Abstract
Asthma is a heterogeneous condition, with dyspnoea during exercise affecting individuals to a variable degree. This narrative review explores the mechanisms and measurement of exertional dyspnoea in asthma and summarises the available evidence for the efficacy of various interventions on exertional dyspnoea. Studies on the mechanisms of dyspnoea in asthma have largely utilised direct bronchoprovocation challenges, rather than exercise, which may invoke different physiological mechanisms. Thus, the description of dyspnoea during methacholine challenge can differ from what is experienced during daily activities, including exercise. Dyspnoea perception during exercise is influenced by many interacting variables, such as asthma severity and phenotype, bronchoconstriction, dynamic hyperinflation, respiratory drive and psychological factors. In addition to the intensity of dyspnoea, the qualitative description of dyspnoea may give important clues as to the underlying mechanism and may be an important endpoint for future interventional studies. There is currently little evidence demonstrating whether pharmacological or non-pharmacological interventions specifically improve exertional dyspnoea, which is an important area for future research.
Abstract
In asthma, mechanisms and management of exertional dyspnoea differ from those provoked by acute bronchoconstriction http://ow.ly/Dxfa30bPsTA
Footnotes
Previous articles in this series: No. 1: Dubé B-P, Agostoni P, Laveneziana P. Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors. Eur Respir Rev 2016; 25: 317–332. No. 2: O'Donnell DE, Elbehairy AF, Faisal A, et al. Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing. Eur Respir Rev 2016; 25: 333–347. No. 3: Bernhardt V, Babb TG. Exertional dyspnoea in obesity. Eur Respir Rev 2016; 25: 487–495. No. 4: Bonini M, Fiorenzano G. Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing. Eur Respir Rev 2017; 26: 160099.
Support statement: Jason Weatherald is the recipient of a joint European Respiratory Society/Canadian Thoracic Society Fellowship (LTRF 2015-4780). Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at err.ersjournals.com
Provenance: Commissioned article, peer reviewed.
- Received February 6, 2017.
- Accepted April 17, 2017.
- Copyright ©ERS 2017.
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