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Mechanisms of dyspnoea and its language in patients with asthma

¹ Dept of Internal Medicine, University of Florence, Florence, and ² Fondazione Don C. Gnocchi, Section of Respiratory Rehabilitation, Pozzolatico, Firenze, Italy.

CORRESPONDENCE: G. Scano, Dept of Internal Medicine, Section of Respiratory Medicine, Policlinico di Careggi, Viale Morgagni 85, 50134 Firenze, Italy. Fax: 39 055412867. E-mail: gscano{at}unifi.it

Keywords: Airway, asthma, dyspnoea, exercise, hyperinflation, methacholine

Received: July 9, 2005
Accepted November 21, 2005

This study hypothesises that regardless of the global score of dyspnoea intensity, different descriptors may be selected by asthmatic patients during short cardiopulmonary exercise test (sCPET) and methacholine (Mch) inhalation. It also examines whether different qualitative dyspnoea sensations can help explain the underlying mechanisms of the symptom.

Minute ventilation (V'_E), tidal volume (V_T) and inspiratory capacity (IC) were measured in 22 stable asthmatic patients, and the sensation of dyspnoea during Mch inhalation and sCPET was quantitatively (Borg scale) and qualitatively (descriptors) assessed. The work rate and oxygen uptake (V'_O2) were also measured during sCPET.

Airway obstruction and hyperinflation, as measured by IC reduction, were the best correlates for dyspnoea with Mch. During sCPET, changes in WR, V'_O2, V'_E and V_T significantly correlated with Borg score, with V'_E being the best predictor of dyspnoea; IC decreased in eight patients. Furthermore, chest tightness (68%) was the highest reported descriptor during Mch inhalation, whereas work/effort (72%) was the highest during sCPET.

In conclusion, obstruction/hyperinflation and work rate are highly reliable predictors of Borg rating of dyspnoea during methacholine inhalation and short cardiopulmonary exercise testing, respectively. Regardless of the global score of intensity dyspnoea, different descriptors may be selected by patients during short cardiopulmonary exercise testing and methacholine inhalation. Various qualities of dyspnoea result from different pathophysiological abnormalities.

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