Psychological implications of respiratory health and disease

Breathing pattern disorder in chronic rhinosinusitis with severe asthma: nasal obstruction and polyps do not increase prevalence

OBJECTIVES

Chronic rhinosinusitis (CRS) with severe asthma are associated with breathing pattern disorder (BPD). Mouth breathing is a sign of breathing pattern disorder, and nose breathing a fundamental part of breathing pattern retraining for BPD. The prevalence of BPD in relation to CRS subtypes and the relationship of nasal obstruction to BPD in CRS and associated severe asthma is unknown. The breathing pattern assessment tool (BPAT) can identify BPD. Our objective was to thus investigate the prevalence of BPD, nasal airflow obstruction and measures of airway disease severity in CRS with (CRSwNP) and without nasal polyps (CRSsNP) in severe asthma.

METHODS

We determined whether CRS status, peak nasal inspiratory flow (PNIF) or polyp disease increased BPD prevalence. Demographic factors, measures of airway function and breathlessness in relation to BPD status and CRS subtypes were also evaluated.

RESULTS

130 Patients were evaluated (n = 69 had BPD). The prevalence of BPD in CRS with severe asthma was 53.1%. There was no difference between BPD occurrence between CRSwNP and CRSsNP. The mean polyp grade and PNIF were not statistically different between the BPD and non-BPD group. The presence of nasal polyps did not increase breathlessness.

CONCLUSIONS

BPD and CRS are commonly co-associated. CRS status and nasal obstruction per se does not increase BPD prevalence.

Management of respiratory complications and rehabilitation in individuals with muscular dystrophies: 1st Consensus Conference report from UILDM - Italian Muscular Dystrophy Association (Milan, January 25-26, 2019)

Respiratory complications are common in the patient with muscular dystrophy. The periodic clinical and instrumental respiratory evaluation is extremely important. Despite the presence in the literature of updated guidelines, patient associations often report lack of knowledge of these pathologies, particularly in peripheral hospitals. The purpose of this work, inspired by the Italian Muscular Dystrophy Association (UILDM) is to improve management of respiratory problems necessary for the management of these patients complex. To this end, the main items that the specialist can meet in the follow-up of these pathologies have been analyzed and discussed, among which the respiratory basal evaluation, the criteria of adaptation to non-invasive ventilation, management of bronchial secretions, situations of respiratory emergency, indications for tracheostomy and the subject of advance directives of treatment (DAT).

Improvement in Lung Function and Patient-Reported Outcomes in Patients with COPD with Comorbid Anxiety and Depression Receiving Nebulized Glycopyrrolate in the GOLDEN 3 and 4 Studies

Background

Anxiety and depression (A/D) are common in patients with chronic obstructive pulmonary disease (COPD) and are often associated with lower adherence to treatment and worse patient-related outcomes. However, studies on the impact of comorbid A/D on responses to bronchodilators are limited.

Methods

This post hoc analysis of pooled data (N=861) from the GOLDEN 3 and 4 studies compared the efficacy and safety of nebulized glycopyrrolate (GLY) 25 µg in patients with moderate-to-very-severe COPD, grouped by self-reported A/D. Changes in forced expiratory volume in 1 second (FEV₁) and health-related quality of life determined by St George’s Respiratory Questionnaire (SGRQ) scores in patients with or without comorbid A/D (A/D [+] or A/D [–]) were examined following 12 weeks of GLY 25 µg twice-daily (BID) or placebo treatment.

Results

A/D (+) patients were predominantly female, younger, included a higher proportion of current smokers, and had higher baseline SGRQ scores compared with the A/D (–) group. At 12 weeks, GLY resulted in placebo-adjusted improvements from baseline in FEV₁ of 46.9 mL (p=0.19; not significant) and 106.7 mL (p<0.0001), in the A/D (+) and A/D (–) groups, respectively. Improvements were observed with GLY compared to placebo in SGRQ scores, regardless of baseline A/D status; the placebo-adjusted least squares mean change from baseline in SGRQ total scores was –3.16 (p>0.05) and –3.34 (p<0.001), for the A/D (+) and A/D (–) groups, respectively. Despite numerical improvements in SGRQ scores with GLY in the A/D (+) group, a higher response to placebo was observed. GLY was generally well tolerated throughout 12 weeks of treatment; incidence of adverse events was higher in the A/D (+) group compared with the A/D (–) group in both treatment arms.

