Symptom Perception and Respiratory Sensation in Asthma

Banzett, Robert B.; Dempsey, Jerome A.; O’Donnell, Denis E.; Wamboldt, Marianne Z.

doi:10.1164/ajrccm.162.3.9909112

Cited by 158 publications

(123 citation statements)

References 28 publications

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“…6 In addition to intensity, dyspnea also encompasses qualitatively distinct sensations, and this symptom perception is the end result of a series of processes including neural activation, integration, and interpretation. 7 As such, it has been shown that healthy adults and patients with breathlessness can be distinguished based on their qualitative descriptors of dyspnea. [8][9][10][11] However, as we reported previously, the quality of respiratory sensation during exercise in otherwise healthy obese men was not different in those with or without DOE.…”

Section: Intensity and Quality Of Respiratory Sensations During Constmentioning

confidence: 99%

“…In patients with asthma, underperception of bronchoconstriction leads to a delay in seeking help, inadequate use of effective medications, and possibly death, whereas overperception of symptoms results in overuse of medical services and potential iatrogenic side effects. 7,18,19 In obesity, overperception of dyspnea during exertion could be an important factor contributing to exercise avoidance, the inability to lose weight, and/or reduced adherence to an exercise program, thus, resulting in more weight gain. However, it is not just the intensity of dyspnea, but also the quality of the sensation that affects the person's willingness to exercise.…”

Section: Intensity and Quality Of Respiratory Sensations During Constmentioning

confidence: 99%

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Respiratory Symptom Perception Differs in Obese Women With Strong or Mild Breathlessness During Constant-Load Exercise

Bernhardt

Babb

2014

Chest

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responses. 1,2 Dyspnea on exertion (DOE) is a very common symptom in obesity. 3 In one large epidemiologic survey, 80% of obese adults reported breathlessness after climbing two fl ights of stairs compared with 16% of nonobese control subjects. 4 Another survey (N 5 16,692) found that 36% of obese adults experienced dyspnea when walking up a hill. 5 Our laboratory D yspnea is defi ned as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity; these sensations originate from interactions among multiple physiologic, psychologic, social, and environmental factors and may induce secondary physiologic and behavioral Background: During constant-load exercise, some otherwise healthy obese women report substantially more dyspnea on exertion (DOE) than do others. The objective of this study was to investigate whether qualitative differences exist between the sensations of dyspnea felt by these women. Methods: Seventy-eight women were categorized based on their ratings of perceived breathlessness (RPBs) (Borg 0-10 scale) after 6 min of 60-W cycling. Thirty-four women rated RPB Ն 4 ( 1 DOE) (34 Ϯ 7 years, 36 Ϯ 5 kg/m 2 BMI), and 22 women rated RPB Յ 2 ( 2 DOE) (32 Ϯ 7 years, 37 Ϯ 4 kg/m 2 BMI). Twenty-two women rated RPB as 3 (RPB 5 3) (34 Ϯ 7 years, 34 Ϯ 4 kg/m 2 BMI) and were grouped separately to allow for a better delineation of the 1 DOE and the 2 DOE groups. After the exercise test, subjects were asked to pick three of 15 statements that best described their respiratory sensations. Results: The 1 DOE and the 2 DOE groups were characterized differentially ( P , .05) by the respiratory clusters "Breathing more" (82% of 2 DOE vs 41% of 1 DOE), "Shallow" (36% vs 6%), and "Heavy" (14% vs 53%). All four descriptors in the cluster "Work/Effort" were chosen more frequently by women in the 1 DOE group than by women in the 2 DOE group. Although relative exercise intensity was higher in the 1 DOE women (75% Ϯ 13% vs 67% Ϯ 10% of oxygen uptake at peak exercise, 41 Ϯ 10 L/min vs 31 Ϯ 8 L/min as % maximal voluntary ventilation, 83% Ϯ 7% vs 76% Ϯ 7% of peak heart rate), none of these variables was signifi cantly associated with RPB. Conclusions: Not only is the intensity of dyspnea signifi cantly different between the 1 DOE and the 2 DOE groups, but so are the self-reported qualitative aspects of their dyspnea. Women in the 1 DOE group reported an increased sensation of the work of breathing relative to women in the 2 DOE group, which may be associated with the elevated RPB.CHEST 2014; 145(2):361-369Abbreviations: DOE 5 dyspnea on exertion; HR 5 heart rate; MVV 5 maximal voluntary ventilation; RPB 5 rating of perceived breathlessness; co 2 5 CO 2 output; e 5 minute ventilation; o 2 5 oxygen uptake; o 2 peak 5 oxygen uptake at peak exercise; V t 5 tidal volume

