Measuring the breathless brain: is real life too noisy?

Abstract

@ERSpublicationsThe first brain study of "real-life" dyspnoea is limited by real-life, but gives us a renewed sense of direction http://ow.ly/T70dpIn our 15-year history of mapping the central neural mechanisms of dyspnoea, we have discovered the complexities of obtaining an objective measure of the sensation and begun discriminating the emotional, cognitive and behavioural responses to it. The task has been complicated by use of a variety of laboratory models that likely produce varying forms of dyspnoea. There are at least three neurally distinct forms (air hunger, effort to breathe and chest tightness [1]) and each form has quantitatively, and maybe qualitatively, different affective components [2]. The stimuli used to gain the first insights into the "breathless brain" were tidal volume restriction [3], hypercapnia [4] and resistance loaded breathing [5]. The most consistent finding in these and subsequent studies [6][7][8] is activation of the insula cortex; a region also involved with the perception of other homeostatic warning signals such as pain, hunger and thirst [9]. The involvement (or not) of other brain regions has varied between studies and likely reflects the variety of stimuli and types of dyspnoea they generated. The most consistent factor throughout these studies is the use of healthy individuals as subjects.

Treating anxious expectations can improve dyspnoea in patients with COPD

“…In this way, patients can learn new, less anxiety-laden associations between these situations/contexts and dyspnoea, and can correct anxious expectations, which ultimately results in reduced dyspnoea and reduced anxiety. However, little-to-nothing is currently known about the neural processing of dyspnoea in patients with COPD, particularly the brain processes that underlie their experience of dyspnoea and anxiety, mutual (learned) associations and anxious expectations, and their potential relationships to treatments such as pulmonary rehabilitation are poorly understood [33]. However, it is in the brain that sensory inputs are integrated with anticipatory processes, anxious expectations, and learned associations in order to finally form the subjective experience of dyspnoea and the potential motivation for avoidance behaviour.…”

“…Of course, intensified future interdisciplinary research efforts are required to establish which treatment strategy in which COPD patient is the most adequate for reducing his or her anxious expectations and, thus, for alleviating the burden of dyspnoea. In this regard, neuroimaging techniques as used by HERIGSTAD et al [34] can certainly help in gaining a better understanding of the brain mechanisms underlying the interrelationships between dyspnoea and anxious expectations in COPD, help developing respective screening tools suited for routine clinical practice, and might even serve as a tool to guide the individualised selection as well as evaluation of respective treatments [2,33].…”