Conclusion

GLY 25 µg BID resulted in numerical improvements in FEV₁, SGRQ total scores and SGRQ responder rates in patients with moderate-to-very-severe COPD, regardless of A/D status at baseline; significant improvements were noted only in the A/D (+) group. The results emphasize the importance of considering underlying comorbidities including A/D when evaluating the efficacy of COPD treatments.

It's hard to talk about breathlessness: a unique insight from respiratory trainees

This paper describes how difficult it can be to discuss the experience of breathlessness with patients, as identified by respiratory trainees in a psychology-led workshop. The reasons why it is considered an essential role for clinicians to facilitate conversations about patients' breathlessness are outlined within the context of the challenges of respiratory care. The benefits for both patient and clinician are described including rapport building, more focused and targeted consultations, and increasing a patient's receptivity to interventions. The value of preparing a patient to actively engage with their breathlessness management is highlighted. As a way to support clinicians to initiate talk about breathlessness, a 'five-step guide to talking' is presented.

Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach

Various breathing training programmes may be helpful for adults with asthma. The main therapeutic aim for many of these programmes is the correction of dysfunctional breathing. Dysfunctional breathing can be viewed practically as a multidimensional entity with the three key dimensions being biochemical, biomechanical and psychophysiological. The objectives of this review are to explore how each of these dimensions might impact on asthma sufferers, to review how various breathing therapy protocols target these dimensions and to determine if there is evidence suggesting how breathing therapy protocols might be optimised. Databases and reference lists of articles were searched for peer-reviewed English language studies that discussed asthma or dysfunctional breathing and various breathing therapies. Biochemical, biomechanical and psychophysiological aspects of dysfunctional breathing can all potentially impact on asthma symptoms and breathing control. There is significant variation in breathing training protocols and the extent to which they evaluate and improve function in these three dimensions. The various dimensions of dysfunctional breathing may be of greater or lesser importance in different cases and the effectiveness of breathing training protocols is likely to be improved when all three dimensions are considered. Outcomes for breathing training for dysfunctional breathing in asthma may be most successful when the three key dimensions of dysfunctional breathing are evaluated at the start of treatment and monitored during treatment. This allows breathing training protocols to be adjusted as appropriate to ensure that treatment is sufficiently comprehensive and intensive to produce measurable improvements where necessary.

Managing respiratory disease

The diverse and evolving role of a psychologist within a respiratory multidisciplinary team (MDT) is described, providing a working model for service provision. The rationale for appointing a psychologist within a respiratory MDT is presented first, citing relevant policy and research and outlining the wider psychosocial impact of respiratory disease. This is followed by an insight into the psychologist's role by highlighting important areas, including key therapy themes and the challenge of patient engagement. The way in which the psychologist supports the collective aims and aspirations of respiratory colleagues to provide a more holistic package of care is illustrated throughout.

Anxiety and depression are related to dyspnea and clinical control but not with thoracoabdominal mechanics in patients with COPD

OBJECTIVE

To investigate the relationship between the presence of symptoms of anxiety or depression with breathing pattern and thoracoabdominal mechanics at rest and during exercise in COPD.

METHODS

Cross-sectional study enrolled 54 patients with COPD ranked according to Hospital Anxiety and Depression Scale (HAD) score and compared to dyspnea, clinical control, hypercapnia, breathing pattern and thoracoabdominal mechanics at rest and during exercise.

RESULTS

Seventeen patients with COPD had no symptoms, 12 had anxiety symptoms, 13 had depressive symptoms and 12 had both symptoms. COPD with depressive symptoms presented greater degree of dyspnea (p<0.01). Poor clinical control was observed in COPD with anxious and/or depressive symptoms (p<0.05). Breathing pattern and thoracoabdominal mechanics were similar among all groups at rest and during exercise.

CONCLUSIONS

COPD with symptoms of depression report more dyspnea. Anxiety and depression are associated with poor clinical control without impact on breathing pattern and thoracoabdominal mechanics in COPD.

Blood pressure and heart rate variability during yoga-based alternate nostril breathing practice and breath awareness

BACKGROUND

Previous research has shown a reduction in blood pressure (BP) immediately after the practice of alternate nostril yoga breathing (ANYB) in normal healthy male volunteers and in hypertensive patients of both sexes. The BP during ANYB has not been recorded.

