The Affective Dimension of Laboratory Dyspnea

Banzett, Robert B.; Pedersen, Sarah; Schwartzstein, Richard M.; Lansing, Robert

doi:10.1164/rccm.200711-1675oc

Cited by 210 publications

(94 citation statements)

References 40 publications

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“…The air hunger sensation was closely associated with the affective domain of dyspnea in our experiment. Banzett et al [26] have demonstrated that maximal respiratory work is less unpleasant than moderately intense air hunger in a brief test in healthy subjects and that unpleasantness of dyspnea can vary independently from perceived intensity. These unpleasant sensations will also affect daily activities, which can be assessed by the impact domain of dyspnea (assessed by MRC scale or BDI) [6].…”

Section: Discussionmentioning

confidence: 99%

Cross-Sectional Assessment of the Relationships between Dyspnea Domains and Lung Function in Diffuse Parenchymal Lung Disease

Londner

Dandachi²,

Plantier³

et al. 2013

Respiration

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Background: Activity-related dyspnea is the main contributor to the altered quality of life in diffuse parenchymal lung diseases (DPLD). Instruments pertaining to dyspnea are classified as pertaining to domains of sensory-perceptual experience, affective distress or symptom/disease impact; whether these domains are equally related to lung function impairments remains to be established. Objectives: They were to assess the relationships between two domains of dyspnea (sensory-perceptual experience and symptom impact) and pulmonary function tests according to their evaluation of ventilatory demand, capacity and drive in patients suffering from DPLD. Methods: Fifty patients were prospectively enrolled (median age, 58 years; 25 women) and underwent spirometry, body plethysmography, measurements of lung diffusion for carbon monoxide (DLCO) and nitric oxide, maximal airway pressures (capacity and demand assessments), mouth occlusion pressure at 0.1 s (P_0.1: respiratory drive assessment) and a 6-min walk test with Borg score assessment (dyspnea: sensory domain). The impact domain of dyspnea was evaluated using the baseline dyspnea index. Results: The sensory domain of dyspnea was linked to demand (CO transfer coefficient, kCO) only, while the impact domain was independently linked to demand and capacity (kCO and forced vital capacity, respectively). Among resting pulmonary function tests, both P_0.1 and DLCO allowed the assessment of these two domains of dyspnea. Conclusions: InDPLD, the sensory-perceptual domain of dyspnea is mainly linked to alterations in ventilatory demand while the impact domain is related to both demand and capacity. DLCO that assesses both demand and capacity and P_0.1 were the strongest correlates of dyspnea.

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Section: Discussionmentioning

confidence: 99%

Cross-Sectional Assessment of the Relationships between Dyspnea Domains and Lung Function in Diffuse Parenchymal Lung Disease

Londner

Dandachi²,

Plantier³

et al. 2013

Respiration

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“…Air hunger (an unpleasant, unsatisfied urge to breathe) is perhaps the most distressing dyspnea modality [18, 19]. This dyspnea modality corresponds to verbal expressions such as “I am not getting enough air”, “I feel that I am suffocating”, “I need more air”.…”

Section: Simplified Physiological Basis Of Dyspneic Sensationsmentioning

confidence: 99%

“…Recent experimental data have demonstrated that both unpleasantness and emotional response can be differentially altered with different dyspnea modality or drug treatment. At similar level of sensory intensity, air hunger elicits more unpleasantness than excessive work/effort and is associated with greater anxiety and fear [19]. Of clinical relevance is the experimental finding that an effective way to induce air hunger is to increase ventilatory demand via mild hypercapnia while hindering the normal ventilatory response [29, 30].…”

Section: Simplified Physiological Basis Of Dyspneic Sensationsmentioning

confidence: 99%

“…In the study by Schmidt et al [27] discussed above, dyspneic patients were more likely to present with anxiety than non-dyspneic patients (71% vs. 24%) and dyspnea was independently associated with anxiety (odd ratio [OR], 8.84; 95% confidence interval [CI], 3.26 – 24.0; p <0.0001). Experimental dyspnea produces anxiety even in healthy subjects who know they are safe and disease free [19, 52]. The interplay between anxiety and dyspnea is complex and causative relationships can exist in both directions.…”

