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Dyspnea: A sensory experience

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Abstract

Dyspnea—an unpleasant or uncomfortable awareness of breathing or need to breathe—is a common symptom of patients with cardiopulmonary disease. Although often thought of as a single symptom, dyspnea probably subsumes many sensations. Experimental conditions used to induce dyspnea are characterized by discrete groups or clusters of descriptive phrases. Similarly, as the language of dyspnea is refined further, different disease states may be distinguishable by the nuances of breathlessness described by patients. Evidence is gathering that the sensations of dyspnea are modified by information from a variety of receptors throughout the respiratory system. The sense of effort, although still important in the breathlessness associated with mechanical loads, is insufficient to explain the dyspnea arising from a number of experimental and clinical conditions. As our understanding of the interactions between effort and afferent information from the respiratory system grows, new therapeutic interventions to alleviate dyspnea are likely to follow.

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References

  1. Adams L, Lane R, Shea SA, Cockroft A, Guz A (1985) Breathlessness during different forms of ventilatory stimulation: a study of mechanisms in normal subjects and respiratory patients. Clin Sci 69:663–672

    PubMed  CAS  Google Scholar 

  2. Affeldt JE, Collier CR, Crane MG, Farr AF (1955) Ventilatory aspects of poliomyelitis. Curr Res Anesth Analg 34:41–53

    PubMed  CAS  Google Scholar 

  3. Altose MD (1984) Mechanisms of dyspnea. In: Montenegro HD (ed), Chronic obstructive pulmonary disease. Churchill Livingstone, New York, pp 117–140

    Google Scholar 

  4. Altose MD (1986) Dyspnea. In: Simmons DH (ed) Current pulmonology, vol 7. Year Book Medical Publishers, Chicago, pp 199–226

    Google Scholar 

  5. Altose M. Cherniack N, Fishman AP (1985) Respiratory sensations and dyspnea. J Appl Physiol 58:1051–1054

    PubMed  CAS  Google Scholar 

  6. Anderson P (1954) Inhibitory reflexes elicited from the trigeminal and olfactory nerves in rabbits. Acta Physiol Scand 30:137–148

    Article  Google Scholar 

  7. Banzett RB, Lansing RW, Brown R (1987) High-level quadriplegics perceive lung volume changes. J Appl Physiol 62:567–573

    PubMed  CAS  Google Scholar 

  8. Banzett RB, Lansing R, Reid MB, Adams L, Brown R (1989) Air hunger arising from increased PCO2 in mechanically ventilated C1-2 quadriplegics. Respir Physiol 76:53–67

    Article  PubMed  CAS  Google Scholar 

  9. Bartlett D (1977) Effects of Valsalva and Mueller maneuvers on breath-holding time. J Appl Physiol 42:717–721

    PubMed  Google Scholar 

  10. Bartlett D (1986) Upper airway motor systems. In: Fishman AP, Cherniack NS, Widdicombe JG, Geiger SR (eds) Handbook of physiology, vol 2. American Physiological Society, Bethesda, MD, pp 223–242

    Google Scholar 

  11. Brown MC, Engberg I, Matthews PBC (1967) The relative sensitivity to vibration of muscle receptors of the cat. J Physiol 192:773–800

    PubMed  CAS  Google Scholar 

  12. Burgess KR, Whitelaw WA (1984) Reducing ventilatory response to carbon dioxide by breathing cold air. Am Rev Respir Dis 129:687–690

    PubMed  CAS  Google Scholar 

  13. Burgess KR, Whitelaw WA (1988) Effects of nasal cold receptors on pattern of breathing. J Appl Physiol 64:371–376

    Article  PubMed  CAS  Google Scholar 

  14. Burki NK (1980) Dyspnea. Clin Chest Med 1:47–56

    PubMed  CAS  Google Scholar 

  15. Burki NK (1987) Dyspnea. Lung 165:269–277

    Article  PubMed  CAS  Google Scholar 

  16. Campbell EJM (1966) The relationship of the sensation of breathlessness to the act of breathing. In: Howell JBL, Campbell EJM (eds) Breathlessness. Blackwell Scientific Publications, Oxford, pp 55–64