MATERIAL/METHODS

Participants were 26 male volunteers (group mean age ±SD, 23.8±3.5 years). We assessed (1) heart rate variability, (2) non-invasive arterial BP, and (3) respiration rate, during (a) ANYB and (b) breath awareness (BAW) sessions. Each session was 25 minutes. We performed assessments at 3 time points: Pre (5 minutes), during (15 minutes; for ANYB or BAW) and Post (5 minutes). A naïve-to-yoga control group (n=15 males, mean age ±SD 26.1±4.0 years) were assessed while seated quietly for 25 minutes.

RESULTS

During ANYB there was a significant decrease (repeated measures ANOVA) in systolic BP and respiration rate; while RMSSD (the square root of the mean of the sum of squares of differences between adjacent NN intervals) and NN50 (the number of interval differences of successive normal to normal intervals greater than 50 ms) significantly increased. During BAW respiration rate decreased. In contrast, respiration rate increased during the control state. ANYB and BAW were significantly different (2-factor ANOVA) in RMSSD and respiration rate. BAW and control were different with respect to respiration rate.

CONCLUSIONS

The results suggest that vagal activity increased during and after ANYB, which could have contributed to the decrease in BP and changes in the HRV.

Integrating psychological screening into reviews of patients with COPD

BACKGROUND

People with chronic obstructive pulmonary disease (COPD) have a high prevalence of anxiety and depression, which can have an impact on their symptoms and the way they manage their condition. Intervention that takes psychological distress into account may lead to better outcomes than simple advice-giving.

AIM

To explore the feasibility of integrating psychological screening and intervention into nurse-led reviews of patients with COPD.

METHOD

Nurses were given training on a pathway developed for patients with COPD. This included screening for depression and anxiety and assessing their severity; providing self-management education by means of a motivational approach; and offering pulmonary rehabilitation.

RESULTS

The nurses' level of confidence increased following training. Patients were accepting of the screening process and felt more able and motivated to manage their condition after the intervention. Eleven of the 35 patients that took part in the study period had evidence of anxiety and/or depression. Out of a total of 16 patients eligible for pulmonary rehabilitation, 12 agreed to referral. Of these, three patients were seen by their GP, one was started on antidepressants, and one was referred to the psychology service.

CONCLUSION

Training practice nurses to screen for depression and anxiety, and to offer self-management education using a motivational interviewing approach, increased the reported capability and motivation of patients with COPD to manage their condition. It may also improve the uptake of pulmonary rehabilitation. Use of this pathway does not place a burden on other care providers or greatly increase prescribing costs.

The involvement of glucocorticoids in psychological stress-induced exacerbations of experimental allergic asthma

BACKGROUND

Psychological stress is associated with the aggravation of asthma symptoms. Glucocorticoids (GC), which are stress hormones released upon exposure to stress, have the potential to shift immune responses towards a predominant Th2 response by priming antigen-presenting cells to produce lower levels of IL-12 as well as reducing the development of regulatory T cells. However, the involvement of GC in psychological stress-induced exacerbations of allergic asthma has not yet been clarified.

METHODS

Sensitized mice were exposed to restraint stress followed by forced swimming stress, during which a GC receptor antagonist or a GC synthesis inhibitor was administered, and then antigen was inhaled. Corticosterone levels in the blood were measured in stressed and nonstressed mice. After antigen inhalation, the airway responses to aerosolized methacholine, epithelial mucus secretion and airway inflammation were evaluated, and the IL-13 contents in bronchoalveolar lavage fluid were measured.

RESULTS

The exposure to stress significantly increased corticosterone levels. Allergic airway responses and the increase of IL-13 contents evoked by antigen inhalation were significantly higher in stressed mice than in nonstressed mice. The administration of a GC receptor antagonist and a GC synthesis inhibitor during stress exposure significantly reduced the exacerbation of the airway responses and the increase of IL-13 contents in stressed mice challenged with antigen.

CONCLUSIONS

These results indicate that the increased release of GC upon exposure to stress has a priming effect on the aggravation of allergic airway responses following the exposure, suggesting a pathophysiological role for the neuroendocrine axis in linking psychological stress to asthma exacerbations.

