1
|
Sandberg J, Sundh J, Anderberg P, Currow DC, Johnson M, Lansing R, Ekström M. Comparing recalled versus experienced symptoms of breathlessness ratings: An ecological assessment study using mobile phone technology. Respirology 2022; 27:874-881. [PMID: 35697350 PMCID: PMC9546302 DOI: 10.1111/resp.14313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/31/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Recall of breathlessness is important for clinical care but might differ from the experienced (momentary) symptoms. This study aimed to characterize the relationship between momentary breathlessness ratings and the recall of the experience. It is hypothesized that recall is influenced by the peak (worst) and end (most recent) ratings of momentary breathlessness (peak-end rule). METHODS This study used mobile ecological momentary assessment (mEMA) for assessing breathlessness in daily life through an application installed on participants' mobile phones. Breathlessness ratings (0-10 numerical rating scale) were recorded throughout the day and recalled each night and at the end of the week. Analyses were performed using regular and mixed linear regression. RESULTS Eighty-four people participated. Their mean age was 64.4 years, 60% were female and 98% had modified Medical Research Council (mMRC) ≥ 1. The mean number of momentary ratings of breathlessness provided was 7.7 ratings/participant/day. Recalled breathlessness was associated with the mean, peak and end values of the day. The mean was most closely associated with the daily recall. Associations were strong for weekly values: peak breathlessness (beta = 0.95, r2 = 0.57); mean (beta = 0.91, r2 = 0.53); and end (beta = 0.67, r2 = 0.48); p < 0.001 for all. Multivariate analysis showed that peak breathlessness had the strongest influence on the breathlessness recalled at the end of the week. CONCLUSION Over 1 week, recalled breathlessness is most strongly influenced by the peak breathlessness; over 1 day, it is mean breathlessness that participants most readily recalled.
Collapse
Affiliation(s)
- Jacob Sandberg
- Department of Clinical Sciences, Division of Respiratory Medicine & AllergologyLund UniversityLundSweden
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Peter Anderberg
- Department of HealthBlekinge Institute of TechnologyKarlskronaSweden
| | - David C. Currow
- Wolfson Palliative Care Research Centre, Hull York Medical SchoolUniversity of HullHullUK
- IMPACCT, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical SchoolUniversity of HullHullUK
| | - Robert Lansing
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Magnus Ekström
- Department of Clinical Sciences, Division of Respiratory Medicine & AllergologyLund UniversityLundSweden
| |
Collapse
|
2
|
Holland AE, Bondarenko J. Breathlessness: Remembering the worst of it. Respirology 2022; 27:806-807. [PMID: 35821602 DOI: 10.1111/resp.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Anne E Holland
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Fukushi I, Pokorski M, Okada Y. Mechanisms underlying the sensation of dyspnea. Respir Investig 2020; 59:66-80. [PMID: 33277231 DOI: 10.1016/j.resinv.2020.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 01/17/2023]
Abstract
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. It is a common symptom among patients with respiratory diseases that reduces daily activities, induces deconditioning, and is self-perpetuating. Although clinical interventions are needed to reduce dyspnea, its underlying mechanism is poorly understood depending on the intertwined peripheral and central neural mechanisms as well as emotional factors. Nonetheless, experimental and clinical observations suggest that dyspnea results from dissociation or a mismatch between the intended respiratory motor output set caused by the respiratory neuronal network in the lower brainstem and the ventilatory output accomplished. The brain regions responsible for detecting the mismatch between the two are not established. The mechanism underlying the transmission of neural signals for dyspnea to higher sensory brain centers is not known. Further, information from central and peripheral chemoreceptors that control the milieu of body fluids is summated at higher brain centers, which modify dyspneic sensations. The mental status also affects the sensitivity to and the threshold of dyspnea perception. The currently used methods for relieving dyspnea are not necessarily fully effective. The search for more effective therapy requires further insights into the pathophysiology of dyspnea.
