Chest
ReviewsCortical Substrates for the Perception of Dyspnea
Section snippets
Physiologic Mechanisms
Past research has shown that a variety of different input mechanisms might lead to the complex sensation of difficult breathing. Afferent signals from pulmonary vagal receptors in the upper and lower airways are one possible source that is triggered by bronchoconstrictions. Pulmonary stretch receptors in the airways smooth muscles are activated as the lung expands, type-J receptors in the walls of alveoli and capillaries are stimulated by increasing intrapulmonary pressure, and irritant
Psychological Mechanisms
Besides physiologic mechanisms, the role of psychological factors in the perception of breathlessness has been recognized,83839 but research on this topic is still at the beginning. To the present time, negative emotions have been shown to be associated predominantly with decreased accuracy of dyspnea perception.3840 Furthermore, a repressive-defensive coping style might be related to blunted symptom perception,4142 but some findings have not been fully conclusive.43 Psychopathologic
Cortical Representation of Dyspnea
Despite a growing understanding of the possible pathways leading to breathlessness, relatively little is known about higher brain centers in humans that process this sensation.20 In particular, the brain areas associated with the perception of the experience have not been well-explored.1819 This is in part attributable to a lack of adequate animal models properly simulating human dyspnea perception49 and, furthermore, is due to an absence of high-resolution imaging techniques, which allow a
Similarities Between Dyspnea and Pain Perception
It has been shown that the anterior insula is a crucial component within a larger brain network underlying the perception of dyspnea. However, it is not exclusively activated during respiratory sensations. Strong insular activation has been found in a variety of predominantly painful sensations (eg, heat, cold, and electrical stimulation)85868788 and during various other aversive sensations (eg, hunger, thirst, unpleasant odors, and negative emotions).84899091 Reiman and coworkers92 have
Implications for Future Research
Based on the various similarities between dyspnea and pain, the adoption of successful strategies and methods from pain research, which is much more advanced, for investigations into dyspnea has been suggested.893 A key contribution has been the realization of the multidimensionality of the pain sensation,9697 which has led to the development of highly useful pain measurement instruments such as the Schmerzempfindungsskala (SES)98 and the McGill Pain Questionnaire.99 Although the first attempts
Summary
Dyspnea is a common and unpleasant symptom in patients with a variety of pathologic states. The failure to perceive this multidimensional sensation might lead to severe or fatal attacks in obstructive respiratory diseases. Multiple peripheral, central, and psychological mechanisms contribute to breathlessness, but little is known about the cortical processing of its perception. Some findings have suggested the presence of deficits in these central cortical mechanisms, which might be responsible
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2020, Clinical Neurology and NeurosurgeryCitation Excerpt :Neuroimaging studies have shown that respiratory input signals are processed within the anterior insular cortex and associated operculum, anterior cingulate cortex, amygdala, and dorsolateral prefrontal cortex [36,37]. Input signals are processed in the cortex by two main pathways: discriminative processing that is related to awareness of intensity components and the structures involved in this pathway include brainstem medulla, and ventroposterior area of the thalamus, and affective processing, which is associated with qualitative components and feelings and begins with the relay of afferent information via the vagal pathway to several structures of the limbic system, such as amygdala [38,39]. Afferent signals are transmitted via the vagal nerve to the central nervous system (CNS) and are then sent to the amygdala and medial dorsal regions of the thalamus and finally ascend specific parts of the limbic system, including the insular and cingulate cortices [40,33].
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