Emotions and neural processing of respiratory sensations investigated with respiratory-related evoked potentials

OBJECTIVE

Patients with respiratory diseases such as asthma and chronic obstructive pulmonary disease frequently experience respiratory sensations, which are often perceived as unpleasant or threatening. However, the accurate perception of respiratory sensations is important for the management and treatment of these diseases. Emotions can substantially influence the perception of respiratory sensations and might affect the course of respiratory diseases, but the underlying neural mechanisms are poorly understood. The respiratory-related evoked potential (RREP) recorded from the electroencephalogram is a noninvasive technique that allowed first studies to examine the impact of emotions on the neural processing of respiratory sensations.

METHODS

In this review, we will briefly introduce the importance of the perception of respiratory sensations and the influence of emotions on respiratory perception. We then provide an overview on the technique of RREP and present a systematic review on recent findings using this technique in the context of emotions.

RESULTS AND CONCLUSIONS

The evidence currently available from studies in healthy individuals suggests that short-lasting emotional states and anxiety affect the later RREP components (N1, P2, P3) related to higher-order neural processing of respiratory sensations, but not the earlier RREP components (Nf, P1) related to first-order sensory processing. We conclude with a discussion of the implications of this work for future research that needs to focus on respiratory patient groups and the associated clinical outcomes.

μ-opioid receptor-mediated alterations of allergen-induced immune responses of bronchial lymph node cells in a murine model of stress asthma

BACKGROUND

Psychological stress has a recognized association with asthma symptoms. Using a murine model of allergic asthma, we recently demonstrated the involvement of μ-opioid receptors (MORs) in the central nervous system in the stress-induced exacerbation of airway inflammation. However, the involvement of MORs on neurons and immunological alterations in the stress asthma model remain unclear.

METHODS

MOR-knockout (MORKO) mice that express MORs only on noradrenergic and adrenergic neurons (MORKO/Tg mice) were produced and characterized for stress responses. Sensitized mice inhaled antigen and were then subjected to restraint stress. After a second antigen inhalation, bronchoalveolar lavage cells were counted. Before the second inhalation, bronchial lymph node (BLN) cells and splenocytes from stressed and non-stressed mice were cultured with antigen, and cytokine levels and the proportions of T cell subsets were measured.

RESULTS

Stress-induced worsening of allergic airway inflammation was observed in wild-type and MORKO/Tg mice but not MORKO mice. In wild-type stressed mice, IFN-γ/IL-4 ratios in cell culture supernatants and the proportion of regulatory T cells in BLN cell populations were significantly lower than those in non-stressed mice. These differences in BLN cells were not observed between the stressed and non-stressed MORKO mice. Restraint stress had no effect on cytokine production or T cell subsets in splenocytes.

CONCLUSIONS

Restraint stress aggravated allergic airway inflammation in association with alterations in local immunity characterized by greater Th2-associated cytokine production and a reduced development of regulatory T cells, mediated by MORs.

Lung function and anxiety in association with dyspnoea: the HUNT study

BACKGROUND

Few studies from the general population have investigated the role of anxiety in reporting dyspnoea. We examined the independent and combined association of lung function and anxiety symptoms with the prevalence of dyspnoea in different situations.

METHODS

The study included 5627 women and 5066 men who participated in the Lung study of the Nord-Trøndelag Health Study second survey in 1995-97. In a cross-sectional design we used logistic regression to calculate adjusted odds ratios (ORs) for reporting dyspnoea associated with levels of percent predicted FEV(1) (ppFEV(1)) and anxiety (Hospital Anxiety and Depression Scale).

RESULTS

Overall, there was a linear inverse association between ppFEV(1) and dyspnoea (all P(trend) < 0.001), and a positive association between anxiety symptoms and dyspnoea (all P(trend) < 0.001). In combined analysis, using people with ppFEV(1) ≥100 without anxiety as reference, the OR (95% confidence interval) for reporting dyspnoea when walking on flat ground was 6.23 (3.45-11.28) in women with ppFEV(1) <80 without anxiety and 15.14 (7.13-32.12) in women with ppFEV(1) <80 with anxiety. The corresponding ORs among men were 5.75 (2.23-14.18) and 15.19 (4.74-48.64), respectively. Similar patterns were seen for dyspnoea when sitting still and woken at night by dyspnoea.

