Mechanisms of dyspnoea and its language in patients with asthma

Laveneziana, Pierantonio

doi:10.1183/09031936.06.00080505

Cited by 64 publications

(64 citation statements)

References 22 publications

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“…In laboratory studies, the relationship between FEV 1 and dyspnea intensity in patients with asthma depends on the particular bronchoprovocation agent used, but descriptions of sensory quality are similar (72). In contrast, patients with asthma are more likely to report tightness and less likely to report increased work or effort during methacholine-evoked bronchoconstriction than when exposed to large external resistive loads (68) or during cardiopulmonary exercise testing (73). Mechanical ventilation can eliminate the sense of excessive respiratory work but does not diminish tightness (74).…”

Section: Qualities Of Dyspneamentioning

confidence: 99%

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

Parshall¹,

Schwartzstein²,

Adams³

et al. 2012

Am J Respir Crit Care Med

1,503

1,328

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Section: Qualities Of Dyspneamentioning

confidence: 99%

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

Parshall¹,

Schwartzstein²,

Adams³

et al. 2012

Am J Respir Crit Care Med

1,503

1,328

View full text Add to dashboard Cite

“…In asthma, DH occurs during bronchoconstriction provoked by methacholine, but DH only occurs in 36-65% of subjects during exercise and, therefore, is not the dominant mechanism of exertional dyspnoea in many individuals [20,21,43]. Those individuals with asthma who develop EIB more frequently develop DH during exercise than asthmatics without EIB [44].…”

Section: Bronchoconstriction and Small Airways Diseasementioning

confidence: 99%

“…Bronchoconstriction and increased mechanical loading due hyperinflation, whether during acute https://doi.org/10.1183/16000617.0015-2017bronchoconstriction or exercise, are associated with different descriptions of dyspnoea [20,30,74]. Furthermore, because the severity of bronchoconstriction affects the quality of dyspnoea [20,39], qualitative descriptors may be as relevant as the magnitude or intensity of dyspnoea [73].…”

Section: Measurement Of Dyspnoea Quality and Intensitymentioning

confidence: 99%

“…with methacholine) may not reflect the experience of dyspnoea during exercise or activities in daily life. Recent evidence suggests that exertional dyspnoea in asthma is qualitatively different from that during methacholine testing [20] and results from bronchoconstriction, mechanical limitations due to dynamic lung hyperinflation [21], ventilatory effort [20] and psychological factors [22]. Importantly, resting measures of lung function, such as forced expiratory volume in 1 s (FEV1), and results of direct bronchoprovocation testing do not predict exertional symptoms or physiological adaptations during exercise in asthma.…”

Section: Introductionmentioning

confidence: 99%

“…Tools for measuring dyspnoea in asthma In asthma, the language used to describe dyspnoea can vary, with different descriptive terms chosen during acute exacerbations compared to during methacholine challenge or exercise [20,73,74]. Bronchoconstriction and increased mechanical loading due hyperinflation, whether during acute https://doi.org/10.1183/16000617.0015-2017bronchoconstriction or exercise, are associated with different descriptions of dyspnoea [20,30,74].…”

Section: Measurement Of Dyspnoea Quality and Intensitymentioning

confidence: 99%

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Mechanisms, measurement and management of exertional dyspnoea in asthma

et al. 2017

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Asthma is a heterogeneous condition, with dyspnoea during exercise affecting individuals to a variable degree. This narrative review explores the mechanisms and measurement of exertional dyspnoea in asthma and summarises the available evidence for the efficacy of various interventions on exertional dyspnoea. Studies on the mechanisms of dyspnoea in asthma have largely utilised direct bronchoprovocation challenges, rather than exercise, which may invoke different physiological mechanisms. Thus, the description of dyspnoea during methacholine challenge can differ from what is experienced during daily activities, including exercise. Dyspnoea perception during exercise is influenced by many interacting variables, such as asthma severity and phenotype, bronchoconstriction, dynamic hyperinflation, respiratory drive and psychological factors. In addition to the intensity of dyspnoea, the qualitative description of dyspnoea may give important clues as to the underlying mechanism and may be an important endpoint for future interventional studies. There is currently little evidence demonstrating whether pharmacological or non-pharmacological interventions specifically improve exertional dyspnoea, which is an important area for future research.

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Physical training for asthma

Carson

Chandratilleke

Picot

et al. 2012

Cochrane Database of Systematic Reviews

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BACKGROUND: People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning as a consequence of inactivity. Some may restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes needs to be considered. OBJECTIVE: To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials. METHODS: Search methods: We searched the Cochrane Airways Group Specialised Register of trials up to January 2013. Selection criteria: We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training or not. Physical training had to be undertaken for at least 20 minutes, two times a week, over a minimum period of four weeks. Data collection and analysis: Two review authors independently assessed eligibility for inclusion and undertook risk of bias assessment for the included studies. MAIN RESULTS: Twenty-one studies (772 participants) were included in this review with two additional 2012 studies identified as 'awaiting classification'. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training showed marked improvement in cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (mean difference (MD) 4.92 mL/kg/min; 95% confidence interval (CI) 3.98 to 5.87; P < 0.00001; 8 studies on 267 participants); however, no statistically significant effects were observed for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), minute ventilation at maximal exercise (VEmax) or peak expiratory flow rate (PEFR). Meta-analysis of four studies detected a statistically significant increase in maximum heart rate, and following a sensitivity analysis and removal of two studies significance was maintained (MD 3.67 bpm; 95% CI 0.90 to 3.44; P = 0.01). Although there were insufficient data to pool results due to diverse reporting tools, there was some evidence to suggest that physical training may have positive effects on healthrelated quality of life, with four of five studies producing a statistically and clinically significant benefit. AUTHORS' CONCLUSIONS: This review demonstrated that physical training showed significant improvement in maximum oxygen uptake, though no effects were observed in other measures of pulmonary function. Physical training was well tolerated among people with asthma in the inc...

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Mechanisms of dyspnoea and its language in patients with asthma

Cited by 64 publications

References 22 publications

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

Mechanisms, measurement and management of exertional dyspnoea in asthma

Physical training for asthma

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