Chest
Volume 128, Issue 5, November 2005, Pages 3345-3349
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Clinical Investigations: RESPIRATORY SYMPTOMS
Differentiation Between the Sensory and Affective Dimension of Dyspnea During Resistive Load Breathing in Normal Subjects

https://doi.org/10.1378/chest.128.5.3345Get rights and content

Study objective: Dyspnea is the uncomfortable sensation of breathing and is an impairing symptom in a variety of diseases. Like pain, it motivates adaptive behavior to regain homeostasis, and both sensations share various characteristics. Whereas the realization of the multidimensionality of pain was a key contribution to pain research, little is known about a similar multidimensionality in the perception of dyspnea. The present study examined whether sensory and affective aspects of induced dyspnea can be differentiated.

Design: A controlled laboratory study.

Setting: Psychophysiologic laboratory of the Psychological Institute III, University of Hamburg, Germany.

Participants: Ten healthy volunteers aged 24 to 52 years (mean, 35 years).

Interventions: Dyspnea was induced by breathing through inspiratory resistive loads of increasing magnitude (0.99 to 2.33 kPa/L/s), alternating with episodes of unloaded breathing. Inspiratory time (Ti) and breathing frequency (f) were continuously monitored. The experienced intensity and unpleasantness of dyspnea were rated after each episode on separate visual analog scales (VASs), which were presented in permuted order. Intraindividual linear regression slopes were calculated separately for both dimensions and compared.

Measurements and results: Breathing through inspiratory resistive loads resulted in increases of VAS ratings for intensity and unpleasantness paralleled by increases in Tiand decreases inf(p = 0.012 and p = 0.003, respectively). The mean regression slope for perceived unpleasantness was higher than for perceived intensity (mean ± SD, 2.83 ± 1.28 and 2.11 ± 1.74, respectively; p = 0.032), indicating stronger increases of unpleasantness with increasing magnitude of resistive loads.

Conclusions: The results show that the sensory and affective dimension of experimentally induced dyspnea can be differentiated in healthy volunteers. The obtained multidimensionality of dyspnea converges with previous reports on similarities between dyspnea and pain. Implications for future studies on the perception of dyspnea are provided.

Section snippets

Participants

Ten healthy, white volunteers were studied.Table 1summarizes the mean baseline characteristics of the volunteers. Pregnancy, acute complaints of the respiratory tract, or any chronic medical conditions such as asthma, chronic pain, and sensory deficits were exclusion criteria. After giving written informed consent, volunteers underwent screening spirometry.15 Participants were free to withdraw at any time during the experiment. The study protocol was approved by the local ethical committee.

Measurement of Lung Function

Ventilation

As expected, breathing through inspiratory resistive loads induced a significant increase in Tiwhen compared to baseline conditions (2.16 ± 1.04 s and 1.56 ± 0.68 s, p = 0.012). This was paralleled by significant decreases inf during loaded breathing when compared to baseline conditions (13.05 ± 3.42 breaths/min and 14.64 ± 3.13 breaths/min, respectively; p = 0.003).

Perceived Sensations

VAS ratings for experienced intensity and unpleasantness of dyspnea showed no difference at baseline (0.6 ± 0.5 cm and 1.1 ± 1.1

DISCUSSION

Dyspnea and pain are both unpleasant, alarming physical sensations, resulting from interactions among multiple factors. Because of various similarities, the differentiation between the sensory and affective dimension of dyspnea has been suggested as being a promising avenue for research on dyspnea since a similar differentiation has been a cornerstone of pain research.6, 7, 14 Beside the development of widespread multidimensional pain assessment instruments and interventions, neuroimaging

CONCLUSION

In summary, our findings show that healthy volunteers are able to differentiate between the sensory and affective dimension of experimentally induced dyspnea. These results add further incidence to the perceptual similarities between dyspnea and pain and provide new strategies for future investigations into dyspnea.

ACKNOWLEDGMENTS

The authors thank Thomas Ritz, PhD, for helpful comments on a prior draft of this article.

REFERENCES (25)

  • Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO...
  • Global strategy for asthma management and prevention. NHLBI/WHO workshop report. Bethesda, MD: National Institutes of...
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