CONCLUSION

Impaired lung function and anxiety symptoms were independently associated with reporting dyspnoea. Within lung function levels, reporting dyspnoea was more common among people with anxiety symptoms than among people without. This suggests that, in addition to its relation to reduced lung function, the subjective experience of breathing discomfort may also influence or be influenced by anxiety.

The impact of anxiety on the neural processing of respiratory sensations

Previous studies demonstrated that anxiety considerably impacts the reported perceptions of respiratory sensations. A novel feature of the current study is exploring the impact of anxiety on the neural processing of respiratory sensations elicited by short inspiratory occlusions during different affective contexts. Using high-density EEG, respiratory-related evoked potentials (RREP) were recorded in 23 low and 23 matched higher anxious individuals when viewing unpleasant or neutral picture series. Low anxious individuals showed the expected pattern of reduced magnitudes of later RREP components P2 and P3 during the unpleasant compared to the neutral affective context (p<0.05 and p<0.01). In contrast, higher anxious individuals showed greater magnitudes of P2 and P3 during the unpleasant compared to the neutral affective context (p's<0.05). Moreover, higher anxiety levels were correlated with greater magnitudes for P2 (r=0.44, p<0.01) and P3 (r=0.54, p<0.001) during the unpleasant relative to the neutral affective context. Earlier components of the RREP (Nf, P1, N1) were not affected by anxiety. This study demonstrates that anxiety affects the later, higher-order neural processing of respiratory sensations, but not its earlier, first-order sensory processing. These findings might represent a neural mechanism that underlies the increased perception of respiratory sensations in anxious individuals.

Dyspnea perception in asthma: role of airways inflammation, age and emotional status

OBJECTIVES

Dyspnea perception in asthmatics differs between subjects. Poor perception is usually associated with increased risk of asthma attack/exacerbation. The advanced stage of the disease and the presence of eosinophilic airways inflammation have been recently recognized as being responsible for poor dyspnea perception. However, few studies are available on this topic.

DESIGN

The aim of this study was to analyse the influence of inflammatory pattern, age and affective status on dyspnea perception in asthmatic subjects.

SUBJECTS AND INTERVENTIONS

Seventy-one consecutive asthmatic patients were recruited and underwent induced sputum, exhaled NO measurement and breath condensate collection. Perception of dyspnea was evaluated as a BORG-VAS/FEV(1) slope before and after the broncho-reversibility test and correlated with the stage of asthma, inflammatory markers, age and depression scale.

RESULTS

Dyspnea perception decreases with the worsening of asthma, with the advance of age and of depression status. Furthermore, airways inflammation plays a key role in the decline of dyspnea perception as proved by the negative correlation observed between inflammatory cells in sputum, exhaled pH and NO and BORG-VAS/FEV(1) slope.

CONCLUSIONS

The results of our study suggested that airways inflammation, depression status, advance age and severity of asthma influence dyspnea perception and suggest a straight control to identify and better manage poor preceptor asthmatics.

The impact of emotion on respiratory-related evoked potentials

Emotion influences the perception of respiratory sensations, although the specific mechanism underlying this modulation is not yet clear. We examined the impact of viewing pleasant, neutral, and unpleasant affective pictures on the respiratory-related evoked potential (RREP) elicited by a short inspiratory occlusion in healthy volunteers. Reduced P3 amplitude of the RREP was found for respiratory probes presented when viewing pleasant or unpleasant series, when compared to those presented during the neutral series. Earlier RREP components, such as Nf, P1, N1, and P2, showed no modulation by emotion. The results suggest that emotion impacts the perception of respiratory sensations by reducing the attentional resources available for processing afferent respiratory sensory signals.

Asthma and lower respiratory symptoms in New York State employees who responded to the World Trade Center disaster

PURPOSE

To investigate whether New York State employees who responded to the World Trade Center disaster were more likely to report asthma or lower respiratory symptoms (LRS; cough, wheeze, chest tightness, shortness of breath) than non-exposed employees, 2 years post-September 11.

METHODS

Participants (578 exposed, 702 non-exposed) completed mailed questionnaires in 2003. A unique exposure assessment method was used; exposure scores were divided at the mean (at/below, above). Poisson regression was used.

