Chest
Volume 128, Issue 1, July 2005, Pages 345-354
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Reviews
Cortical Substrates for the Perception of Dyspnea

https://doi.org/10.1378/chest.128.1.345Get rights and content

Dyspnea is a common, unpleasant, and impairing symptom in various respiratory diseases and other diseases. Despite growing understanding of the multiple peripheral mechanisms giving rise to dyspnea, little is known about the cortical mechanisms underlying its perception. The results of neuroimaging studies have shown that distinct brain areas process the dyspneic sensation, among which the anterior insular seems to be the most important. Based on the findings of the first relevant neuroimaging studies, this review describes the cortical structures associated with the perception of dyspnea. Moreover, similarities to the perception of pain are discussed, and implications for future research are provided.

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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    We declare that we have not received any financial support for the present manuscript, that we are not involved in any organization with financial interest in the work to be addressed in this manuscript and that there is no other potential conflict of interest associated with this manuscript.

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