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
References (108)
- et al.
The risk of hospitalization and near-fatal and fatal asthma in relation to the perception of dyspnea
Chest
(2002) - et al.
Acute asthma in adults: a review
Chest
(2004) - et al.
Perception of asthma
Lancet
(1976) Brain, breathing and breathlessness
Respir Physiol
(1997)- et al.
Air hunger from increased Pco2persists after complete neuromuscular block in humans
Respir Physiol
(1990) - et al.
Respiratory-associated thalamic activity is related to level of respiratory drive
Respir Physiol
(1992) - et al.
Descriptors of breathlessness in healthy individuals: distinct and separable constructs
Chest
(2000) - et al.
Dyspnea: the role of psychological processes
Clin Psychol Rev
(2004) - et al.
Symptom perception in pediatric asthma: relationship to functional morbidity and psychological factors
J Am Acad Child Adolesc Psychiatry
(1996) - et al.
The perception of dyspnea in patients with mild asthma
Chest
(2001)
Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli
Chest
Projection of phrenic nerve afferents to the cat sensorimotor cortex
Brain Res
Effects of vagal volleys on units of intralaminar and juxtalaminar thalamic nuclei in monkeys
Brain Res
Evoked cortical responses to vagal, laryngeal and facial afferents in monkeys under chloralose anaesthesia
Electroencephalogr Clin Neurophysiol
Projection of low-threshold afferents from human intercostal muscles to the cerebral cortex
Respir Physiol
Circuitry and functional aspects of the insular lobe in primates including humans
Brain Res Brain Res Rev
Connections of the rostral ventral respiratory neuronal cell group: an anterograde and retrograde tracing study in the rat
Brain Res Bull
Functional imaging of brain responses to pain. a review and meta-analysis
Neurophysiol Clin
The cortical representation of pain
Pain
The pulmonary manifestations of left heart failure
Chest
The McGill Pain Questionnaire: major properties and scoring methods
Pain
Dyspnea: mechanisms, assessment, and management; a consensus statement
Am J Respir Crit Care Med
Breathlessness in hospitalised adult patients
Postgrad Med J
Expert panel report 2: guidelines for the diagnosis and management of asthma
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO workshop report
Global strategy for asthma management and prevention: NHLBI/WHO workshop report
Evidence-based health policy-lessons from the global burden of disease study
Science
Symptomwahrnehmung beim Asthma bronchiale
Symptom perception and respiratory sensation in asthma
Am J Respir Crit Care Med
Blunted perception and death from asthma
N Engl J Med
Respiratory-related evoked potentials in children with life-threatening asthma
Am J Respir Crit Care Med
P3-specific amplitude reductions to respiratory and auditory stimuli in subjects with asthma
Am J Respir Crit Care Med
Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma
N Engl J Med
Respiratory sensations, cardiovascular control, kinaesthesia and transcranial stimulation during paralysis in humans
J Physiol
Neural substrates for the perception of acutely induced dyspnea
Am J Respir Crit Care Med
Pathophysiology of dyspnea
N Engl J Med
Breathlessness in humans activates insular cortex
Neuroreport
Oral mucosal stimulation modulates intensity of breathlessness induced in normal subjects
Am Rev Respir Dis
Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea
J Appl Physiol
Effect of lung volume on breath holding
J Appl Physiol
Effect of chest wall vibration on breathlessness in normal subjects
J Appl Physiol
Hypoxic and hypercapnic drives to breathe generate equivalent levels of air hunger in humans
J Appl Physiol
Effect of increased lung volume on perception of breathlessness, effort, and tension
J Appl Physiol
Respiratory-associated rhythmic firing of midbrain neurones in cats: relation to level of respiratory drive
J Physiol
Breathlessness induced by dissociation between ventilation and chemical drive
Am Rev Respir Dis
Distinguishable types of dyspnea in patients with shortness of breath
Am Rev Respir Dis
Cerebral cortex and respiration
Perception of increased resistance to breathing
Respiratory sensations in asthma: physiological and clinical implications
J Asthma
Respiratory sensations arising from pulmonary and chemoreceptor afferents
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2022, Biological PsychologyCitation Excerpt :Two dimensions underlying a dyspnea experience can be distinguished; a sensory dimension referring to the intensity, quality and time course of dyspnea sensations, and an affective dimension referring to perceived unpleasantness of dyspnea sensations and related evaluative/emotional responses (Banzett & Moosavi, 2001, 2017; Banzett, Pedersen, Schwartzstein, & Lansing, 2008; Lansing, Gracely, & Banzett, 2009; Scano, Gigliotti, Stendardi, & Gagliardi, 2013; von Leupoldt, Ambruzsova, Nordmeyer, Jeske, & Dahme, 2006; von Leupoldt & Dahme, 2005; von Leupoldt, Mertz et al., 2006). Both dimensions result from partly distinct neurobiological pathways for respectively sensory-discriminative (somatosensory cortex, associated thalamic nuclei and higher order association areas) and affective-motivational processing (amygdala, insular cortex and thalamic relay nuclei) (Davenport & Vovk, 2009; von Leupoldt & Dahme, 2005; von Leupoldt, Sommer et al., 2008). Although dimensions of intensity and unpleasantness typically correlate strongly, they can diverge to a certain extent in particular conditions (Walentynowicz, Witthöft, Raes, Van Diest, & Van den Bergh, 2018), as observed for example during physical exercise and resistive loaded breathing (von Leupoldt et al., 2010), rebreathing (Wan, Van Diest, De Peuter, Bogaerts, & Van den Bergh, 2009), and bronchoconstriction (De Peuter et al. 2007).
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