Mechanisms of activity-related dyspnea in pulmonary diseases

O’Donnell, Denis E.; Ora, Josuel; Webb, Katherine A.; Laveneziana, Pierantonio; Jensen, Dennis

doi:10.1016/j.resp.2009.01.010

Cited by 194 publications

(169 citation statements)

References 193 publications

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“…COPD limits ventilation causing dynamic hyperinflation when expiratory time is not sufficient to enable lung emptying [37,38]. This imposes constraints on tidal volume, leading to dyspnoea, the most common activity-limiting symptom of COPD.…”

Section: Source Of Gait Abnormalities In Copdmentioning

confidence: 99%

Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

et al. 2018

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Background: Gait instability is a major fall-risk factor in patients with chronic obstructive pulmonary disease (COPD). Clinical gait analysis is a reliable tool to predict fall onsets. However, controversy still exists on gait impairments associated with COPD. Research question: Thus, the aims of this review were to evaluate the current understanding of spatiotemporal, kinematic and kinetic gait features in patients with COPD. Methods: In line with PRISMA guidelines, a systematic literature search was performed throughout Web of Science, PubMed Medline, Scopus, PEDro and Scielo databases. We considered observational cross-sectional studies evaluating gait features in patients with COPD as their primary outcome. Risk of bias and applicability of these papers were assessed according to the QUADAS-2 tool. Results: Seven articles, cross-sectional studies published from 2011 to 2017, met the inclusion criteria. Sample size of patients with COPD ranged 14-196 (mean age range: 64-75 years). The main reported gait abnormalities were reduced step length and cadence, and altered variability of spatiotemporal parameters. Only subtle biomechanical changes were reported at the ankle level. Significance: A convincing mechanistic link between such gait impairments and falls in patients with COPD is still lacking. The paucity of studies, small sample sizes, gender and disease status pooling were the main risk of biases affecting the results uncertainty. Two research directions emerged: stricter cohorts characterization in terms of COPD phenotype and longitudinal studies. Quantitative assessment of gait would identify abnormalities and sensorimotor postural deficiencies that in turn may lead to better falling prevention strategies in COPD.

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Section: Source Of Gait Abnormalities In Copdmentioning

confidence: 99%

Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

et al. 2018

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“…7,8,14,18,19,21,48 Unless participants were volunteering or selecting descriptors randomly on both assessment occasions, the descriptors are likely to reflect the individual's current perception of breathlessness. The pattern of descriptor modification in relation to changes in primary outcomes after CPRP varied substantially (see Tables 3 and 4).…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Exercise of sufficient duration and intensity is associated with reduction in skeletal muscle dysfunction, may enhance mechanical efficiency of physical activities, and may reduce or delay the onset of dynamic hyperinflation during exercise and reduce sensitivity to dyspnea. [1][2][3][4][5][6][7] While participation in CPRP has been shown to reduce the intensity of dyspnea and impact of dyspnea on health related quality of life, 2 whether participation in CPRP moderates the qualitative sensation of dyspnea is less clear.…”

Section: Introductionmentioning

confidence: 99%

“…Physical terms (eg, work effort, unsatisfied inspiration/air hunger, tightness) 8,12 are thought to involve the somatosensory cortex and association cortex (among other neural structures) monitoring efferent information such as the magnitude of efferent motor output via central corollary discharge (sense of work/effort) or discrepancies between central respiratory motor output and the mechanical/muscular response of the respiratory system (sense of unsatisfied inspiration/air hunger). 7 The sensation of air hunger has the potential to evoke an affective (fear) response and is associated with greater unpleasantness than the induced sense of respiratory work/effort. 13 There are a variety of instruments with which to assess the sensory quality of breathlessness (descriptors), including instruments that invite respondents to volunteer descriptors, 14 select from a series of descriptors statements, 15,16 or rate the intensity of descriptor statements.…”

Section: Introductionmentioning

confidence: 99%

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A Reduction in the Use of Volunteered Descriptors of Air Hunger Is Associated With Increased Walking Distance in People With COPD