Collapse
Affiliation(s)
- Isato Fukushi
- Faculty of Health Sciences, Uekusa Gakuen University, 1639-3 Ogura-cho, Wakaba-ku, Chiba, 264-0007, Japan; Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan.
| | - Mieczyslaw Pokorski
- Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan; Faculty of Health Sciences, The Jan Dlugosz University in Czestochowa, 4/8 Jerzego Waszyngtona Street, 42-200, Czestochowa, Poland
| | - Yasumasa Okada
- Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Breathlessness debilitates countless people with a wide range of common diseases. For some people, the experience of breathlessness is poorly explained by the findings of medical tests. This disparity complicates diagnostic and treatment options and means that disease-modifying treatments do not always have the expected effect upon symptoms. These observations suggest that brain processing of respiratory perceptions may be somewhat independent of disease processes. This may help to explain the dissonance observed in some patients between physical disease markers and the lived experience of breathlessness. RECENT FINDINGS A body of breathlessness research using functional neuroimaging has identified a relatively consistent set of brain areas that are associated with breathlessness. These areas include the insula, cingulate and sensory cortices, the amygdala and the periaqueductal gray matter. We interpret these findings in the context of new theories of perception that emphasize the importance of distributed brain networks. Within this framework, these perceptual networks function by checking an internal model (a set of expectations) against peripheral sensory inputs, instead of the brain acting as a passive signal transducer. Furthermore, other factors beyond the physiology of breathlessness can influence the system. SUMMARY A person's expectations and mood are major contributors to the function of the brain networks that generate perceptions of breathlessness. Breathlessness, therefore, arises from inferences made by the brain's integration of both expectations and sensory inputs. By better understanding individual differences across these contributing perceptual factors, we will be better poised to develop targeted and individualized treatments for breathlessness that could complement disease-modifying therapies.
Collapse
Affiliation(s)
- Lucy L. Marlow
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Olivia K. Faull
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Sarah L. Finnegan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Sandberg J, Ekström M. Differences between experienced and recalled breathlessness: a review. Curr Opin Support Palliat Care 2019; 13:161-166. [PMID: 31365460 DOI: 10.1097/spc.0000000000000448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Experienced breathlessness and recalled breathlessness are two different entities, which may be associated with different factors and might have different impacts on function for the individual. The aim was to review the knowledge from the last 2 years concerning experienced breathlessness and recalled breathlessness and related factors. RECENT FINDINGS Experienced breathlessness was most often induced or measured during exercise testing in a lab environment using a modified Borg scale. It was associated with both psychological factors, such as social rejection, presence of others, psychosocial stress and prenatal exposure to stress, as well as physical factors, such as hypoxia and frequent exacerbations.Recalled breathlessness was most often measured in epidemiological studies, most commonly using the modified Medical Research Council scale. It was associated with lung volumes, overweight, exercise training, frailty, smoking, personality traits, behavior and marital and occupational status. SUMMARY No studies during the review period had directly compared experienced breathlessness and recalled breathlessness. Several factors were related to either experienced breathlessness or recalled breathlessness but no clear differences between factors were found in this review. There is a need for comparative studies using the same measurement methods and in the same settings in order to examine their relation.
Collapse
Affiliation(s)
- Jacob Sandberg
- Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden
| | | |
Collapse
|
6
|
|
7
|
Sandberg J, Lansing R, Anderberg P, Currow D, Sundh J, Ahmadi Z, Palmqvist S, Ekström M. Relating Experienced To Recalled breathlessness Observational (RETRO) study: a prospective study using a mobile phone application. BMJ Open Respir Res 2019; 6:e000370. [PMID: 30956800 PMCID: PMC6424247 DOI: 10.1136/bmjresp-2018-000370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/05/2018] [Indexed: 12/25/2022] Open
Abstract
Background Breathlessness, the subjective sensation of breathing discomfort, is common and appears in the daily life of people with cardiorespiratory diseases. Physicians often rely on patient's history based on symptom recall. The relation between recalled and experienced breathlessness is still poorly understood. This paper presents the protocol for a study primarily aimed at evaluating the relationship between experienced breathlessness and (1) recalled breathlessness and (2) predicted future breathlessness. Methods A mobile phone application will be used to collect data during daily life. Medically stable participants, ≥18 years of age with mean daily breathlessness of Numerical Rating Scale (NRS) 3/10 and able to use a mobile phone with internet will rate their breathlessness intensity on a 0-10 NRS prompted the user several times daily for 1 week. Participants will recall their breathlessness each day and week. Multivariable random effects regression models will be used for statistical analyses. Results Results of the study will be submitted for publication in peer-reviewed journals and presented at relevant conferences. Discussion This protocol describes a study aimed at investigating previously unknown areas of the experience and recall of breathlessness using a new method of data collection. Registration details Prospectively registered with ClinicalTrials.gov (Nr: NCT03468205). Ethics and dissemination The study has received ethical approval from the Regional Ethical Review Board Lund (DNr 2017/149). After a general study information including that participation is entirely voluntary, participants will answer the eligibility criteria and be asked to consent to participate before entering the study questions. Written informed consent to participate will be obtained for participants in the clinical sub-cohort. Participation can be discontinued at the discretion of the participant in which case no further data will be collected.
