Chemosensitivity and Perception of Dyspnea in Patients with a History of Near-Fatal Asthma

Kikuchi, Yoshihiro; Okabe, Shinichi; Tamura, Gen; Hida, Wataru; Homma, Masaaki; Shirato, Kunio; Takishima, Tamotsu

doi:10.1056/nejm199405123301901

Cited by 464 publications

(276 citation statements)

References 27 publications

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“…Although it is possible that the degree of physiological deficit in some of these patients may not have been clinically significant enough for them all to have symptoms at rest, not all patients with asthma who have deficits in lung function appreciate the degree to which their asthma contributes to symptoms of airflow limitation until they are given bronchodilators, with resultant improvement in lung function and symptoms. [1][2][3][4] In our study, active bronchodilator resulted in a substantial improvement in lung function as compared with no treatment control (20.1% vs.…”

Section: Irccs Burlo Garofolo University Trieste Italysupporting

confidence: 44%

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Placebo and Other Interventions in Asthma

Straumann¹,

Safroneeva²,

Schoepfer³

2011

N Engl J Med

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Section: Irccs Burlo Garofolo University Trieste Italysupporting

confidence: 44%

“…2 Paradoxical activation of the RAF-MEK-ERK pathway by CRAF activation has been suggested by in vitro studies. 3 Unlike vemurafenib-induced squamous-cell carcinomas, early changes in melanocytic lesions are difficult to identify and require examination with the use of dermoscopy.…”

Section: To the Editormentioning

confidence: 99%

Placebo and Other Interventions in Asthma

Straumann¹,

Safroneeva²,

Schoepfer³

2011

N Engl J Med

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“…The vastly improved survival chances that administration of oxygen conferred showed that death resulted from asphyxiation, which was consistent with the aberrant accumulation of lung parenchymal inflammatory cells observed in MMP2 −/− mice. Asphyxiation is the major cause of mortality in human asthma 40,41 , which highlights the relevance of this asthma model and the critical role played by MMPs in clearing inflammatory cells and preventing death. Because we measured similar AHR in allergen-challenged MMP2 −/− and wild-type mice, differences in smooth muscle or other contractile cell function cannot explain the increased mortality observed.…”

Section: Discussionmentioning

confidence: 91%

Decreased allergic lung inflammatory cell egression and increased susceptibility to asphyxiation in MMP2-deficiency

et al. 2002

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Clearance of recruited immune cells is necessary to resolve inflammatory reactions. We show here that matrix metalloproteinase 2 (MMP2), as part of an interleukin 13 (IL-13)-dependent regulatory loop, dampens inflammation by promoting the egress of inflammatory cells into the airway lumen. MMP2 −/− mice showed a robust asthma phenotype and increased susceptibility to asphyxiation induced by allergens. However, whereas the lack of MMP2 reduced the influx of cells into bronchoalveolar lavage (BAL), numerous inflammatory cells accumulated in the lung parenchyma. BAL of MMP2 −/− mice lacked normal chemotactic activity, whereas lung inflammatory cells from the same mice showed appropriate chemotactic responses. Thus, MMP2 establishes the chemotactic gradient required for egression of lung inflammatory cells and prevention of lethal asphyxiation.

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“…(6,17) Patients with asthma can have a diminished perception of dyspnea during EIB. This phenomenon might be associated with reduced chemosensitivity (18) or with low baseline FEV 1 and high bronchial responsiveness. (19,20) However, the Dalhousie Dyspnea Scales (pictorial scales for measuring dyspnea) have been described as constituting a useful and accurate tool to measure dyspnea during histamine bronchoconstriction challenge in children.…”

Section: Resultsmentioning

confidence: 99%

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

et al. 2010

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Objective: There is an indirect relationship between airway obstruction in asthma and the intensity of breathlessness (dyspnea). A word labeled visual analog dyspnea scale with a 0-3 score has been widely used for the assessment of the degree of bronchoconstriction, although the perception of such obstruction varies considerably. The objective of this study was to determine whether children and adolescents are able to perceive acute exercise-induced bronchoconstriction (EIB), as well as to measure the discriminatory power of a word labeled visual analog dyspnea scale in relation to the intensity of the EIB. Methods: A cross-sectional study involving 134 children and adolescents with asthma and submitted to a six-minute steady-state exercise test on a cycle ergometer. The intensity of dyspnea was determined using a word labeled visual analog dyspnea scale prior to each determination of FEV 1 . The scale is scored from 0 to 3, with a logical sequence of pictures, ranging from "no symptoms" to "severe dyspnea". Variables were determined at baseline, as well as at 5, 10, and 20 min after the exercise test. The accuracy of the dyspnea scale in identifying the degree of EIB was determined by means of ROC curves for the post-exercise fall in FEV 1 , using cut-off points of 10%, 20%, 30%, and 40%. Results: Of the patients selected, 111 finished the study, and 52 (46.8%) presented with EIB. The area under the ROC curve increased in direct proportion to increases in the degree of bronchoconstriction. Conclusions: Among children and adolescents with asthma, the accuracy of this dyspnea scale improves as the post-exercise percentage fall in FEV 1 increases. However, the predictive value of the scale is suboptimal when the percentage fall in FEV 1 is lower.Keywords: Asthma; Asthma, exercise-induced; Dyspnea. ResumoObjetivo: Existe uma relação indireta entre a obstrução das vias aéreas em asma e a intensidade de falta de ar (dispneia). Uma escala visual analógica legendada de dispneia com escore de 0-3 pontos tem sido amplamente utilizada na avaliação da broncoconstrição, embora a percepção de tal obstrução seja muito variável. O objetivo deste estudo foi determinar se crianças e adolescentes são capazes de perceber a broncoconstrição aguda induzida por exercício (BAIE), bem como medir o poder discriminatório de uma escala visual analógica legendada de dispneia em relação à intensidade de BAIE. Métodos: Estudo transversal com 134 crianças e adolescentes asmáticos que foram submetidos a um teste de broncoespasmo induzido por seis minutos de exercício em um cicloergômetro. A intensidade da dispneia foi determinada utilizando-se uma escala visual analógica legendada de dispneia antes de cada determinação de VEF 1 . A escala tem um escore de 0-3 pontos, com desenhos em uma sequência lógica variando entre "sem sintomas" e "dispneia grave". As variáveis foram determinadas no momento basal, assim como em 5, 10 e 20 minutos após o término do teste de exercício. A acurácia da escala de dispneia em detectar o grau de BAIE foi d...

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Chemosensitivity and Perception of Dyspnea in Patients with a History of Near-Fatal Asthma

Abstract: Reduced chemosensitivity to hypoxia and blunted perception of dyspnea may predispose patients to fatal asthma attacks.

Cited by 464 publications

References 27 publications

Placebo and Other Interventions in Asthma

Placebo and Other Interventions in Asthma

Decreased allergic lung inflammatory cell egression and increased susceptibility to asphyxiation in MMP2-deficiency

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

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