Descriptors of Breathlessness in Children With Persistent Asthma

Abstract

Dyspnea, or breathlessness, is used to characterize a subjective experience of breathing discomfort that is composed of qualitatively distinct sensations that vary in intensity. 1 It is a common symptom in patients with respiratory and cardiovascular diseases, and a cause of morbidity in the elderly. 2 Dyspnea varies along several dimensions, including intensity and salience, and can include cognitive and emotional components. 3 As such, it is a complex sensory experience, derived from physiologic conditions that both infl uence and are infl uenced by psychologic processes and social variables. [1][2][3][4] The terms used to describe dyspnea have been developed and studied extensively in both laboratory and clinical settings. 5-9 These studies have included: asking adults to select items from standardized questionnaires; identifying, by cluster analysis, descriptor groupings (clusters) that are independent of one another; and relating clusters with physiologic elements of disease. The work has shown that descriptor clusters are fairly consistent among patients with a disease but vary between patients with different disorders. Patients with asthma, for example, are likely to endorse the questionnaire items "My chest feels tight" Background: In adult patients, the consistent use of language to describe dyspnea enhances patient-provider communication and contributes to diagnostic and therapeutic decisions. The objective of this research was to determine whether pediatric patients similarly display consistency in the language used to describe "uncomfortable awareness of breathing." Methods: One hundred children between the ages of 8 and 15 years with moderate to severe persistent asthma enrolled in an asthma education research program completed questionnaires regarding descriptors of asthma on each of two occasions. In addition to the breathlessness questionnaires, demographic information, self-reported asthma severity, ED visits, missed school days, anthropometrics, and spirometry were obtained for each participant. Results: Children were reliable in their choice of the descriptors that they applied to their breathing discomfort across two occasions, and they selected the same descriptors that were used by adults with asthma in previous studies. Children with greater self-reported asthma severity endorsed more descriptors to characterize breathing discomfort than did children with less severe asthma, but no differences were found among children based on demographic or anthropometric variables. Conclusions: Children with moderate to severe persistent asthma are reliable in their choice of descriptors of breathlessness. Knowledge of their experience of symptoms may be helpful clinically in the assessment and management of asthma.

Two novel, severe asthma phenotypes identified during childhood using a clustering approach

“…Severe asthma with bronchial obstruction This phenotype of severe asthma is characterised in our study by a significant decrease in FEV1 (mean 82, range 78-86% pred) even if it remains within the accepted limits of normal, as in other studies in severe asthmatic children [22,23]. This finding is probably due to the fact that the normal value of FEV1 in children at school age is .90%, as in our cluster 3 in which the mean value of FEV1 was 97% pred (range 95-100% pred).…”

Test–retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

“…The instrument’s structure and content are based on a theoretical model of dyspnea sensation and affect [ 29 ] that was derived from an extensively validated multidimensional model of pain [ 30 - 36 ] that proposes potentially discriminable dimensions of sensation (intensity and quality) and two affective stages: immediate unpleasantness and emotional distress (e.g., judgments as to the meaning or significance of the experience). The relevance of this model to dyspnea is supported by multiple lines of laboratory and clinical research in dyspnea that have demonstrated the potential separability of dyspnea intensity and its associated emotional distress [ 37 - 44 ] or unpleasantness [ 26 , 45 , 46 ] as well as mechanistic distinctions among dyspnea sensory qualities (e.g., different peripheral afferent pathways or higher central nervous system processing) [ 19 , 25 , 42 , 47 - 58 ].…”

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

“…Qualities of clinical dyspnea are not limited to the foregoing categories. Rather, sensations of effort, tightness, and air hunger are more reliably characterized than others (e.g., rapid or heavy breathing) (36,69,97,114,125). In addition, the mechanisms described above do not provide a good explanation for dyspnea arising from vascular problems such as congestive heart failure and pulmonary hypertension.…”

“…"Tightness" is commonly experienced during bronchoconstriction (27,(65)(66)(67)(68)(69). Some studies suggest that chest tightness is the dominant experience in the early stages of an asthma attack, but as airway narrowing worsens, patients also report work/effort and air hunger/unsatisfied inspiration (65,68).…”