The Unpleasantness of Perceived Dyspnea Is Processed in the Anterior Insula and Amygdala

Leupoldt, Andreas von; Sommer, Tobias; Kegat, Sarah; Baumann, Hannes; Klose, Hans; Dahme, Bernhard; Büchel, Christian

doi:10.1164/rccm.200712-1821oc

Cited by 269 publications

(235 citation statements)

References 49 publications

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“…We analyzed amygdala functional connectivity, which has been repeatedly associated with increased anxiety and dyspnea perception (53)(54)(55)(56).…”

Section: Resultsmentioning

confidence: 99%

Stress and Bronchodilator Response in Children with Asthma

Brehm

Ramratnam

Tse

et al. 2015

Am J Respir Crit Care Med

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“…We analyzed amygdala functional connectivity, which has been repeatedly associated with increased anxiety and dyspnea perception (53)(54)(55)(56).…”

Section: Resultsmentioning

confidence: 99%

Stress and Bronchodilator Response in Children with Asthma

Brehm

Ramratnam

Tse

et al. 2015

Am J Respir Crit Care Med

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“…Nonetheless, some important conclusions can be drawn from several studies that have produced similar results using different approaches. A core pattern has emerged: dyspnea activates cortico-limbic structures (134)(135)(136)(137)(138)(139)(140)(141)(142)(143) that also subserve interoceptive awareness of homeostatic threats such as thirst and hunger (144)(145)(146)(147)(148) or pain (134,(137)(138)(139)(140)(149)(150)(151)(152). Recent reviews provide a comprehensive analysis of both the power and limitations of these techniques (141,153).…”

Section: Descriptors For Air Hunger Commonly Chosen From Listsmentioning

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

1,500

1,328

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“…Such studies suggest that the insula and operculum mediate dyspnea (Banzett et al, 2000;Evans et al, 2002;McKay et al, 2008;Peiffer, 2008;Peiffer et al, 2008;von Leupoldt et al, 2008), and the cingulate gyrus, the prefrontal cortex, and the supramarginal gyrus integrate emotional and sensory aspects of respiration. The motor cortex is implicated in the volitional control of breathing and speech (Gandevia and Rothwell, 1987;McKay et al, 2003;Brown et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Opioids Depress Cortical Centers Responsible for the Volitional Control of Respiration

Pattinson¹,

Governo²,

MacIntosh³

et al. 2009

Journal of Neuroscience

156

138

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Respiratory depression limits provision of safe opioid analgesia and is the main cause of death in drug addicts. Although opioids are known to inhibit brainstem respiratory activity, their effects on cortical areas that mediate respiration are less well understood. Here, functional magnetic resonance imaging was used to examine how brainstem and cortical activity related to a short breath hold is modulated by the opioid remifentanil. We hypothesized that remifentanil would differentially depress brain areas that mediate sensoryaffective components of respiration over those that mediate volitional motor control. Quantitative measures of cerebral blood flow were used to control for hypercapnia-induced changes in blood oxygen level-dependent (BOLD) signal. Awareness of respiration, reflected by an urge-to-breathe score, was profoundly reduced with remifentanil. Urge to breathe was associated with activity in the bilateral insula, frontal operculum, and secondary somatosensory cortex. Localized remifentanil-induced decreases in breath hold-related activity were observed in the left anterior insula and operculum. We also observed remifentanil-induced decreases in the BOLD response to breath holding in the left dorsolateral prefrontal cortex, anterior cingulate, the cerebellum, and periaqueductal gray, brain areas that mediate task performance. Activity in areas mediating motor control (putamen, motor cortex) and sensory-motor integration (supramarginal gyrus) were unaffected by remifentanil. Breath hold-related activity was observed in the medulla. These findings highlight the importance of higher cortical centers in providing contextual awareness of respiration that leads to appropriate modulation of respiratory control. Opioids have profound effects on the cortical centers that control breathing, which potentiates their actions in the brainstem.

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The Unpleasantness of Perceived Dyspnea Is Processed in the Anterior Insula and Amygdala

Abstract: The results of the present brain imaging study suggest that the unpleasantness of subjectively perceived dyspnea is processed in the right human anterior insula and amygdala.

Cited by 269 publications

References 49 publications

Stress and Bronchodilator Response in Children with Asthma

Stress and Bronchodilator Response in Children with Asthma

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

Opioids Depress Cortical Centers Responsible for the Volitional Control of Respiration

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