RESULTS

Exposure was associated with LRS, but not asthma. Participants with exposure scores at/below the mean had a twofold increased risk of most LRS. Those with scores above the mean had a three to fourfold increased risk. For scores above the mean, the magnitude of effect was consistently higher for smoke exposure.

CONCLUSIONS

Moderately exposed responders may experience health impacts from exposures in later stages of a disaster. Exposure to smoke may have had a greater lower respiratory impact than resuspended dust.

The impact of affective states on the perception of dyspnea in patients with chronic obstructive pulmonary disease

Dyspnea is the cardinal symptom of chronic obstructive pulmonary disease (COPD). Affective states can profoundly impact upon the perception of dyspnea, but little is known about this relationship in patients with COPD. We, therefore, examined the impact of viewing positive versus negative affective picture series on perceived dyspnea during two cycle ergometer exercise tests (CEET) in 30 patients with COPD. Whereas cardiopulmonary measures indicated comparable exercise intensity during both CEETs, parallel viewing of negative affective pictures resulted in increased dyspnea ratings compared to positive affective pictures. Regression analyses showed that only during positive picture viewing increases in the affective unpleasantness of dyspnea, but not in the sensory intensity of dyspnea, during CEETs were predictive of greater dyspnea during everyday activities and reduced health-related quality of life. The results suggest that negative affective states increase perceived dyspnea in patients with COPD and underline the importance of targeting the affect-dyspnea-relationship in this patient group.

[Psychoneuroimmunology: an update]

Psychoneuroimmunology (PNI) is closely associated with the bidirectional pathways between mind/brain and the immune system. PNI research represents a rapidly growing area within psychosomatic research. Recent studies in PNI are based mainly on the immunological concepts of Th1/Th2 dichotomy and inflammation. This review covers human PNI studies dealing with stress-associated changes in cytokine (Th1, Th2) levels in immune-related processes such as wound healing, atopic diseases as well as autoimmune and other inflammatory diseases. It is shown that PNI studies measuring immune activity near the site of the disease (e. g. woundhealing) and dealing with objective stressors show more consistent findings (stress-associated Th1/Th2 shift, stress-associated proinflammatory activation) than those dealing with chronic and complex diseases (e. g., autoimmune disease). This warrants the expansion of the methodological repertoire in future PNI research toward designs allowing for the investigation of complex psychosomatic phenomena.

Distractive Auditory Stimuli Reduce the Unpleasantness of Dyspnea During Exercise in Patients With COPD

BACKGROUND

Dyspnea is the primary symptom limiting exercise in patients with COPD. Recent research has demonstrated that psychological factors can substantially influence the perception of dyspnea, but little is known about the modulation of perceived intensity or unpleasantness of dyspnea by attentional distraction. Therefore, we examined the impact of distractive auditory stimuli on the perception of exercise-induced dyspnea and the affective state in patients with COPD during 6-min walking tests (6MWTs).

METHODS

Twenty patients with mild-to-severe COPD (mean FEV1, 55.9% predicted) underwent two 6MWTs. Under one exercise condition, distractive auditory stimuli were presented with headphones, while the other condition was performed without auditory distraction. Lung function (FEV1), heart rate (HR), pulse oximetric saturation (SpO2), perceived intensity of dyspnea (ie, visual analog scale for perceived intensity of dyspnea [VAS-I]), and perceived unpleasantness of dyspnea (visual analog scale for perceived unpleasantness of dyspnea [VAS-U]) were measured before and after exercise. In addition, the global level of dyspnea (Borg score), positive affectivity (PA), and negative affectivity were assessed after both conditions.

RESULTS

A similar exercise level during both conditions was confirmed by comparable results in FEV1, HR, SpO2, and distances walked. During auditory distraction, Borg scores and increases in VAS-U were smaller, while PA was higher compared to the nondistraction condition (p<0.05). VAS-I did not show differences across conditions.

CONCLUSIONS

Distractive auditory stimuli decrease the global level of exercise-induced dyspnea in patients with COPD by reducing the perceived unpleasantness of dyspnea and lead to an additional increase in PA. Auditory distraction might therefore serve as an intervention for the reduction of dyspnea during exercise in this patient group.

