Pathophysiology of Dyspnea

Manning, Harold L.; Schwartzstein, Richard M.

doi:10.1056/nejm199512073332307

Cited by 412 publications

(274 citation statements)

References 44 publications

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“…1,2 Numerous peripheral afferent pathways are involved in the development of breathlessness, including chemoreceptors and mechanoreceptors located in the upper airways, lungs and chest wall. 1,2,6 The present evidence indicates that dyspnea results from multiple and simultaneous sensory inputs, emphasizing a fundamental role for the CNS in the final integration of this complex sensation. However, until recently little was known about the brain regions involved in these processes.…”

Section: Discussionmentioning

confidence: 60%

“…5 Knowledge of dyspnea pathogenesis necessarily involves the understanding of nervous mechanisms involved in the generation, transmission and modulation of respiratory rhythm, both at the peripheral and central nervous system (CNS) levels. 1,2,6 The most important neurotransmitters involved in these phenomena at CNS level appear to be glutamate, gamma-aminobutyric acid (GABA), glycine and serotonin (5-hydroxytryptamine, 5-HT). Indeed, it has been shown that 5-HT has diverse and complex effects on respiratory physiology.…”

Section: Introductionmentioning

confidence: 99%

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Effects of ondansetron on respiratory pattern and sensation of experimentally induced dyspnea

et al. 2002

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CONTEXT: Dyspnea remains a therapeutic challenge, especially in chronic respiratory conditions. Recent studies have shown that the induction of unpleasant dyspnea sensations activates areas in the insular cortex. OBJECTIVE: This study was designed to investigate the potential effects of ondansetron, a potent anti-serotonin agent, on induced dyspnea sensation. TYPE OF STUDY: A randomized double blind study. SETTING: Pulmonary Function Laboratory of Hospital das Clínicas de Ribeirão Preto. PARTICIPANTS: Ten healthy male volunteers (mean age ± standard error = 23.1 ± 0.41 years) without respiratory diseases and showing normal spirometric tests. INTERVENTIONS: Uncomfortable breathing was induced in the volunteers on two different days, via the use of inspiratory resistors (loads of 0, 7, 14 and 21 cm H2O/l/sec) and breathholding, two hours after taking 8 mg of ondansetron (Ond) or placebo (Plac). MAIN MEASUREMENTS: Respiratory discomfort during breathing under loading was evaluated on a 100-mm visual analog scale. The maximum length of time of voluntary apnea was measured in seconds. RESULTS: The mean maximum voluntary apnea time did not differ between the ondansetron and placebo days (Plac = 96 ± 6.6 sec vs. Ond = 100 ± 7.9 sec). Ondansetron did not influence the dyspnea sensation induced by different inspiratory loads (0 cm H2O/l/sec: Ond = 1.4 mm ± 0.44 vs. Plac = 2.1 ± 0.85 mm; 7 cm H2O/l/sec: Ond = 16.6 ± 2.74 mm vs. Plac = 13.7 ± 2.06 mm; 14 cm H2O/l/sec; Ond = 30.5 ± 4.50 mm vs. Plac = 27.1 ± 3.44 mm; 21 cm H2O/l/sec: Ond = 50.3 ± 6.72 mm vs. Plac = 49.4 ± 6.72 mm). Ondansetron led to significant decreases in tidal volume under basal conditions and when breathing under the highest inspiratory loading (0 cm H2O/l/sec: Ond = 0.83 ± 0.26 l vs. Plac = 1.0 ± 0.28 l; 21 cm H2O/l/sec: Ond = 0.86 ± 0.23 l vs. Plac = 1.1 ± 0.22 l) CONCLUSION: The present results suggest that 5-HT3 receptors do not play an important role in the mediation of dyspnea sensations.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Effects of ondansetron on respiratory pattern and sensation of experimentally induced dyspnea

et al. 2002

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“…The sensation of "effort to breathe" arises whenever the central motor command to the respiratory muscles increases. (9,10) This usually occurs in response to an increase in the respiratory muscle workload. Another condition in which this phenomenon occurs is the presence of respiratory muscle weakness due to fatigue, paralysis, or lung hyperinflation.…”

