Structural Brain Changes Related to Disease Duration in Patients with Asthma

Leupoldt, Andreas von; Brassen, Stefanie; Baumann, Hannes; Klose, Hans; Büchel, Christian

doi:10.1371/journal.pone.0023739

Cited by 34 publications

(24 citation statements)

References 54 publications

(70 reference statements)

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“…Changes in these brain structures were related to illness duration [34]. The insular cortex is an important multisensory integration area involved in the processing of various unpleasant bodily signals and emotions, while the PAG plays an important role in the up- and downregulation of pain sensations [34].…”

Section: Discussionmentioning

confidence: 99%

Blunted perception of neural respiratory drive and breathlessness in patients with cystic fibrosis

et al. 2016

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The electromyogram recorded from the diaphragm (EMGdi) and parasternal intercostal muscle using surface electrodes (sEMGpara) provides a measure of neural respiratory drive (NRD), the magnitude of which reflects lung disease severity in stable cystic fibrosis. The aim of this study was to explore perception of NRD and breathlessness in both healthy individuals and patients with cystic fibrosis. Given chronic respiratory loading and increased NRD in cystic fibrosis, often in the absence of breathlessness at rest, we hypothesised that patients with cystic fibrosis would be able to tolerate higher levels of NRD for a given level of breathlessness compared to healthy individuals during exercise.15 cystic fibrosis patients (mean forced expiratory volume in 1 s (FEV1) 53.5% predicted) and 15 age-matched, healthy controls were studied. Spirometry was measured in all subjects and lung volumes measured in the cystic fibrosis patients. EMGdi and sEMGpara were recorded at rest and during incremental cycle exercise to exhaustion and expressed as a percentage of maximum (% max) obtained from maximum respiratory manoeuvres. Borg breathlessness scores were recorded at rest and during each minute of exercise.EMGdi % max and sEMGpara % max and associated Borg breathlessness scores differed significantly between healthy subjects and cystic fibrosis patients at rest and during exercise. The relationship between EMGdi % max and sEMGpara % max and Borg score was shifted to the right in the cystic fibrosis patients, such that at comparable levels of EMGdi % max and sEMGpara % max the cystic fibrosis patients reported significantly lower Borg breathlessness scores compared to the healthy individuals. At Borg score 1 (clinically significant increase in breathlessness from baseline) corresponding levels of EMGdi % max (20.2±12% versus 32.15±15%, p=0.02) and sEMGpara % max (18.9±8% versus 29.2±15%, p=0.04) were lower in the healthy individuals compared to the cystic fibrosis patients.In the cystic fibrosis patients EMGdi % max at Borg score 1 was related to the degree of airways obstruction (FEV1) (r=−0.664, p=0.007) and hyperinflation (residual volume/total lung capacity) (r=0.710, p=0.03). This relationship was not observed for sEMGpara % max.These data suggest that compared to healthy individuals, patients with cystic fibrosis can tolerate much higher levels of NRD before increases in breathlessness from baseline become clinically significant. EMGdi % max and sEMGpara % max provide physiological tools with which to elucidate factors underlying inter-individual differences in breathlessness perception.

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Section: Discussionmentioning

confidence: 99%

Blunted perception of neural respiratory drive and breathlessness in patients with cystic fibrosis

et al. 2016

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“…Neuroimaging studies have demonstrated that brain areas with high relevance to emotion processing such as the insular cortex, anterior cingulate cortex and amygdala play an important role in the processing of dyspnea, presumably for its affective aspects (Evans, 2010; von Leupoldt, Sommer et al, 2008). There is evidence that negative affective quality of dyspnea can habituate in some asthma patients, which is accompanied by insular cortex down-regulation as well as functional and structural up-regulation in the brainstem periaqueductal grey (von Leupoldt et al, 2009, von Leupoldt, Brassen, Baumann, Klose & Büchel, 2011). First attempts have also been documented linking neural processing of asthma-relevant stimuli with airway and inflammatory responses to allergen challenge (Rosenkranz & Davidson, 2009)…”

Section: Psychosocial Influences On Asthma: Psychobiology and Health mentioning

confidence: 99%

Psychosocial factors and behavioral medicine interventions in asthma.

Ritz

Meuret

Trueba

et al. 2013

Journal of Consulting and Clinical Psychology

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Objective This review examines the evidence for psychosocial influences in asthma and behavioral medicine approaches to its treatment. Method We conducted a systematic review of the literature on psychosocial influences and the evidence for behavioral interventions in asthma with a focus on research in the past 10 years and clinical trials. Additional attention was directed at promising new developments in the field. Results Psychosocial factors can influence the pathogenesis and pathophysiology of asthma, either directly through autonomic, endocrine, immunological, and central nervous system mechanisms, or indirectly through lifestyle factors, health behaviors, illness cognitions, and disease management including medication adherence and trigger avoidance. The recent decade has witnessed surging interest in behavioral interventions that target the various pathways of influence. Among these, self-management training, breathing training, and exercise or physical activation programs have proven particularly useful, whereas other essential or promising interventions, such as smoking cessation, dietary programs, perception and biofeedback training, and suggestive or expressive psychotherapy, require further more rigorous evaluation. Given the high comorbidity with anxiety and mood disorders, further evaluation of illness-specific cognitive behavior therapy is of particular importance. Progress has also been made in devising community-based and culturally tailored intervention programs. Conclusion In concert with an essential medication treatment, behavioral medicine treatment of asthma is moving closer towards an integrated biopsychosocial approach to disease management.

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“…The newborns with congenital heart disease (45,46). For other diseases, changes have been found in adult brain for type 2 diabetes (47-50), asthma (51,52), and chronic obstructive pulmonary disease (53)(54)(55). Improvements in diagnostic methods will make it possible to establish changes during early life.…”

Section: The Role Of Hypoxia In the Neurogenesis Stimulationmentioning

confidence: 99%