Collapse
Affiliation(s)
- Jacob Sandberg
- Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Robert Lansing
- Department of Psychology, University of Arizona Tucson, Arizona, USA
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - David Currow
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Zainab Ahmadi
- Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Sweden, Lund, University, Neurology Clinic, Skåne University Hospital, Sweden, Europe
| | - Magnus Ekström
- Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| |
Collapse
|
8
|
Williams MT, John D, Frith P. Comparison of the Dyspnoea-12 and Multidimensional Dyspnoea Profile in people with COPD. Eur Respir J 2016; 49:13993003.00773-2016. [DOI: 10.1183/13993003.00773-2016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/26/2016] [Indexed: 11/05/2022]
Abstract
We directly compared convergent, discriminant and concurrent validity of the Dyspnoea-12 (D-12) and Multidimensional Dyspnoea Profile (MDP) in people with chronic obstructive pulmonary disease.Breathlessness measures (D-12, MDP, visual analogue scales and descriptors) were completed for two focal periods (daily life and end of walk test). Instrument structure (D-12 and MDP item grouping) was assessed with factor analysis. Differences between airflow severity stage and focal periods (ANOVA, t-test and Chi-squared test), associations between D-12 and MDP (r, r2 for static pulmonary function, 6-min walk test and self-reported measures of impairment) and individual consistency for comparable items of the D-12 and MDP (McNemar's test) were assessed.In 84 participants (mean±sd age 70±9 years, 47 males, forced expiratory volume in 1 s 48±17% predicted), item groupings were confirmed for both focal periods. Developer-recommended single and subdomain scores were highly correlated, and demonstrated similar convergent, discriminant and concurrent validity. Individual consistency differed between the D-12 and MDP according to item/item groups.At the level of developer-recommended single and subdomain scores, the D-12 and MDP share similar psychometric properties, but these instruments serve different purposes, do not assess the same sensations or emotions and are not interchangeable.
Collapse
|
9
|
Williams MT, Gerlach Y, Moseley L. The 'survival perceptions': time to put some Bacon on our plates? J Physiother 2012; 58:73-5. [PMID: 22613235 DOI: 10.1016/s1836-9553(12)70085-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
10
|
Parshall MB, Meek PM, Sklar D, Alcock J, Bittner P. Test-retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study. BMC Emerg Med 2012; 12:6. [PMID: 22624887 PMCID: PMC3464619 DOI: 10.1186/1471-227x-12-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 05/24/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Dyspnea is among the most common reasons for emergency department (ED) visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients. METHODS Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154) completed the Multidimensional Dyspnea Profile (MDP) several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68). The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP) or at the time of administration ("now" MDP). The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA) with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach's alpha. Test-retest reliability was assessed with intraclass correlation coefficients (ICCs) for absolute agreement for individual items and domains. RESULTS PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach's alpha = .89 to .94; Emotional Response, 5 items; Cronbach's alpha = .81 to .85). Test-retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66) and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively). CONCLUSIONS During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for individual items and the two domains, that a time lag between arrival and questionnaire administration does not critically affect recall of perceptual and emotional characteristics immediately prior to the visit. However, test-retest reliability of recall over a 4- to 6-week interval is poor for individual items and significantly attenuated for the two domains.
Collapse
|
11
|
Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O'Donnell DE. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012; 185:435-52. [PMID: 22336677 PMCID: PMC5448624 DOI: 10.1164/rccm.201111-2042st] [Citation(s) in RCA: 1109] [Impact Index Per Article: 92.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. PURPOSE The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea. METHODS An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members. RESULTS Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. CONCLUSIONS Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.
Collapse
|
12
|
Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O'Donnell DE. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012. [PMID: 22336677 DOI: 10.1164/rccm.201111–2042st] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. PURPOSE The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea. METHODS An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members. RESULTS Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. CONCLUSIONS Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.
Collapse
|
13
|
Moore RP, Berlowitz DJ. Dyspnoea and oxygen therapy in chronic obstructive pulmonary disease. PHYSICAL THERAPY REVIEWS 2011. [DOI: 10.1179/1743288x11y.0000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
14
|
Williams M, Cafarella P, Olds T, Petkov J, Frith P. Affective Descriptors of the Sensation of Breathlessness Are More Highly Associated With Severity of Impairment Than Physical Descriptors in People With COPD. Chest 2010; 138:315-22. [DOI: 10.1378/chest.09-2498] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
15
|
Current World Literature. Curr Opin Support Palliat Care 2010; 4:111-20. [DOI: 10.1097/spc.0b013e32833a1dfc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|