Chronic lung diseases and the perception of breathlessness: a clinical perspective

Burdon, Jonathan; Pain, M. C. F.; Rubinfeld, Abe R.; Nana, Arth

doi:10.1183/09031936.94.07071342

Cited by 40 publications

(20 citation statements)

References 55 publications

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“…Downgrading of the sensory experience is consistent with the phenomenon of temporal adaptation. It is reasonable to believe that such downgrading takes a significant length of time, but this has not yet been defined [30]. This could explain the difference between the results of Burdon et al [1] and the present ones.…”

Section: Discussioncontrasting

confidence: 77%

Perception of bronchoconstriction and bronchial hyper-responsiveness in asthma

et al. 2000

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The inter-relationship between the perception of bronchoconstriction, bronchial hyper-responsiveness and temporal adaptation in asthma is still a matter of debate. In a total of 52 stable asthmatic patients, 32 without airway obstruction ¿forced expiratory volume in 1 s (FEV(1))/vital capacity (VC) 84.1% (S.D. 7.9%), and 20 with airway obstruction [FEV(1)/VC 60% (4%)], we assessed the perception of bronchoconstriction during methacholine inhalation by using: (i) the slope and intercept of the Borg and VAS (Visual Analog Scale) scores against the decrease in FEV(1), expressed as a percentage of the predicted value; and (ii) the Borg and VAS scores at a 20% decrease in FEV(1) from the lowest post-saline level (PB(20)). Bronchial hyper-responsiveness was assessed as the provocative concentration of methacholine causing a 20% fall in FEV(1) (PC(20)FEV(1)). The reduction in FEV(1) was significantly related to the Borg and VAS scores, with values for the group mean slope and intercept of this relationship of 0.13 (S.D. 0.08) and -1.1 (3.02) for Borg, and 1.5 (1.19) and -12.01 (35) for VAS. PB(20) was 3 (1.75) with Borg scores and 34.6 (20.5) with VAS scores. Compared with the subgroup without airway obstruction, the obstructed subgroup exhibited similar slopes, but lower Borg and VAS intercepts. For similar decreases in FEV(1) (5-20% decreases from the lowest post-saline values), the Borg and VAS scores were lower in the non-obstructed than in the obstructed subgroup. PC(20)FEV(1) was significantly related to both Borg PB(20) and VAS PB(20) when considering all patients. When assessing the subgroups, PC(20)FEV(1) was related to Borg PB(20) and VAS PB(20) in the non-obstructed subjects, but not in the obstructed subjects. In neither subgroup was the log of the cumulative dose related to the Borg and VAS scores at the end of the test. We conclude that, unlike in previous studies, the ability to perceive acute bronchoconstriction may be reduced as background airflow obstruction increases in asthma. Bronchial hyper-responsiveness did not play a major role in perceived breathlessness in patients without airway obstruction, and even less of a role in patients with obstruction. The cumulative dose of agonist did not appear to influence the perception of bronchoconstriction.

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Section: Discussioncontrasting

confidence: 77%

Perception of bronchoconstriction and bronchial hyper-responsiveness in asthma

et al. 2000

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“…The decrease in lung function in patients with COPD (and to some extent in patients with asthma) is gradual during their lives. Due to patients adapting to this gradual decrease [7][8][9] or due to the doctor not being aware of the symptoms and risk factors, COPD is often diagnosed late in its course [4,7]. In the developing world, lack of resources, diagnostic facilities and physicians working on a community level, often constitute an even greater obstacle in establishing an early diagnosis.…”

mentioning

confidence: 99%

Detection of asthma and chronic obstructive pulmonary disease in primary care

Schayck¹,

Chavannes²

2003

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) and asthma are major health problems, the number of patients with these diseases is still rising and only 25–50% of these patients are known to their doctors.Lung function gradually decreases in COPD and asthmatic patients during their lives. Due to adaptation of the patients or due to the doctor being unaware of the symptoms, COPD is often diagnosed late in its course and when finally diagnosed, lung function is often relatively poor. Underdiagnosis and consequently undertreatment might play an important role in the increase in morbidity and mortality as a result of COPD and asthma. Early detection and treatment might improve the long-term prognosis of these patients and this secondary prevention may also prevent irreversible loss of function.The identification of patients is useless if no effective preventive measures are available. In asthma, inhaled corticosteroids have been shown to have distinct effects on the progression of the disease. However, in COPD inhaled corticosteroids have only been shown to have some effects and the long-term effects on lung function have been disappointing. At present, the most effective treatment available for COPD is the cessation of smoking. It appears that a smoker at risk of developing COPD is more motivated to stop smoking than someone who is not at risk and this may help a physician in encouraging an attempt to quit.General practitioners appear to be already using this knowledge, as they seem more likely to advise smokers to quit smoking if they perceive their problems to be smoking related.

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“…This perception is modulated by past experience: the brain seems to memorize the level and the characteristics/quality of dyspnea induced by a previous activity, effort, or situation, to set the expectations accordingly, and ultimately compare the current input with that in the past [52,53]. It has been shown that, following conditioning, even harmless cues per se may trigger dyspnea with varying susceptibilities in different groups of individuals [54].…”

Section: Neurophysiologymentioning

confidence: 98%