Neurogenic Dyspnea: Is Idiopathic Dyspnea Related to a Post-Viral Sensory Neuropathy? A Case Series Supporting a New Hypothesis

Abstract

Objective: To propose a hypothesis of a novel potentially post-viral sensory neuropathic disorder, termed neurogenic dyspnea, and assess the therapeutic efficacy of a trigger reduction approach in this unique patient population. Methods: A retrospective chart review of patients seen between January 2011 and April 2018 for persistent dyspnea of unknown etiology was conducted. All patients failed to improve with treatment for presumptive diagnoses of allergy, asthma, sinus disease, and reflux. Patients were educated on our treatment protocol consisting of a Mediterranean style, plant-based diet with alkaline water, saline irrigation, and combined azelastine/fluticasone nasal spray. Treatment response was followed using two validated symptom questionnaires, Reflux Symptom Index (RSI) and Dyspnea Index (DI). Results: Of 57 initial patients, 8 were included in the final analysis. Mean age was 38.8 years (range 11-68). Six (75%) patients were female. All patients were followed for a minimum of 4 weeks. Using the reduction in DI and RSI as continuous variables to assess response, patients experienced a 9.4 (95% CI: 3.9-14.9) and 14.1 (95% CI: 6.0-22.2) mean point reduction, respectively. One patient saw a 100% and another a 95% reduction in DI. Six of eight patients experienced more than a 50% reduction in RSI. Conclusion: We hypothesize that Neurogenic Dyspnea is a newly described clinical phenomenon with a possible post-viral etiology. This pilot study demonstrated that our trigger reduction approach improved subjective symptoms in the majority of patients with unexplained dyspnea with previous treatment failure for common etiologies. Further studies are required to validate these findings.