‘Air hunger’ from increased PCO2 persists after complete neuromuscular block in humans

Banzett, Robert B.; Lansing, Robert; Brown, Robert H.; Topulos, George P.; Yager, Dorne R.; Steele, Susan M.; Londoño, Beatriz; Loring, Stephen H.; Reid, Michael B.; Adams, Lewis; Nations, Christopher S.

doi:10.1016/0034-5687(90)90065-7

Cited by 201 publications

(116 citation statements)

References 15 publications

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“…Other investigators have replicated this effect by corseting the chest during exercise (82,83), or limiting the volume available at the airway opening (46,81,84), giving rise to sensations of air hunger (82), inspiratory difficulty, or unsatisfied inspiration (83). Similar sensations have been reported during symptom-limited exercise testing by patients with restrictive (32) or obstructive (31,32,65) lung disease (in particular, when dynamic hyperinflation restricts inspiratory capacity among the latter) (31,52,53,65,66,79,(85)(86)(87)(88).…”

Section: Qualities Of Dyspneamentioning

confidence: 78%

“…From the 1960s through the 1980s, it was widely believed that the sense of respiratory effort/work was responsible for all dyspnea (e.g., see Reference 45), an idea that has been disproved (46)(47)(48). Nonetheless, an uncomfortable sense of respiratory "work" and "effort" is commonly reported by patients with conditions such as asthma, chronic obstructive pulmonary disease (COPD), and diseases that impair respiratory muscle performance (27,31,32).…”

Section: Qualities Of Dyspneamentioning

confidence: 99%

“…It has been reported in quadriplegic patients in response to increased partial pressure of carbon dioxide (PCO 2 ) (47), decreased tidal volume (100), or methacholine challenge (66), as well as in response to increased PCO 2 in normal subjects undergoing neuromuscular blockade (46,48). In addition, patients with asthma, COPD, interstitial lung disease, and idiopathic hyperventilation are significantly more likely than healthy control subjects to report perceptions of air hunger when recalling perceptions of breathing at the end of exercise (113).…”

Section: Qualities Of Dyspneamentioning

confidence: 99%

See 2 more Smart Citations

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

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1,472

1,328

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Section: Qualities Of Dyspneamentioning

confidence: 78%

Section: Qualities Of Dyspneamentioning

confidence: 99%

Section: Qualities Of Dyspneamentioning

confidence: 99%

See 1 more Smart Citation

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

Self Cite

1,472

1,328

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“…Using a hand-held controller, the subject selected one of seven LEDs, each corresponding to an intensity of discomfort (see below) in response to a rating request. This system for rating respiratory discomfort has been described previously (Banzett et al 1990 Following each of the sessions, subjects were debriefed using a standard questionnaire to further evaluate their subjective experiences.…”

Section: Subjectsmentioning

confidence: 99%

Ventilatory relief of the sensation of the urge to breathe in humans: are pulmonary receptors important?

Harty

Mummery

Adams

et al. 1996

The Journal of Physiology

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1. The sensation of an urge to breathe (air hunger) associated with a fixed level of hypercapnia is reduced when ventilation increases. The aim of the present study was to investigate whether pulmonary receptors are important in this mechanism. 2. Five heart-lung transplant (HLT) subjects and five control subjects were studied during periods of mechanical and spontaneous ventilation. End-tidal PCO, (PET,Co2) was increased by altering the level of inspired C02. Throughout, subjects rated sensations of air hunger. Air hunger was also monitored during and immediately following maximal periods of breath-holding. 3. When the level of mechanical ventilation was fixed, both groups experienced a high degree of air hunger when PET,co, was increased by about 10 mmHg. At similar levels of hypercapnia, both groups derived relief from approximately twofold increases in tidal volume, although relief was slightly less effective in HLT subjects. This was reversible, with decreases in the level of mechanical ventilation rapidly giving rise to increased ratings of air hunger. 4. With breath-holding, all subjects obtained some respiratory relief within 2 s of the break point; there was no significant difference between the groups. 5. The results suggest that sensations of an urge to breathe induced by hypercapnia can be modulated by changes in tidal volume in the presumed absence of afferent information from the lung.

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“…The sense of air hunger appears to arise from an increased brain stem 'drive' to breathe (35,36,52,53). Even patients with normal lung function and without signs of hypercapnia and hypoxia may suffer from air hunger (51,(54)(55)(56)(57).…”

Section: Dyspneamentioning

confidence: 99%

Diagnosis of asthma – a new approach

Löwhagen

2012

Allergy

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Current definition of asthma involves four cornerstones: inflammation, hyperresponsiveness, bronchoconstriction, and symptoms. In research, the symptoms have had the slightest attention. According to international guidelines, the asthma symptoms are episodic breathlessness, wheeze, cough, tightness of the chest, and shortness of breath. As there are several symptoms, a primary question is how they are related to bronchoconstriction, the main clinical feature of asthma. Symptoms and lung function tests are regularly used for the evaluation of clinical health status and effect of treatment. However, there is no or poor correlation between these two variables, which means that they represent different mechanisms. Reduced lung function, such as a low FEV 1 , represents bronchial constriction, what do the symptoms represent? Some symptoms such as breathlessness and shortness of breath seem not to be evidence-based asthma symptoms. Focusing on bronchial obstruction is important in view of the potential risk of asthma attacks, but nonobstructive symptoms occur frequently and may also cause severe discomfort and poor quality of life. Interpreting all symptoms as signs of bronchoconstriction (asthma) may lead to misinterpretation when assessing health status and effect of treatment. Although a 'soft' variable, the strength of symptoms is that they are representing various mechanisms. The physiological preconditions for control and defense of respiration must be considered in the diagnostic process, regardless of inflammation, allergy, psychology, or other etiological factors. Based on studies on dyspnea in cardiopulmonary diseases, including asthma and asthma-like disorders, there seems to be a continuous spectrum of symptoms and mechanisms integrated in a single asthma syndrome.

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‘Air hunger’ from increased PCO2 persists after complete neuromuscular block in humans

Cited by 201 publications

References 15 publications

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

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

Ventilatory relief of the sensation of the urge to breathe in humans: are pulmonary receptors important?

Diagnosis of asthma – a new approach

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