    Google Scholar 

  17. Campbell EJM, Guz A (1981) Breathlessness. In: Hornbein TF (ed) Regulation of breathing. Marcel Dekker, New York, pp 1181–1195

    Google Scholar 

  18. Campbell EJM, Howell JBL (1963) The sensation of breathlessness. Br Med Bull 19:36–40

    PubMed  CAS  Google Scholar 

  19. Campbell EJM, Godfrey S, Clark TJH, Freedman S, Norman J (1969) The effect of muscular paralysis induced by tubocurarine on the duration and sensation of breath-holding during hypercapnia. Clin Sci 36:323–328

    PubMed  CAS  Google Scholar 

  20. Chonan T, Mulholland MB, Cherniack NS, Altose MD (1987) Effects of voluntarily constraining of thoracic displacement during hypercapnia. J Appl Physiol 63:1822–1828

    PubMed  CAS  Google Scholar 

  21. Comroe JH (1974) Physiology of respiration. Yearbook Medical Publishers, Chicago

    Google Scholar 

  22. Couser JF, Make BJ (1989) Transtracheal oxygen decreases inspired minute ventilation. Am Rev Respir Dis 139:627–631

    PubMed  Google Scholar 

  23. Cross BA, Guz A, Jain SK, Sietske A, Stevens J, Reynolds F (1976) The effect of anesthesia of the airway in dog and man: a study of respiratory reflexes, sensations and lung mechanics. Clin Sci 50:439–454

    CAS  Google Scholar 

  24. Demediuk B, Manning H, Lilly J, Basner R, Fenel V, Weinberger S, Weiss JW, Schwartzstein R (1990) Dissociation between breathlessness and respiratory effort. Am Rev Respir Dis 141:A551

    Google Scholar 

  25. Douglas NJ, White DP, Weil JV, Zwillich CW (1983) Effect of breathing route on ventilation and ventilatory drive. Respir Physiol 51:209–218

    Article  PubMed  CAS  Google Scholar 

  26. Dubuisson D, Melzak R (1976) Classification of clinical pain descriptions by multiple group discriminant analysis. Exp Neurol 51:480–487

    Article  PubMed  CAS  Google Scholar 

  27. El-Manshawi A, Killian KJ, Summers E, Jones NL (1986) Breathlessness during exercise with and without resistive loading. J Appl Physiol 61:896–905

    PubMed  CAS  Google Scholar 

  28. Fowler WS (1954) Breaking point of breathholding. J Appl Physiol 6:539–545

    PubMed  CAS  Google Scholar 

  29. Freedman S, Lane R, Guz A (1987) Breathlessness and respiratory mechanics during reflex or voluntary hyperventilation in patients with chronic airflow limitation. Clin Sci 73:311–318

    PubMed  CAS  Google Scholar 

  30. Gandevia SC, McCloskey DI (1976) Changes in the pattern of breathing caused by chest vibration. Respir Physiol 26:163–171

    Article  PubMed  CAS  Google Scholar 

  31. Guz A (1977) Respiratory sensations in man. Br Med Bull 33:175–177

    PubMed  CAS  Google Scholar 

  32. Hamilton RD, Winning AF, Perry A, Guz A (1987) Aerosol anesthesia increases hypercapnic ventilation and breathlessness in laryngectomized humans. J Appl Physiol 63:2286–2292

    PubMed  CAS  Google Scholar 

  33. Hida W, Susuki R, Kikuchi Y, Shmdoh C, Chonan T, Sasaki H, Takashima T (1987) Effect of local vibration on ventilatory response to hypercapnia in normal subjects. Bull Eur Physiopathol Respir 23:227–232

    PubMed  CAS  Google Scholar 

  34. Homma I (1980) Inspiratory inhibitory reflex caused by the chest wall vibration in man. Respir Physiol 39:345–353

    Article  PubMed  CAS  Google Scholar 

  35. Homma I, Eklund G, Hagbarth KE (1978) Respiration in man affected by TVR contractions elicited in inspiratory and expiratory intercostal muscles. Respir Physiol 35:335–348

    Article  PubMed  CAS  Google Scholar 

  36. Homma I, Nagai T, Sakai T, Ohashi M, Beppu M, Yonemoto K (1981) Effect of chest wall vibration on ventilation in patients with spinal cord lesion. J Appl Physiol 50:107–111

