Breathlessness and the brain: the role of expectation

Abstract

Purpose of review Breathlessness debilitates countless people with a wide range of common diseases. For some people, the experience of breathlessness is poorly explained by the findings of medical tests. This disparity complicates diagnostic and treatment options and means that disease-modifying treatments do not always have the expected effect upon symptoms. These observations suggest that brain processing of respiratory perceptions may be somewhat independent of disease processes. This may help to explain the dissonance observed in some patients between physical disease markers and the lived experience of breathlessness. Recent findings A body of breathlessness research using functional neuroimaging has identified a relatively consistent set of brain areas that are associated with breathlessness. These areas include the insula, cingulate and sensory cortices, the amygdala and the periaqueductal gray matter. We interpret these findings in the context of new theories of perception that emphasize the importance of distributed brain networks. Within this framework, these perceptual networks function by checking an internal model (a set of expectations) against peripheral sensory inputs, instead of the brain acting as a passive signal transducer. Furthermore, other factors beyond the physiology of breathlessness can influence the system. Summary A person's expectations and mood are major contributors to the function of the brain networks that generate perceptions of breathlessness. Breathlessness, therefore, arises from inferences made by the brain's integration of both expectations and sensory inputs. By better understanding individual differences across these contributing perceptual factors, we will be better poised to develop targeted and individualized treatments for breathlessness that could complement disease-modifying therapies.

Attitude change and increased confidence with management of chronic breathlessness following a health professional training workshop: a survey evaluation

“…A wide range of other factors not encapsulated by the familiarity/confidence items may influence clinician attitudes regarding chronic breathlessness. This is consistent with research using functional neuroimaging showing how a person's prior experience and emotions contribute to the brain networks that shape perception of breathlessness through inference from predictions [53]. Previous clinician experiences and expectations may similarly shape attitudes such as hope and optimism versus helplessness [54].…”

The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise

“…Importantly, a neurophysiological link between dyspnea and f R is evident because they are both regulated, at least to some extent, by the activity of areas of the brain relating to motor control, volition, cognition, and emotion processing [11,21,22,[144][145][146]. On the other hand, dyspnea is a multidimensional sensation composed of three respiratory sensations with somewhat different underlying mechanisms and signs, i.e., respiratory effort, air anger, and chest tightness [145].…”

How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease

“… 25–27 Breathlessness can, therefore, be disproportionate to the level of underlying cardiorespiratory derangement when the individual relies on expectations rather than sensory cues to inform breathlessness predictions and perception. 26 …”

“…24 Breathlessness sensations depend not only on incoming sensory (afferent) information but also on how the individual centrally processes and interprets this information. 25,26 Past experiences, beliefs, and environmental cues collectively inform expectations around breathlessness, and influence the brain's prediction of what is happening in the body. [25][26][27] Breathlessness can, therefore, be disproportionate to the level of underlying cardiorespiratory derangement when the individual relies on expectations rather than sensory cues to inform breathlessness predictions and perception.…”