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Section: Intensity and Quality Of Respiratory Sensations During Constmentioning

confidence: 99%

Section: Intensity and Quality Of Respiratory Sensations During Constmentioning

confidence: 99%

Respiratory Symptom Perception Differs in Obese Women With Strong or Mild Breathlessness During Constant-Load Exercise

Bernhardt

Babb

2014

Chest

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“…Only one study on this issue is available, reporting increased dyspnea ratings when a tourniquet pain was added, whereas tourniquet pain showed a nonsignificant trend to decrease after additional induction of dyspnea (Nishino, Shimoyama, Ide, & Isono, 1999). Because of the various similarities between dyspnea and pain, it was recently suggested to adopt successful methods and strategies from pain research, which is by far more advanced, for investigations into dyspnea (Banzett, Dempsey, O'Donnell, & Wamboldt, 2000;Banzett & Moosavi, 2001). For example, the realization of the multidimensionality of pain, e.g., the difference between sensory and affective aspects of this sensation, has been a key contribution that has led to the development of highly useful pain measurement instruments.…”

mentioning

confidence: 99%

Experimental comparison of dyspnea and pain

Leupoldt¹,

Dahme²

2007

Behav Res

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“…Some authors, moreover, have associated reduced perception of dyspnoea with certain psychological characteristics and psychiatric disorders frequently observed in NFA patients [7,8]. As a result, the affective component of dyspnoea, the component that evokes distress and motivates behaviour, is considered a key aspect in asthmatics' response to exacerbations of their disease [9].…”

mentioning

confidence: 99%

Alexithymia: a relevant psychological variable in near-fatal asthma

Serrano

Plaza²,

Sureda³

et al. 2006

European Respiratory Journal

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Alexithymia is a psychological trait characterised by difficulty in perceiving and expressing emotions and body sensations. Failure to perceive dyspnoea could lead alexithymic asthmatics to underestimate the severity of an asthma exacerbation, and thereby increase the risk of developing a fatal or near-fatal asthma (NFA) attack. The objective of the present study was to determine the prevalence of alexithymia in NFA patients and to analyse their clinical characteristics.Alexithymia was assessed using the Toronto Alexithymia Scale in this multicentric prospective observational study. From 33 Spanish hospitals, 179 NFA patients and 40 non-NFA patients, as a control group, were enrolled.There was a higher proportion of alexithymia in the NFA group than in the non-NFA group (36 versus 13%). Patients with NFA and alexithymia were older than the rest of the NFA group, and had a lower level of education, a higher level of psychiatric morbidity, a higher proportion of severe persistent asthma and a greater number of prior very severe asthma exacerbations (49 versus 27%). Alexithymia, severe persistent asthma and a low level of education were identified as independent variables related to repeated very severe asthma exacerbations.The results show that alexithymia is more frequent in near-fatal asthma patients compared to the rest of asthmatics and is associated with recurrent very severe asthma exacerbations.

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Symptom Perception and Respiratory Sensation in Asthma

Cited by 158 publications

References 28 publications

Respiratory Symptom Perception Differs in Obese Women With Strong or Mild Breathlessness During Constant-Load Exercise

Respiratory Symptom Perception Differs in Obese Women With Strong or Mild Breathlessness During Constant-Load Exercise

Experimental comparison of dyspnea and pain

Alexithymia: a relevant psychological variable in near-fatal asthma

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