Dyspnea and Symptom Amplification in Asthma

Abstract

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.

The Asthma Control Test, Japanese Version (ACT-J) as a Predictor of Global Initiative for Asthma (GINA) Guideline-Defined Asthma Control: Analysis of a Questionnaire-Based Survey

“…37,38 Somatosensory amplification has been reported to play an important role in patients with asthma. 39 Further investigation, e.g., of race-specific differences in somatosensory amplification, might be required to explain the different cut-off point of the ACT-J score.…”

Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea: a retrospective, nonrandomized controlled study

“…In actuality, patients may also use stronger subjective terms such as “suffocating” to describe these experiences. Once a pattern of expiratory intolerance emerges, we have observed that psychiatric patients in general and PTSD patients in particular with their tendencies toward anxiety sensitivity [50] are highly susceptible to the development of an attention amplification response [51–53], which we speculate magnifies feelings of discomfort and intolerance not unlike somatosensory amplification observed with conditions such as pain in migraine headache [54], susceptibility to drug side-effects [55], and dyspnea in patients with asthma [56].…”

The many faces of somatosensory amplification: The relative contribution of body awareness, symptom labeling, and anxiety

“…In non-psychiatric patients, it was hypothesized that SSA could explain (a) the frequently disproportionate relation between underlying somatic pathology and individual complaints, as well as (b) interindividual differences in symptom reporting (Nakao and Barsky, 2007). Accordingly, empirical evidence has consistently linked SSAS scores to an increased cross-sectional self-report of somatic symptoms, as measured by an array of instruments, in patients with varying medical conditions (Carpenter et al, 2014; Ciccone et al, 2007; Lavietes et al, 2006; Muramatsu et al, 2002; Nakao et al, 2002; Versteeg et al, 2010; Yavuz et al, 2013). Unfortunately, most of these instruments assess symptoms in a retrospective manner, and prospective studies with symptom reports yielded more contradictory results (Aronson et al, 2001; Köteles and Simor, 2013).…”