The impact of emotions on the perception of dyspnea in pediatric asthma

Inadequate symptom perception is increasingly recognized as a contributing factor in asthma morbidity. Recent research has shown that psychological factors can influence the perception of asthmatic symptoms such as dyspnea, but little is known, about the impact of emotions on the perception of dyspnea in pediatric asthma. Therefore, we examined the impact of viewing affective film clips of positive, neutral, and negative valence on perceived dyspnea during resistive load breathing in children with stable mild asthma. Perceived dyspnea decreased during the positive film compared to baseline and neutral film whereas the level of respiratory loading and respiratory resistance (R5) remained unchanged across conditions. The results underline the potential impact of psychological factors such as emotions on the perception of dyspnea in children with asthma.

Sensory and Affective Aspects of Dyspnea Contribute Differentially to the Borg Scale’s Measurement of Dyspnea

BACKGROUND

Recent research has shown that distinct dimensions in the perception of dyspnea can be differentiated; however, most studies to date have only used a global rating scale for the measurement of this sensation.

OBJECTIVES

This study examined the different influence of sensory and affective aspects of perceived dyspnea on the commonly used Borg scale, which measures the global perception of dyspnea.

METHODS

Dyspnea was induced in 16 healthy volunteers (mean age 26.2 +/- 6.3 years) by breathing through an inspiratory resistive load (3.57 kPa/l/s) in two experimental conditions (attention and distraction). After each of the two conditions the experienced intensity (i.e., sensory dimension) and unpleasantness (i.e., affective dimension) of dyspnea were rated on separate visual analog scales (VAS), followed by a global rating of dyspnea on the Borg scale. Hierarchical multiple linear regression models were calculated to analyze the predictive validity of VAS ratings of intensity and unpleasantness on the Borg scale ratings.

RESULTS

When subjects attended to their breathing, only VAS intensity scores showed a significant influence on Borg scale ratings (p < 0.05). In contrast, only the VAS unpleasantness scores showed a significant influence on Borg scale ratings (p < 0.05) when subjects were distracted.

CONCLUSIONS

These findings show that sensory and affective aspects of perceived dyspnea differentially influence the global measure of dyspnea as determined by the Borg scale. A differentiation between these aspects in future studies through the use of separate rating scales could yield more detailed information on the perception and report of dyspnea.

The impact of emotions on the sensory and affective dimension of perceived dyspnea

Dyspnea is an impairing symptom in various diseases. Recent research has shown that the perception of dyspnea, like pain, consists of a sensory (intensity) and an affective (unpleasantness) dimension, but little is known about the specific impact of different emotions on these distinct dimensions. We therefore examined the impact of viewing affective picture series of positive, neutral, and negative valence on perceived dyspnea during resistive load breathing in healthy volunteers. Inspiratory time (Ti), breathing frequency (f), and oscillatory resistance (Ros) remained unchanged across conditions. Ratings for unpleasantness of dyspnea increased from positive to neutral to negative series, but ratings for intensity of dyspnea showed no changes. The results suggest that the affective dimension of the perception of dyspnea is particularly vulnerable to emotional influences, irrespective of objective lung function.

Relationship between Symptoms and Quality of Life in a Sarcoidosis Population

BACKGROUND

As sarcoidosis is a multisytemic disorder, patients may suffer from various symptoms. The relationship between frequently reported symptoms and quality of life (QOL) has not yet been studied.

OBJECTIVES

The aim of the present cross-sectional study was to examine the predictive value of the most frequently reported subjective symptoms on QOL after controlling for demographic variables and clinical parameters.

METHODS

A cross-sectional study was conducted at an outpatient pulmonary clinic in Zagreb, Croatia. One hundred and fifty outpatients with sarcoidosis were seen between January 2002 and May 2004. Symptoms were assessed with a symptom inventory questionnaire, and QOL was measured using the World Health Organization Quality of Life Assessment Instrument. Clinical parameters were derived from the patients' medical files. Regression analyses were performed to examine the predictive value of symptoms on QOL.

RESULTS

The four most frequently mentioned symptoms were fatigue, breathlessness, reduced exercise capacity and arthralgia. In various combinations, being female, using corticosteroids and fatigue predicted the QOL domains physical and psychological health as well as level of independence.

CONCLUSIONS

Fatigue appeared to be the most important symptom in predicting various QOL domains after controlling for demographics, disease stage and clinical parameters. Therefore, considering improvement in the patients' QOL, it is recommended to focus not only on objective health parameters, but also on fatigue in the management of sarcoidosis.