PT  - JOURNAL ARTICLE
AU  - Athénaïs Boucly
AU  - Capucine Morélot-Panzini
AU  - Gilles Garcia
AU  - Jason Weatherald
AU  - Xavier Jaïs
AU  - Laurent Savale
AU  - David Montani
AU  - Marc Humbert
AU  - Thomas Similowski
AU  - Olivier Sitbon
AU  - Pierantonio Laveneziana
TI  - Intensity and quality of exertional dyspnoea in patients with stable pulmonary hypertension
AID  - 10.1183/13993003.02108-2018
DP  - 2019 Jan 01
TA  - European Respiratory Journal
PG  - 1802108
4099  - http://erj.ersjournals.com/content/early/2019/10/31/13993003.02108-2018.short
4100  - http://erj.ersjournals.com/content/early/2019/10/31/13993003.02108-2018.full
AB  - Dynamic hyperinflation is observed during exercise in 60% of patients with clinically stable pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH), intensifying exertional dyspnoea.The impact of dynamic changes in respiratory mechanics during exercise on qualitative dimensions of dyspnoea in these patients has not been evaluated.Twenty-six patients (PAH n=17; CTEPH n=9) performed an incremental symptom-limited cycle exercise test. Ventilation (V’E), breathing pattern, operating lung volumes, and dyspnoea intensity were assessed throughout exercise. Dyspnoea quality was serially assessed during exercise using a 3-item questionnaire (dyspnoea descriptors). The inflection point of tidal volume (VT) relative to V’E was determined for each incremental test. Changes in inspiratory capacity (IC) during exercise defined two groups of patients: hyperinflators (65%) and non-hyperinflators (35%), respectively. Multidimensional characterisation of dyspnoea was performed after exercise using the Multidimensional Dyspnea Profile (MDP).In hyperinflators, IC decreased progressively throughout exercise by 0.36 L, while remaining stable in non-hyperinflators. The “work/effort” descriptor was most frequently selected throughout exercise in both types of patients (65% of all responses). At the VT/V’E inflection, “work/effort” plateaued while “unsatisfied inspiration” descriptors became selected predominantly only in hyperinflators (77% of all responses). In the affective domain, the emotion most frequently associated with dyspnoea was anxiety.In PH patients who develop hyperinflation during exercise, dyspnoea descriptors referring to unsatisfied inspiration become predominant following the VT/V’E inflection. As these descriptors are generally associated with more negative emotional experiences, delaying or preventing the VT/V’E inflection may have important implications for symptom management in PH patients.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Boucly reports personal fees and non-financial support from Actelion Pharmaceuticals, non-financial support from Bayer HealthCare, non-financial support from GlaxoSmithKline, personal fees and non-financial support from Merck, outside the submitted work.Conflict of interest: Dr. Morélot-Panzini reports personal fees from Astra-Zeneca, personal fees from Chiesi, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Philips, personal fees from ADEP, personal fees from SOS oxygene, outside the submitted work.Conflict of interest: Dr. garcia has nothing to disclose.Conflict of interest: Dr. Weatherald has nothing to disclose.Conflict of interest: Dr. JAÏS reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, grants, personal fees and non-financial support from Bayer HealthCare, grants, personal fees and non-financial support from GlaxoSmithKline, grants, personal fees and non-financial support from MSD, outside the submitted work.Conflict of interest: Dr. Savale reports grants and personal fees from Actelion Pharmaceuticals, grants and personal fees from Bayer HealthCare, personal fees from GlaxoSmithKline, personal fees from Merck, outside the submitted work.Conflict of interest: Dr. Montani reports grants and personal fees from Actelion Pharmaceuticals, grants and personal fees from Bayer HealthCare, personal fees from GlaxoSmithKline, personal fees from Novartis, personal fees from Pfizer, personal fees from BMS, outside the submitted work.Conflict of interest: Dr. Humbert reports personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from GSK, personal fees from Merck, from United Therapeutics, outside the submitted work.Conflict of interest: Dr. Similowski reports personal fees from AstraZeneca, personal fees from Boerhinger Ingelheim France, personal fees from GSK, personal fees and non-financial support from Novartis, personal fees from Lungpacer Inc., personal fees from TEVA, personal fees from Chiesi, personal fees from Invacare, outside the submitted work.Conflict of interest: Dr. SITBON reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, personal fees from Acceleron Pharmaceuticals, personal fees from Arena Pharmaceuticals, grants and personal fees from Bayer HealthCare, grants, personal fees and non-financial support from GlaxoSmithKline, personal fees from Gossamer Bio, grants and personal fees from Merck, outside the submitted work.Conflict of interest: Dr. Laveneziana reports personal fees from NOVARTIS France, personal fees from BOEHRINGER France, outside the submitted work.