Williams¹,

Petkov²,

Olds

et al. 2012

Respir Care

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BACKGROUND: This study investigated whether descriptors of breathlessness differed after participation in an 8 week pulmonary rehabilitation program and whether changes in sensory quality would be reflected in responsiveness to pulmonary rehabilitation. METHODS: People with COPD provided descriptors for their sensation of breathlessness before and after an 8 week pulmonary rehabilitation program. Primary outcomes for responsiveness to pulmonary rehabilitation were the 6 minute walk distance (6MWD) and the St George Respiratory questionnaire. Significant proportional shifts for sensory categories after rehabilitation were identified using the McNemar test. Random effects mixed modeling was used to determine significance of differences for primary outcomes between subjects modifying or not modifying descriptors of breathlessness. RESULTS: Of the 107 people referred to the pulmonary rehabilitation program, 94 met the spirometric criteria for COPD, with 58 having data for pre and post assessments (36 males, 71 ؎ 9 years old, percent of predicted FEV 1 58 ؎ 24%). A significant proportion of subjects reduced descriptors of air hunger (P ‫؍‬ .03, odds ratio 0.31, 95% CI 0.09 -0.89) and depressed, regret, helpless (P ‫؍‬ .04, odds ratio 0.36, 95% CI 0.10 -1.05) following rehabilitation. Subjects reducing their use of descriptors of air hunger had greater improvements in the 6MWD after rehabilitation (P ‫؍‬ .006, mean increase 46 m). CONCLUSIONS: The sensory quality of breathlessness was modified for approximately one third of subjects after pulmonary rehabilitation, with significant improvements in the 6MWD for subjects who reduced their use of descriptors of air hunger.

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“…Musculoskeletal disorders, as well as dyspnea, are among the most common manifestations in patients with chronic obstructive pulmonary disease 1,2 , impacting greatly on the exercise performance capacity 3,4 and muscular strength of these patients [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Efeitos de um treinamento resistido com tubos elásticos sobre a força muscular, qualidade de vida e dispneia de pacientes com doença pulmonar obstrutiva crônica

et al. 2016

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RESUMOO objetivo deste estudo foi analisar os efeitos do treinamento resistido com tubos elásticos e aparelhos de musculação (convencional) sobre a força muscular, qualidade de vida e dispneia em pacientes com doença pulmonar obstrutiva crônica (DPOC). Pacientes alocados em grupos de treinamento com tubos elásticos (ETG, n=9) e convencional (CRG, n=10) foram avaliados por força isométrica e questionários de qualidade de vida (CRQ) e dispneia (MRC). A força isométrica aumentou em ~25% em ambos os grupos em todos os movimentos (p<0,05). MRC e o domínio dispneia de CRQ apresentaram melhoras de -28,70% e -6,05 % no ETG, e -33,33% e -16,23% no CRG, respectivamente. Força de flexão de ombro e cotovelo apresentaram correlação negativa com a variável MRC (p<0,05) para CRG. Ambas intervenções foram benéficas para aumento da força e redução do MRC, com aumento da força de membros superiores correlacionado à redução da sensação de dispneia nos pacientes com DPOC. Palavras-chave: Exercício. Doença pulmonar obstrutiva crônica. Qualidade de vida. ABSTRACTThe objective of this study was to analyze the effects of resistance training with elastic tubes and weight machines (conventional) on muscle strength, quality of life and dyspnea in patients with chronic obstructive pulmonary disease (COPD). Patients were allocated in training groups with elastic tubes (ETG, n = 9) and conventional (CRG, n = 10) and evaluated by isometric strength and quality of life questionnaire (CRQ) and dyspnea (MRC). Isometric strength increased by ~25% in both groups in all movements (p <0.05). MRC and the CRQ dyspnea domain showed improvement of -28.70% and -6.05% in the ETG, and -33.33% and -16.23% at CRG, respectively. Shoulder and elbow flexion showed a negative and significant correlation with MRC (p <0.05), for CRG. Both interventions were beneficial for increasing the strength and reducing the MRC score, and increased strength of upper limbs correlated to the reduction of the sensation of dyspnea in patients with COPD.

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Mechanisms of activity-related dyspnea in pulmonary diseases

Cited by 194 publications

References 193 publications

Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

A Reduction in the Use of Volunteered Descriptors of Air Hunger Is Associated With Increased Walking Distance in People With COPD

Efeitos de um treinamento resistido com tubos elásticos sobre a força muscular, qualidade de vida e dispneia de pacientes com doença pulmonar obstrutiva crônica

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