    PubMed  CAS  Google Scholar 

  37. Homma I, Obata T, Sibuya M, Uchida M (1984) Gate mechanism in breathlessness caused by chest wall vibration in humans. J Appl Physiol 56:8–11

    PubMed  CAS  Google Scholar 

  38. Ingram RH, Schilder DP (1967) Effect of pursed lips expiration on the pulmonary pressure-flow relationship in obstructive lung disease. Am Rev Respir Dis 96:381–388

    PubMed  Google Scholar 

  39. Killian KJ, Campbell EJM (1985) Dypsnea. In: Roussos C, Macklem PT (eds) The thorax. Marcel Dekker, New York, pp 787–828

    Google Scholar 

  40. Killian KJ, Gandevia SC, Summers E, Campbell EJM (1984) Effect of increased lung volume on perception of breathlessness, effort, and tension. J Appl Physiol 57:686–691

    PubMed  CAS  Google Scholar 

  41. Lane R, Adams L, Guz A (1987) Is low-level respiratory resistive loading during exercise perceived as breathlessness? Clin Sci 73:627–634

    PubMed  CAS  Google Scholar 

  42. Lane R, Cockroft A, Guz A (1987) Voluntary isocapnic hyperventilation and breathlessness during exercise in normal subjects. Clin Sci 73:519–523

    PubMed  CAS  Google Scholar 

  43. Liss HP, Grant JB (1988) The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 137:1285–1288

    PubMed  CAS  Google Scholar 

  44. Manning H, Schwartzstein R, Rand C, Basner R, Ringler J, Fenel V, Weinberger SE, Weiss JW (1989) Chest wall vibration reduces breathlessness in normals. Am Rev Respir Dis 139:A320

    Google Scholar 

  45. McBride B, Whitelaw WA (1981) A physiologic stimulus to upper airway receptors in humans. J Appl Physiol 51:1189–1197

    PubMed  CAS  Google Scholar 

  46. McCloskey DI, Gandevia S, Potter EK, Colebatch JG (1983) Muscle sense and effort: motor commands and judgements about muscular contractions. In: Desmedt JE (ed) Mechanisms in health and disease. Raven Press, New York, pp 151–167

    Google Scholar 

  47. Melzak R (1975) The McGill pain questionnaire: major properties and scoring methods. Pain 1:277–299

    Article  Google Scholar 

  48. Melzak R, Togerson WS (1971) On the language of pain. Anesthesiology 34:50–59

    Google Scholar 

  49. Mueller RE, Petty TL, Filley GF (1970) Ventilation and arterial blood gas changes induced by pursed lips breathing. J Appl Physiol 28:784–789

    PubMed  CAS  Google Scholar 

  50. Noble MIM, Eisele JH, Trenchard D, Guz A (1970) Effect of selective peripheral nerve blocks on respiratory sensations. In: Porter R (ed) Breathing: Hering-Breuer centenary symposium. Churchill, London, pp 233–251

    Chapter  Google Scholar 

  51. Noble MIM, Eisele JH, Frankel HL, Else W, Guz A (1971) The role of the diaphragm in the sensation of holding the breath. Clin Sci 41:275–283

    PubMed  CAS  Google Scholar 

  52. O’Donnell DE, Sanii R, Giesbrecht G, Younes M (1987) Effect of continuous positive airway pressure on respiratory sensation in patients with chronic obstructive pulmonary disease during submaximal exercise. Am Rev Respir Dis 138:1185–1191

    Google Scholar 

  53. O’Donnell DE, Sanii R, Anthonisen NR, Younes M (1988) Effect of dynamic airway compression on breathing pattern and respiratory sensation in severe chronic obstructive lung disease. Am Rev Respir Dis 138:1185–1191

    PubMed  Google Scholar 

  54. O’Neill PA, Stark RD, Morton PB (1985) Do prostaglandins have a role in breathlessness? Am Rev Respir Dis 132:22–24

    PubMed  Google Scholar 

  55. O’Neill PA, Stark RD, Allen SC, Stretton TB (1986) The relationship between breathlessness and ventilation during steady-state exercise. Bull Eur Physiopathol Respir 22:247–250

