Distinguishable Types of Dyspnea in Patients with Shortness of Breath

Abstract

Dyspnea frequently accompanies a variety of cardiopulmonary abnormalities. Although dyspnea is often considered a single sensation, alternatively it may encompass multiple sensations that are not well explained by a single physiologic mechanism. To investigate whether breathlessness experienced by patients represents more than one sensation, we studied 53 patients with one of the following seven conditions: pulmonary vascular disease, neuromuscular and chest wall disease, congestive heart failure, pregnancy, interstitial lung disease, asthma, and chronic obstructive pulmonary disease. Patients were asked to choose descriptions of their sensation(s) of breathlessness from a dyspnea questionnaire listing 19 descriptors. Cluster analysis was used to identify natural groupings among the chosen descriptors. We found that patients could distinguish different sensations of breathlessness. In addition, we found an association between certain groups of descriptors and specific conditions producing dyspnea. These findings concur with those in an earlier study in normal volunteers in whom dyspnea was induced by various stimuli. We conclude that different types of dyspnea exist in patients with a variety of cardiopulmonary abnormalities. Furthermore, different mechanisms may mediate these various sensations.

Effect of obesity on breathlessness and airway responsiveness to methacholine in non-asthmatic subjects

“…During the first 60 s period of tidal breathing, subjects indicated the intensity of 'any sensation of uncomfortable breathing' using a modified Borg scale. 23 The Borg scale ranged from 0 to 10, and included descriptors ranging from 'not at all' to 'maximal discomfort'. FEV 1 was measured after the completion of the FOT measurement.…”

Validation of a Swedish Version of the Cancer Dyspnea Scale

“…A structure of the descriptors emerged with four classes, physical sensation, affective/evaluative, low energy and a fourth class which was divided in two subclasses, hyperventilation and speechless. In the study by Simon et al (1990), none of the 48 included patients had lung cancer and in the study by Skevington et al (1997), 15 of a total of 53 patients had cancer of different sites. In the study by Wilcock et al (2002), there were 131 patients with lung cancer, but the descriptions they were presented and requested to choose among were pre-determined and not elaborated among patients with lung cancer.…”

“…Clusters of descriptors of dyspnea and connections to diagnoses were investigated in a study where patients with dyspnea due to various diagnoses were presented a list of descriptors (Simon et al 1990). Fourteen clusters were found and three of them, namely gasping, effort and shallow, were associated with interstitial lung disease, i.e.…”

“…sarcoidosis and idiopathic pulmonary fibrosis. Fifteen of the descriptors in the study by Simon et al (1990) were subsequently used in a study in patients with asthma, COPD, chronic cardiorespiratory disease and lung cancer, classified by different manifestations, such as tumour mass, pleural effusion, collapse, metastases, pleural thickening and lymfangitis carcinomatosis (Wilcock et al 2002). Cluster analysis was performed and connections with the diseases were examined.…”

“…Other descriptions included "not getting enough air" and "feelings of suffocating or tightness". There seems to be agreement that dyspnea concerns both physical and emotional experiences (Skevington et al 1997;O'Driscoll et al 1999) and that dyspnea could be described as being unable to get enough air (O'Driscoll et al 1999;Wilcock et al 2002), to gasp (Simon et al 1990;Skevington et al 1997;Wilcock et al 2002), that breathing requires effort (Simon et al 1990;Wilcock et al 2002) and can be shallow (Simon et al 1990;Wilcock et al 2002). To date, it has not been possible to connect specific descriptors of dyspnea to the lung cancer disease.…”