronic bronchitis identified by a history of prolonged cough and sputum production but with normal spirometry. Twelve additional workers had a restrictive lung disease. Abnormal spirometric results were found in 74 of the patients. Abnormal lung sounds analyses were found in 54 patients, including 14 of the chronic bronchitis cases, so that the overall sensitivity of objective screening tests increased from 71% to 87% by combining the two tests. Thirty three of the subjects considered normal by evaluation of their questionnaire and spirometry had abnormal lung sounds. Of the twenty four who were re-evaluated 12-18 months after the first tests, three had developed a lung or heart disease. We conclude that the combination of spirometry and lung sounds analysis significantly increased the sensitivity of detection of pulmonary diseases by objective tests, and provided an early sign of lung disease that was not detected by spirometry alone.

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Section: Discussionmentioning

confidence: 99%

Respiratory health screening using pulmonary function tests and lung sound analysis

et al. 1994

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“…Although it has long been recognized that the dyspnoea associated with a given level of bronchoconstriction varies widely among subjects [3,4], the determinants of this variability are still poorly understood. It has been suggested that the differences in resting airway calibre could account for the differences in the sensation of dyspnoea associated with bronchoconstriction.…”

Section: A) B)mentioning

confidence: 99%

“…Although it has been reported that the magnitude of dyspnoea perceived is related to the severity of airflow obstruction [1,2], patients with similar degrees of airflow obstruction experience different levels of dyspnoea during either spontaneously occurring asthma [3], or methacholine-induced bronchoconstriction [4]. The reason for such interindividual variability of intensity of dyspnoea is not known.…”

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confidence: 99%

Changes in respiratory drive account for the magnitude of dyspnoea during bronchoconstriction in asthmatics

Bellofiore¹,

Ricciardolo²,

Ciancio³

et al. 1996

Eur Respir J

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To evaluate whether the interindividual differences in dyspnoea perceived by asthmatic subjects for the same level of airway narrowing could depend on different changes in respiratory drive, we assessed the relationship between changes in airway calibre, changes in neuromuscular output, and dyspnoea rate during progressive bronchoconstriction induced by methacholine.We studied 18 asymptomatic asthmatic subjects (aged 18-36 yrs; 11 males and 7 females) with normal lung function. Dyspnoea (Borg scale), mouth occlusion pressure (P0.1), and forced expiratory volume in one second (FEV1) were measured at baseline and after inhalation of aerosols of doubling concentrations of methacholine (MCh).The progressive bronchoconstriction induced by MCh was associated with a progressive increase both of P0.1 and dyspnoea. Dyspnoea score was linearly related either to the fall in FEV1, or to the increase in P0.1. However, the slope values of the relationship between dyspnoea score and the corresponding percent fall in FEV1 showed a large interindividual variability (0.05-0.32; coefficient of variability (CoV) 43%). By contrast, the slope values of the relationship between dyspnoea score and the corresponding percent increase in P0.1 ranged 0.02-0.05 (CoV=14%), indicating a more homogeneous response to dyspnoea for the same change in P0.1. At the highest MCh concentration, the dyspnoea score was linearly related to the corresponding change in P0.1 (r=0.91; p<0.01), but not to the corresponding percentage fall in FEV1 (r=0.28).These results show that the interindividual differences in dyspnoea perceived by asthmatic subjects for the same level of airway narrowing are associated with different changes in respiratory drive during bronchoconstriction.

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“…That FEV 1 and R aw could be used interchangeably was surprising. While a correlation between FEV 1 and the signs (or symptoms) of asthma is found over the range of airway function observed in this study group, the elevated R aw as measured by plethysmography is often not seen in asthma unless patients show signs of severe airway obstruction, a degree of obstruction not seen in most of our patients [23]. …”

Section: Discussionmentioning

confidence: 79%

Dyspnea and Symptom Amplification in Asthma

Lavietes

Ameh²,

Cherniack³

2007

Respiration

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Background: The severity of a patient’s asthma and the intensity with which he describes his dyspnea do not correlate. Objectives: There is an indirect relationship between airway function in asthma and the intensity of dyspnea; this relationship is found only when the measure of a patient’s general tendency to exaggerate the intensity of any somatic symptom is considered simultaneously. Methods: Lung function, including spirometry (forced expiratory volume in 1 s, FEV₁) and plethysmography (airway resistance, R_aw), dyspnea (Borg scale score) and the tendency to exaggerate (the somatosensory amplification scale score, SSAS) have been quantified in 42 stable asthmatic patients. Results: There was no correlation between the Borg score and any spirometric or plethysmographic measure in these subjects. By contrast, there was a moderate correlation between the Borg score and the SSAS (r = 0.36, p = 0.03). However, when FEV₁ or R_aw (abscissa) and Borg scores (ordinate) were converted to residuals, there was a moderate correlation between the residuals and the SSAS score (for FEV₁, r = 0.33 and p = 0.05; for R_aw, r = –0.36 and p = 0.03). Conclusion: A physician may make a reasonable estimate of an asthmatic patient’s lung function from the intensity of his complaint only if he – the physician – considers the patient’s tendency to symptom amplify as well.

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Acute Bronchial Asthma

Cited by 423 publications

References 28 publications

Respiratory health screening using pulmonary function tests and lung sound analysis

Respiratory health screening using pulmonary function tests and lung sound analysis

Changes in respiratory drive account for the magnitude of dyspnoea during bronchoconstriction in asthmatics

Dyspnea and Symptom Amplification in Asthma

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