Perception of Airway Obstruction and Airway Inflammation in Asthma: A Review

Rosi, Elisabetta; Stendardi, Loredana; Binazzi, Barbara; Scano, Giorgio

doi:10.1007/s00408-005-2590-z

Cited by 30 publications

(35 citation statements)

References 65 publications

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“…In this regard, it would be highly informative to include additional outcome measures that closely mirror the course of the disease such as frequency of exacerbations, hospitalisations or emergency treatments which were not available in the present study. Furthermore, effects of long-term use of asthma medication on the perception of dyspnea have been suggested [54], [55] and we cannot rule out respective effects on the underlying brain structures including the PAG. Therefore, future controlled studies should try to examine the impact of asthma medication on brain structure.…”

Section: Discussionmentioning

confidence: 86%

Structural Brain Changes Related to Disease Duration in Patients with Asthma

et al. 2011

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Dyspnea is the impairing, cardinal symptom patients with asthma repeatedly experience over the course of the disease. However, its accurate perception is also crucial for timely initiation of treatment. Reduced perception of dyspnea is associated with negative treatment outcome, but the underlying brain mechanisms of perceived dyspnea in patients with asthma remain poorly understood. We examined whether increasing disease duration in fourteen patients with mild-to-moderate asthma is related to structural brain changes in the insular cortex and brainstem periaqueductal grey (PAG). In addition, the association between structural brain changes and perceived dyspnea were studied. By using magnetic resonance imaging in combination with voxel-based morphometry, gray matter volumes of the insular cortex and the PAG were analysed and correlated with asthma duration and perceived affective unpleasantness of resistive load induced dyspnea. Whereas no associations were observed for the insular cortex, longer duration of asthma was associated with increased gray matter volume in the PAG. Moreover, increased PAG gray matter volume was related to reduced ratings of dyspnea unpleasantness. Our results demonstrate that increasing disease duration is associated with increased gray matter volume in the brainstem PAG in patients with mild-to-moderate asthma. This structural brain change might contribute to the reduced perception of dyspnea in some patients with asthma and negatively impact the treatment outcome.

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Section: Discussionmentioning

confidence: 86%

Structural Brain Changes Related to Disease Duration in Patients with Asthma

et al. 2011

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“…Indeed, lung function does not correlate strongly with asthma symptoms [56,57]. Short-term PEF monitoring may be useful for assessing response to treatment and exposure to triggers for worsening symptoms, whereas long-term PEF monitoring is recommended only for patients with severe asthma or those with impaired perception of airway limitation [58]. There is growing evidence that measurement of the fractional concentration of exhaled nitric oxide (FENO) may be useful for monitoring both response and adherence to anti-inflammatory treatment in patients with eosinophilic asthma [59].…”

Section: Assessment Of Asthmamentioning

confidence: 99%

Diagnosis and Management of Asthma – The Swiss Guidelines

et al. 2018

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The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA (“Global Strategy for Asthma Management and Prevention”) report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a “new” definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient.

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“…335 A minority of patients may perceive symptoms poorly and experience a significant decline in lung function without a perceptible change in symptoms. 108,109,117 This situation especially affects patients with a history of near-fatal asthma and also appears to be more common in males.…”

Section: Diagnosis Of Exacerbationsmentioning

confidence: 99%