    PubMed  Google Scholar 

  56. Opie LH, Smith AC, Spaulding JMK (1959) Conscious appreciation of the effects produced by independent changes of ventilation, volume, and of end-tidal PCO2 in paralysed patients. J Physiol 149:494–499

    PubMed  CAS  Google Scholar 

  57. Orem J, Netick A (1986) Behavioral control of breathing in the cat. Brain Res 366:238–253

    Article  PubMed  CAS  Google Scholar 

  58. Patterson JL, Mullinax PF, Bain T, Kreuger JJ, Richardson DW (1962) Carbon dioxide induced dyspnea in a patient with respiratory muscle paralysis. Am J Med 32:811–816

    Article  Google Scholar 

  59. Remmers JE, Brooks JG, Tenney SM (1968) Effect of controlled ventilation on the tolerable limits of hypercapnia. Respir Physiol 4:78–90

    Article  PubMed  CAS  Google Scholar 

  60. Rigg JRA, Rebuck AS, Campbell EJM (1974) A study of factors influencing relief of discomfort in breathholding in normal subjects. Clin Sci 47:193–199

    CAS  Google Scholar 

  61. Rodenstein DO, Mercenier C, Stanescu DC (1985) Influence of the respiratory route on the resting breathing pattern in humans. Am Rev Respir Dis 131:163–166

    PubMed  CAS  Google Scholar 

  62. Savoy J, Dhingra S, Anthonisen NR (1982) Inhaled lidocaine aerosol changes resting human breathing pattern. Respir. Physiol 50:41–49

    Article  PubMed  CAS  Google Scholar 

  63. Schmidt RW, Wasserman K, Lillington GA (1964) The effect of air flow and oral pressure on the mechanics of breathing in patients with asthma and emphysema. Am Rev Respir Dis 90:564–571

    PubMed  CAS  Google Scholar 

  64. Schwartzstein RM, LaHive K, Pope A, Weinberger SE, Weiss JW (1987) Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis 136:58–61

    PubMed  CAS  Google Scholar 

  65. Schwartzstein RM, LaHive K, Pope A, Steinbrook RA, Leith DE, Weiss JW, Fenel V, Weinberger SE (1987) Detection of hypercapnia by normal subjects. Clin Sci 73:333–335

    PubMed  CAS  Google Scholar 

  66. Schwartzstein RM, Simon PM, Weiss JW, Fenel V, Weinberger SE (1989) Breathlessness induced by dissociation between ventilation and chemical drive. Am Rev Respir Dis 139:1231–1237

    PubMed  CAS  Google Scholar 

  67. Sciurba FC, Owens GR, Sanders MH, Griffith BP, Hardesty RL, Paradis IL, Costatino JP (1988) Evidence of an altered pattern of breathing during exercise in recipients of heart-lung transplants. N Engl J Med 319:1186–1192

    Article  PubMed  CAS  Google Scholar 

  68. Sempik A, Patrick JM (1980) The effect of thoracic vibration on ventilation and breath-holding in man. Respir Physiol 44:381–391

    Article  Google Scholar 

  69. Shannon R (1986) Reflexes from respiratory muscles and costovertebral joints. In: Fishman AP, Cherniack NS, Widdicombe JG, Geiger SR (eds) Handbook of physiology, vol 2. American Physiological Society, Bethesda, MD, pp 431–447

    Google Scholar 

  70. Simon P, Basner R, Schwartzstein RM, Weinberger SE, Fenel V, Weiss JW (1988) Oral mucosal stimulation modulates intensity of breathlessness induced in normal subjects. Am Rev Respir Dis 137:A387

    Google Scholar 

  71. Simon PM, Schwartzstein RM, Weiss JW, LaHive K, Fenel V, Teghtsoonian M, Weinberger SE (1989) Distinguishable sensations of breathlessness induced in normal volunteers. Am Rev Respir Dis 140:1021–1027

    PubMed  CAS  Google Scholar 

  72. Smith SM, Brown HO, Toman JEP, Goodman LS (1947) The lack of cerebral effects of d-tubocurarine. Anesthesiology 8:1–14

    CAS  PubMed  Google Scholar 

  73. Sperry RW (1950) Neural basis of the spontaneous optokinetic response produced by visual neural inversion. J Comp Physiol Psychol 45:482–489