Section: Discussionmentioning

confidence: 99%

“…In studies of methacholine-induced bronchoconstriction in patients with asthma, various respiratory sensations arise in sequence. (10,25) In the presence of initial bronchoconstriction, a sensation of "chest tightness" predominates. As the FEV 1 drops and the mechanical load increases, a sensation of increased "respiratory effort/work" arises.…”

Section: Discussionmentioning

confidence: 99%

“…(5) There is mounting evidence that dyspnea does not involve a single, specific perception; rather, it involves a set of distinct sensations. (6)(7)(8)(9)(10) As has been observed for pain, different terms used by patients to describe the sensation of dyspnea might reflect the underlying pathophysiological mechanisms and therefore be related to the underlying diagnoses. For instance, in a study of healthy volunteers submitted to eight distinct respiratory stimuli, such as carbon dioxide inhalation, breathing against elastic load, and physical exercise, the authors identified clusters of descriptive terms applied to the respiratory sensations; those clusters were associated with the different agents employed.…”

Section: Introductionmentioning

confidence: 99%

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Uso de descritores de dispneia desenvolvidos no Brasil em pacientes com doenças cardiorrespiratórias ou obesidade

Teixeira¹,

Rodrigues-Júnior

Straccia

et al. 2011

J. bras. pneumol.

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Objective: To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. Methods: We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. Results: The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rápido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiração (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiração clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/ inspiração, and falta de ar clusters. Obesity was associated only with the falta de ar cluster. Conclusions: In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.Keywords: Dyspnea; Pulmonary disease, chronic obstructive; Asthma; Heart failure. ResumoObjetivo: Desenvolver um conjunto de termos descritores de dispneia para uso no Brasil. Investigar a utilidade desses descritores em quatro condições distintas que cursam com dispneia. Métodos: Um conjunto de 111 frases descritivas da sensação de falta de ar foi coletado a partir das informações de 67 pacientes e de 10 profissionais da saúde. Tais frases foram analisadas e reduzidas a 15 expressões, em função de sua frequência de citação, similaridade de significados e potencial importância fisiopatológica. O conjunto de expressões foi aplicado a 50 pacientes com asma, 50 com DPOC, 30 com insuficiência cardíaca e 50 com obesidade graus II ou III. Os três melhores termos selecionados pelos pacientes foram estudados por análise de agrupamentos. Também foram investigadas as possíveis associações entre os agrupamentos encontrados e as quatro condições clínicas incluídas. Resultados: O emprego dessa lista de descritores levou a uma solução com sete agrupamentos, denominados sufoco, aperto, rápido, fadiga, abafado, trabalho/inspiração e falta de ar. Houve grande superposição no uso de descritores pelos pacientes com as quatro condições clínicas. A asma mostrou associações ex...

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Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?

Wang

FitzGerald²,

Schulzer³

et al. 2005

JAMA

514

345

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A 70-year-old woman with a history of a previous myocardial infarction and heart failure presents to the emergency department (ED) with a 2-day history of dyspnea at rest, orthopnea, and paroxysmal nocturnal dyspnea. Physical examination reveals an elevated jugular venous pressure, a third heart sound (ventricular filling gallop), bibasilar rales and wheezing, and bilateral lower extremity edema. The chest radiograph reveals cardiomegaly. An electrocardiogram (ECG) shows atrial fibrillation. Case 2A 65-year-old previously healthy man with a 30 pack-year smoking history presents to the ED with a 3-week history of dyspnea on exertion and at rest, associated with productive cough and sputum. Physical examination reveals bilateral rales and wheezing. The chest radiograph reveals pulmonary venous congestion and a pattern of interstitial edema. An ECG shows lateral STsegment depression. Case 3A 60-year-old man with a history of chronic obstructive pulmonary dis-ease (COPD) and previous myocardial infarction presents to the ED with a 2-week history of worsening dyspnea on exertion and cough. Physical examination reveals an elevated jugular venous pressure, bilateral wheezing, and bilateral lower extremity edema. The chest radiograph shows CME available online at www.jama.com

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Pathophysiology of Dyspnea

Cited by 412 publications

References 44 publications

Effects of ondansetron on respiratory pattern and sensation of experimentally induced dyspnea

Effects of ondansetron on respiratory pattern and sensation of experimentally induced dyspnea

Uso de descritores de dispneia desenvolvidos no Brasil em pacientes com doenças cardiorrespiratórias ou obesidade

Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?

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