Relationship between breathlessness and hypoxic and hypercapnic ventilatory response in patients with COPD

Kobayashi, Shingo; Nishimura, Masaharu; Yamomoto, M.; Akiyama, Yasushi; Miyamoto, K.; Kawamaki, Y.

doi:10.1183/09031936.96.09112340

Cited by 13 publications

(12 citation statements)

References 21 publications

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“…Our results confirm this theory. In contrast, Kobayashi et al 31 found that hypercapnia had no additional dyspnogenic effect during a hypercapnic ventilatory response which was also seen by Clague et al 32 Interestingly, Kobayashi et al also found a dyspnogenic effect of hypoxia during a hypoxic ventilatory response which occurred during moderate hypoxia (desaturation to 80%). Peripheral chemoreceptors normally respond to hypoxia only at very low levels of Pa o 2 ; the relationship between afferent impulse activity and Pa o 2 is hyperbolic.…”

Section: Discussionmentioning

confidence: 89%

Exertional dyspnoea in patients with airway obstruction, with and without CO2 retention

Cloosterman

Hofland

Schayck

et al. 1998

Thorax

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Background-Dyspnoea is a common and disabling symptom in patients with cardiopulmonary disease. Unfortunately the mechanisms that produce dyspnoea are still poorly understood. The relationship between dyspnoea and the load on the ventilatory muscles, chemical drive, and ventilatory indices was therefore assessed in patients with obstructive pulmonary disease during an incremental exercise test. Methods-Fifty patients with a wide range of obstructive pulmonary disease (mean forced expiratory volume in one second (FEV 1 ) 66.1 (28.8)% predicted) performed an incremental cycle ergometer test. A subdivision was made between subjects with CO 2 retention ( PaCO 2 >0, n = 22) and subjects without CO 2 retention ( PaCO 2 <0, n = 28) during exercise. During the test dyspnoea (Borg score), oesophageal pressures (mechanical load on the ventilatory muscles (time tension index (TTI)), blood gas tensions, and minute ventilation were measured. Correlations for changes in mechanical and chemical factors with changes in dyspnoea score were calculated to assess relevant factors. An analysis of covariance was used to examine whether there was a relationship between dyspnoea score and each of these factors and whether this relationship was diVerent between the subgroups with and without CO 2 retention. Multiple regression analysis was used to assess the independent eVect of each parameter on dyspnoea sensation. Furthermore, the amplitude of pleural pressure swing ((Pi + Pe)act) generated at maximal work load (Ptot, an indication of the load on all respiratory muscles) was calculated. Analysis of covariance was used to assess whether there was a relationship between tidal volume (VT) and Ptot and whether this relationship was diVerent between the groups (slopes are an expression of the length-tension inappropriateness, LTI). Results-In the total group and the group without CO 2 retention a significant correlation between dyspnoea and the increase in the inspiratory time tension index (TTIi) was present. In the group with CO 2 retention a significant correlation was seen between dyspnoea and PaCO 2 . The factors PaO 2 , VE%MVV and (VT/Ti) showed a correlation with a p value of <0.10 both in the total group and in those without CO 2 retention. In an analysis of covariance the relationship between dyspnoea score and PaCO 2 appeared to be significantly diVerent between the two subgroups, being more pronounced in the group with CO 2 retention. No other relationships with change in dyspnoea score were found. There was no significant relationship between VT and Ptot in the total group nor in the two subgroups, indicating some length-tension inappropriateness in both groups. Conclusion-In patients with distinctive pulmonary disease who are normocapnic or hypocapnic the mechanical load ( TTIi) and length-tension inappropriateness (LTI) on ventilatory muscles seem to be the main determinant of exertional dyspnoea. As soon as hypercapnia occurs, this seems to override all other inputs for dyspnoea. (Thorax 1998;53:768-774)

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Section: Discussionmentioning

confidence: 89%

Exertional dyspnoea in patients with airway obstruction, with and without CO2 retention

Cloosterman

Hofland

Schayck

et al. 1998

Thorax

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“…Carbon dioxide retention is more strongly correlated with breathlessness in lung disease than is hypoxemia. 33 In patients who can increase breathing and lower arterial partial pressure of carbon dioxide, breathlessness will be limited. 34 This is similar to what is experienced by most people on ascent to high altitude: arterial hypoxemia is present but subjective breathlessness is limited by subtle, often unnoticed increases in the respiratory rate that helps the lungs “blow off” enough arterial carbon dioxide to mitigate the sensation of dyspnea.…”

Section: Hypoxemia and Breathlessness: Variability In Humansmentioning

confidence: 99%

“Silent” Presentation of Hypoxemia and Cardiorespiratory Compensation in COVID-19

Bickler¹,

Feiner²,

Lipnick³

et al. 2020

Anesthesiology

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“…Low self-efficacy, anxiety, depression, hypoxia, hypercapnia, hypoxia-induced cognitive decline, skeletal dysfunction, weight loss or obesity and other concomitant diseases each compromise patients' breathing abilities and functional level in daily living (American Thoracic Society/European Respiratory Society, 1999; Davis et al, 2006;Kobayashi et al, 1996;Masuda et al 2001;Nonoyama et al, 2007). Consequently, coping with breathlessness may constitute a complex process involving physiological, cognitive, affective and psychosocial dimensions (Nici et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Four types of coping with COPD-induced breathlessness in daily living: a grounded theory study

Jørgensen

Dahl

Pedersen

et al. 2012

Journal of Research in Nursing

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Coping with breathlessness is a complex and multidimensional challenge for people with chronic obstructive pulmonary disease (COPD) and involves interacting physiological, cognitive, affective, and psychosocial dimensions. The aim of this study was to explore how people with moderate to most severe COPD predominantly cope with breathlessness during daily living. We chose a multimodal grounded theory design that holds the opportunity to combine qualitative and quantitative data to capture and explain the multidimensional coping behaviour among people with COPD. The participants' main concern in coping with breathlessness appeared to be an endless striving to economise on resources in an effort to preserve their integrity. In this integrity-preserving process, four predominant coping types emerged and were labelled: 'Overrater', 'Challenger', 'Underrater', and 'Leveller'. Each coping type comprised distinctive physiological, cognitive, affective and psychosocial features constituting coping-type-specific indicators. In theory, four predominant coping types with distinct physiological, cognitive, affective and psychosocial properties are observed among people with COPD. The four coping types seem to constitute a coping trajectory. This hypothesis should be further tested in a longitudinal study.

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Relationship between breathlessness and hypoxic and hypercapnic ventilatory response in patients with COPD

Cited by 13 publications

References 21 publications

Exertional dyspnoea in patients with airway obstruction, with and without CO2 retention

Exertional dyspnoea in patients with airway obstruction, with and without CO2 retention

“Silent” Presentation of Hypoxemia and Cardiorespiratory Compensation in COVID-19

Four types of coping with COPD-induced breathlessness in daily living: a grounded theory study

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