A physiological model of patient-reported breathlessness during daily activities in COPD

Abstract

Breathlessness during daily activities has a significant impact on quality of life in chronic obstructive pulmonary disease. Herein, we present a physiological model of patient-reported breathlessness based on the relationship between ventilatory load, respiratory muscle capacity, neural respiratory drive and neuromechanical dissociation during daily activities. This model should facilitate an understanding of the mechanisms driving increased intensity of breathlessness during daily activities and the relief of breathlessness following medical or surgical interventions. The model should also provide a structure on which to base the development of patient-reported outcome instruments to measure the severity of breathlessness during daily activities in chronic obstructive pulmonary disease.

Neural respiratory drive and breathlessness in COPD

“…Our understanding of the psychophysiological mechanisms underlying breathlessness remains incomplete [2,3]. Although it is widely appreciated that an awareness of levels of motor output to the respiratory muscles from the brainstem respiratory centre is important to the sensation of breathlessness 4, the identification of reliable physiological measures of neural respiratory drive (NRD) poses a significant challenge.…”

Activity limitation: a major consequence of dyspnoea in COPD

“…Therefore, understanding the corresponding mechanisms of dyspnoea is of utmost importance. The readers will be greatly helped to reach this objective by the paper by JOLLEY and MOXHAM [1] in this issue of the Review.…”

“…In that sense, the approach proposed by MOXHAM and JOLLEY [1] is of major interest. For instance, in some patients, physiotherapy approaches such as pursed-lips breathing may be of help by reducing exertional dyspnoea and improving physical function [44].…”

“…I n the present issue of the European Respiratory Review, JOLLEY and MOXHAM [1] present ''A physiological model of patient-reported breathlessness during daily activities in COPD [chronic obstructive pulmonary disease]''. The purpose of their interesting approach is to explain why a given patient may experience breathlessness in some particular situations of his/her daily life, based on the various possible mechanisms of dyspnoea in COPD.…”

Development of a Barthel index based on dyspnea for patients with respiratory diseases

“…1 Relief from dyspnea during activities of daily living (ADLs) represents the major goal of respiratory rehabilitation 2 and its quantification through specific instruments (scales) is essential to define disability level and postrehabilitation improvement. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Approximately 40% of patients with chronic obstructive pulmonary disease (COPD) report a degree of disability and 68% lose at least one relevant function in daily life. 18 In routine clinical practice, various scales measuring ADLs are used to evaluate patients' motor and functional autonomy/disability, the most widely used being the Barthel Index (BI).…”