    Article  Google Scholar 

  74. Stark RD (1988) Dyspnoea: assessment and pharmacological manipulation. Eur Respir J 1:280–287

    PubMed  CAS  Google Scholar 

  75. Stark RD, Morton PB, Sharman P, Percival PG, Lewis JA (1981) Effects of codeine on the respiratory responses to exercise in healthy subjects. Br J Clin Pharmacol 12:497–501

    PubMed  CAS  Google Scholar 

  76. Stark RD, Gambles SA, Lewis JA (1981) Methods to assess breathlessness in healthy subjects. Clin Sci 61:429–439

    PubMed  CAS  Google Scholar 

  77. Stark RD, O’Neill PA, Russell NJ, Heapy CG, Stretton TB (1985) Effects of small-particle aerosols of local anesthetic on dyspnea in patients with respiratory disease. Clin Sci 69:29–36

    PubMed  CAS  Google Scholar 

  78. Sullivan TY, DeWeese EL (1985) Lack of effect of airway anesthesia on hypoxic ventilation. J Appl Physiol 58:1698–1702

    Article  PubMed  CAS  Google Scholar 

  79. Sullivan TY, DeWeese EL, Yu PL, Aronoff GR (1986) Ventilatory response during CO2 inhalation after airway anesthesia with lidocaine. J Appl Physiol 61:2230–2237

    PubMed  CAS  Google Scholar 

  80. Sullivan TY, DeWeese EL, Yu PL, Aronoff GR (1987) Lung mechanics and neuromuscular output during CO2 inhalation after airway anesthesia. J Appl Physiol 63:2542–2548

    PubMed  CAS  Google Scholar 

  81. Taguchi O, Kikuchi Y, Hida W, Iwase N, Okabe S, Satoh M, Chonan T, Inone H, Takashima T (1989) Effects of airway anesthesia on dyspnea during bronchoconstriction and loaded breathing in normal subjects. Am Rev Respir Dis 139:A322

    Google Scholar 

  82. Thoman RL, Stoker GL, Ross JC (1966) The efficacy of pursed lips breathing in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 93:100–106

    PubMed  CAS  Google Scholar 

  83. Tiep BL, Burns M, Kao D, Madison R, Herrera J (1986) Pursed lips breathing training using ear oximetry. Chest 90:218–221

    Article  PubMed  CAS  Google Scholar 

  84. von Holst E (1954) Relations between the central nervous system and the peripheral organs. Br J Animal Behav 2:89–94

    Article  Google Scholar 

  85. Wesmiller SW, Hoffman LA, Sciurba FC, Ferson PF, Johnson JT, Dauber JH (1990) Exercise tolerance during nasal cannula and transtracheal oxygen delivery. Am Rev Respir Dis 141:789–791

    PubMed  CAS  Google Scholar 

  86. Whitelaw WA, McBride B, Amar J, Corbet K (1981) Respiratory neuromuscular output during breathholding. J Appl Physiol 50:435–443

    PubMed  CAS  Google Scholar 

  87. Winning AJ, Hamilton RD, Shea SA, Knott C, Guz A (1985) The effects of airway anesthesia on the control of breathing and the sensation of breathlessness in man. Clin Sci 68:215–225

    PubMed  CAS  Google Scholar 

  88. Woodcock AA, Gross ER, Gellert A (1981) Effects of dihydrocodeine, alcohol and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases. N Engl J Med 305:1611–1616

    PubMed  CAS  Google Scholar 

  89. Young IH, Daviskas E, Keena VA (1989) Effect of low dose nebulised morphine on exercise endurance in patients with chronic lung disease. Thorax 44:387–390

    Article  PubMed  CAS  Google Scholar 

  90. Zechman FW, Wiley RL (1986) Afferent inputs to breathing: respiratory sensation. In: Fishman AP, Cherniack NS, Widdicombe JG, Geiger SR (eds) Handbook of physiology, vol 2. American Physiological Society, Bethesda, MD, pp 449–474

    Google Scholar 

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Schwartzstein, R.M., Manning, H.L., Weiss, J.W. et al. Dyspnea: A sensory experience. Lung 168, 185–199 (1990). https://doi.org/10.1007/BF02719692

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