Impact of trigeminal and/or olfactory nerve stimulation on measures of inspiratory neural drive: Implications for breathlessness

Aucoin, Rachelle; Lewthwaite, Hayley; Ekström, Magnus; Leupoldt, Andreas von; Jensen, Dennis

doi:10.1016/j.resp.2023.104035

Cited by 5 publications

(3 citation statements)

References 51 publications

(74 reference statements)

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“…Buonviso et al, 2006;Rojas-Líbano et al, 2014, our Fig. S4), nasal mechanoreceptors and trigeminal afferents also contribute to this patterning even in the absence of odorants (Aucoin et al, 2023;Grosmaitre et al, 2007). Respiratory rhythmicity is transmitted to upstream higher brain areas such as the hippocampus, prefrontal cortex and primary visual cortex (reviewed in Goheen et al, 2023;Tort et al, 2018); there respiration patterning most likely arises from efference copies from the respiratory centers within the brain stem (Karalis & Sirota, 2022).…”

Section: Possible Link To Respiratory Rhythm Coupling Between Respira...mentioning

confidence: 98%

Blood pressure pulsations modulate olfactory bulb neuronal activity via mechanosensitive ion channels

Jammal

Bitzenhofer

Hanganu‐Opatz

et al. 2023

Preprint

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The transmission of heartbeat through the cerebral vascular system is known to cause intracranial pressure pulsations. Here we describe that arterial pressure pulsations within the brain can directly modulate central neuronal activity. In a semi-intact rat brain preparation, pressure pulsations elicit correlated local field oscillations in the olfactory bulb (OB) that are sensitive to hypoxia and block of mechanosensitive channels. We find that mitral cell spiking activity is in part synchronized to these oscillations. Indeed, in awake animals the firing of a subset of OB neurons is entrained to heartbeat within ~ 20 ms. Several lines of evidence indicate the expression of a mechanosensitive ion channel within the mitral cell membranes, most likely Piezo2, implementing a pressure pulsation transduction pathway and thus baroreception within the OB. We propose that this intrinsic interoceptive mechanism modulates OB neuronal activity e.g. during arousal and also could influence brain activity on a wider scale.

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Section: Possible Link To Respiratory Rhythm Coupling Between Respira...mentioning

confidence: 98%

Blood pressure pulsations modulate olfactory bulb neuronal activity via mechanosensitive ion channels

Jammal

Bitzenhofer

Hanganu‐Opatz

et al. 2023

Preprint

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“…Self-reported breathlessness during nasal administration of airflow with/without oxygenation is increased with lidocaine anaesthesia of the nasal mucosae (26). Facial airflow may activate the insular cortex, anterior cingulate cortex and the amygdala, a common pathway for the perception of pain and anxiety, which are relevant in breathlessness for healthy subjects and patients (27).…”

Section: Mechanisms Of Perceived Breathlessnessmentioning

confidence: 99%

Airflow rates and breathlessness recovery from submaximal exercise in healthy adults: prospective, randomised, cross-over study

Brew,

O’Beirne,

Johnson

et al. 2023

BMJ Support Palliat Care

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ObjectivesFacial airflow from a hand-held fan may reduce breathlessness severity and hasten postexertion recovery. Data from randomised controlled trials are limited and the optimal airflow speed remains unknown. We aimed to determine the effect of different airflow speeds on recovery from exercise-induced breathlessness.MethodsA prospective, randomised, cross-over design. Ten healthy participants (seven male; mean age 29±4 years; height 175±9 cm; body mass 76.9±14.1 kg) completed six bouts of 4 min of exercise. During the first 5 min of a 20 min recovery phase, participants received one of five airflow speeds by holding a fan ~15 cm from their face, or no fan control, administered in random order. Fan A had an internal blade, and fan B had an external blade. Breathlessness was measured using a numerical rating scale (NRS) at minute intervals for the first 10 min, and facial skin temperature was recorded using a thermal imaging camera (immediately postexertion and 5 min recovery).ResultsNine participants completed the trial. A significant main effect for airflow speed (p=0.016, ηp2=0.285) and interaction effect for airflow speed over time (p=0.008, ηp2=0.167) suggest that the airflow speed modifies breathlessness during recovery from exercise. Fan speeds of 1.7 m/s or greater increased the speed of recovery from breathlessness compared with control (p<0.05) with the highest airflow speeds (2.5 m/s and 3.3 m/s) giving greatest facial cooling.ConclusionHigher airflow rates (1.7 m/s or greater) reduced self-reported recovery times from exercise-induced breathlessness and reduced facial temperature .

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“…Holistic services are endorsed for effective clinical management of chronic breathlessness [3][4][5] and incorporate non-pharmacological measures targeting such breathlessness perception pathways such as cool facial airflow delivered from a handheld battery-operated fan ('fan'), in addition to optimal disease-directed management. Cool airflow is thought to work by modulation of central perception of breathlessness through stimulation of the trigeminal nerve, nasal mucosa and upper airway flow receptors, all acting to decrease neural respiratory drive [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The handheld fan for chronic breathlessness: Clinicians’ experiences and views of implementation in clinical practice

Brown,

Miller,

Barnes-Harris

et al. 2023

PLoS ONE

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Introduction The handheld fan (‘fan’) is useful for chronic breathlessness management, however little is known about clinicians’ implementation of the fan in clinical practice. Aim To explore clinicians’ experiences and views of fan implementation. Methods A qualitative approach, using semi-structured interviews. Participants were purposively sampled from clinicians who had completed an on-line fan implementation survey and were willing to participate. A topic guide was developed using the Theoretical Domains Framework (TDF). Data were analysed using an inductive approach informed by the TDF. Findings Twelve clinicians participated (doctors n = 4; nurses n = 4; allied health professionals n = 4) from respiratory and palliative care. Analysis generated three major themes: i) Clinician knowledge and skills in fan implementation, ii) environmental constraints on fan use and iii) clinician beliefs about the consequences of fan use. Implementation by clinicians was positively influenced by having a scientific rationale for fan use presented (mechanism of action). Clinicians believed that the fan relieved breathlessness and did not carry a significant infection risk. Opportunity for fan use varied across healthcare settings; key environmental influences were COVID-19 restrictions, lack of access to resources and funding to provide fans, particularly in acute and respiratory services. Clinicians commonly encountered scepticism among patients and colleagues who felt the fan was an implausible intervention for breathlessness. Conclusion Implementation of the fan is motivated by clinician beliefs about patient-benefit, a scientific rationale to counter clinician and patient scepticism, and access to fans in clinic. Funding to allow patients to be supplied with and taught how to use a fan would support uptake. Research is needed to address concerns about infection risk.

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Impact of trigeminal and/or olfactory nerve stimulation on measures of inspiratory neural drive: Implications for breathlessness

Cited by 5 publications

References 51 publications

Blood pressure pulsations modulate olfactory bulb neuronal activity via mechanosensitive ion channels

Blood pressure pulsations modulate olfactory bulb neuronal activity via mechanosensitive ion channels

Airflow rates and breathlessness recovery from submaximal exercise in healthy adults: prospective, randomised, cross-over study

The handheld fan for chronic breathlessness: Clinicians’ experiences and views of implementation in clinical practice

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