Section: Clinical Relevance Of Dyspnea In Mechanically Ventilated Patmentioning

confidence: 99%

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Unrecognized suffering in the ICU: addressing dyspnea in mechanically ventilated patients

et al. 2013

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Background Intensive care unit (ICU) patients are exposed to many sources of discomfort. Although growing attention has been given to the detection and treatment of pain, very little has been given to the detection and treatment of dyspnea (defined as ‘breathing discomfort’). Discussion In this article, we review the published information on prevalence, mechanisms and potential negative impacts of dyspnea in mechanically ventilated patients. In addition, we review the most appropriate tools to detect and quantify dyspnea in ICU patients. Conclusions Growing evidence suggests that dyspnea is a frequent issue in mechanically ventilated ICU patients, is highly associated with anxiety and pain, and is improved in many patients by altering ventilator settings. Future studies are needed to better delineate the impact of dyspnea in the ICU, and to define diagnostic, monitoring and therapeutic protocols.

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“…No FDA approved agents list dyspnea as an indication. Since dyspnea is not only unpleasant but also evokes fear and anxiety (Banzett et al, 1996; Banzett et al, 2008; Evans and Banzett, 2014; O’Donnell et al, 2013) there is an increasing awareness of the need for compassionate management of this symptom (Brody et al, 1997; Campbell, 2004; Jones et al, 2004; LaDuke, 2001; Perkin and Resnik, 2002). Objective measurements of dyspnea will enhance drug development and help meet this obligation.…”

Section: Introductionmentioning

confidence: 99%

The time-course of cortico-limbic neural responses to air hunger

Binks

Evans

Reed

et al. 2014

Respiratory Physiology & Neurobiology

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Several studies have mapped brain regions associated with acute dyspnea perception. However, the time-course of brain activity during sustained dyspnea is unknown. Our objective was to determine the time-course of neural activity when dyspnea is sustained. Eight healthy subjects underwent brain blood oxygen level dependent functional magnetic imaging (BOLD-fMRI) during mechanical ventilation with constant mild hypercapnia (~45 mmHg). Subjects rated dyspnea (air hunger) via visual analog scale (VAS). Tidal volume (VT) was alternated every 90 seconds between high VT (0.96±0.23 L) that provided respiratory comfort (12±6% full scale) and low VT (0.48±0.08 L) which evoked air hunger (56±11% full scale). BOLD signal was extracted from a priori brain regions and combined with VAS data to determine air hunger related neural time-course. Air hunger onset was associated with BOLD signal increases that followed two distinct temporal profiles within sub-regions of the anterior insula, anterior cingulate and prefrontal cortices (cortico-limbic circuitry): (1) fast, BOLD signal peak <30 seconds and (2) slow, BOLD signal peak >40 seconds. BOLD signal during air hunger offset followed fast and slow temporal profiles symmetrical, but inverse (signal decreases) to the time-courses of air hunger onset. We conclude that differential cortico-limbic circuit elements have unique contributions to dyspnea sensation over time. We suggest that previously unidentified sub-regions are responsible for either the acute awareness or maintenance of dyspnea. These data enhance interpretation of previous studies and inform hypotheses for future dyspnea research.

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The Affective Dimension of Laboratory Dyspnea

Cited by 210 publications

References 40 publications

Cross-Sectional Assessment of the Relationships between Dyspnea Domains and Lung Function in Diffuse Parenchymal Lung Disease

Cross-Sectional Assessment of the Relationships between Dyspnea Domains and Lung Function in Diffuse Parenchymal Lung Disease

Unrecognized suffering in the ICU: addressing dyspnea in mechanically ventilated patients

The time-course of cortico-limbic neural responses to air hunger

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