1
|
Peiffer C. Puzzled by dysfunctional breathing disorder(s)? Consider the Bayesian brain hypothesis! Front Neurosci 2023; 17:1270556. [PMID: 37877012 PMCID: PMC10593455 DOI: 10.3389/fnins.2023.1270556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 10/26/2023] Open
Abstract
There is currently growing clinical concern regarding dysfunctional breathing disorder(s) (DBD), an umbrella term for a set of multidimensional clinical conditions that are characterized by altered breathing pattern associated with a variety of intermittent or chronic symptoms, notably dyspnea, in the absence or in excess of, organic disease. However, several aspects of DBD remain poorly understood and/or open to debate, especially the inconsistent relationship between the array of experienced symptoms and their supposedly underlying mechanisms. This may be partly due to a more general problem, i.e., the prevailing way we conceptualize symptoms. In the present article, after a brief review of the different aspects of DBD from the current perspective, I submit a call for considering DBD under the innovating perspective of the Bayesian brain hypothesis, i.e., a potent and novel model that fundamentally changes our views on symptom perception.
Collapse
Affiliation(s)
- Claudine Peiffer
- Dyspnea Clinic, Department of Physiology, University Children Hospital Robert Debré (AP-HP), Paris, France
| |
Collapse
|
2
|
Bokov P, Peiffer C, Gallego J, Pautrat J, Matrot B, Delclaux C. A decrease in plant gain, namely CO 2 stores, characterizes dysfunctional breathing whatever its subtype in children. Front Physiol 2023; 14:1217391. [PMID: 37469562 PMCID: PMC10352948 DOI: 10.3389/fphys.2023.1217391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Background: Whether dysfunctional breathing (DB) subtype classification is useful remains undetermined. The hyperventilation provocation test (HVPT) is used to diagnose DB. This test begins with a 3-min phase of hyperventilation during which fractional end-tidal CO2 (FETCO2) decreases that could be an assessment of plant gain, which relies on CO2 stores. Our aim was to assess 1) whether the children suffering from different subtypes of DB exhibit decreased plant gain and 2) the relationships between HVPT characteristics and plant gain. Methods: We retrospectively selected 48 children (median age 13.5 years, 36 females, 12 males) who exhibited during a cardiopulmonary exercise test either alveolar hyperventilation (transcutaneous PCO2 < 30 mmHg, n = 6) or inappropriate hyperventilation (increased VE'/V'CO2 slope) without hypocapnia (n = 18) or dyspnea without hyperventilation (n = 18) compared to children exhibiting physiological breathlessness (dyspnea for sports only, n = 6). These children underwent tidal-breathing recording (ventilation and FETCO2 allowing the calculation of plant gain) and a HVPT. Results: The plant gain was significantly higher in the physiological group as compared to the dyspnea without hyperventilation group, p = 0.024 and hyperventilation without hypocapnia group, p = 0.008 (trend for the hyperventilation with hypocapnia group, p = 0.078). The slope of linear decrease in FETCO2 during hyperventilation was significantly more negative in physiological breathlessness group as compared to hyperventilation without hypocapnia group (p = 0.005) and dyspnea without hyperventilation group (p = 0.049). Conclusion: The children with DB, regardless of their subtype, deplete their CO2 stores (decreased plant gain), which may be due to intermittent alveolar hyperventilation, suggesting the futility of our subtype classification.
Collapse
Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique -Centre du Sommeil—CRMR Hypoventilations Alvéolaires Rares, AP-HP, Hôpital Robert Debré, INSERM NeuroDiderot, Université de Paris, Paris, France
| | - Claudine Peiffer
- Service de Physiologie Pédiatrique, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Jorge Gallego
- INSERM NeuroDiderot, Université de Paris, Paris, France
| | - Jade Pautrat
- Service de Physiologie Pédiatrique, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Boris Matrot
- INSERM NeuroDiderot, Université de Paris, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique -Centre du Sommeil—CRMR Hypoventilations Alvéolaires Rares, AP-HP, Hôpital Robert Debré, INSERM NeuroDiderot, Université de Paris, Paris, France
| |
Collapse
|
3
|
Gouzi F, Dubois-Gamez AS, Lacoude P, Abdellaoui A, Hédon C, Charriot J, Boissin C, Vachier I, Hayot M, Molinari N, Bourdin A. Feasibility of a nasal breathing training during pulmonary rehabilitation. A pilot randomized controlled study. Respir Physiol Neurobiol 2023; 308:103987. [PMID: 36372120 DOI: 10.1016/j.resp.2022.103987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Hyperventilation syndrome (HVS) is a common source of dyspnea and disability. While pulmonary rehabilitation (PR) including breathing exercises is indicated, randomized controlled trial are warranted to recommend one type of breathing exercise than another. We aimed to compare during PR, the effect of 5 sessions of nasal ventilation exercise (NV+PR) versus voluntary hypoventilation (vHV+PR) on exercise dyspnea (primary outcome) and capacity and health-related quality of life in patients. In this open label randomized controlled trial, 19 HVS patients (age=48.3 ± 15.2 y.o, female/male=18/1, Nijmegen score=33 ± 7.7) were randomized in a NV+PR (n = 9) or vHV+PR (n = 10) group. Modified Medical Research Council (mMRC) dyspnea, 6-minute walking distance (6MWD) with nasal/oral ventilation were assessed before and after 3 months of PR, and questionnaires (Nijmegen, VQ-11). There was a significant effect of PR of but no significant difference between groups in the improvements of dyspnea@max exercise (time effect (T): p < 0.01; group (G): p = 0.63; group*time interaction (G*T): p = 0.49), mMRC dyspnea (T: p < 0.01; G: p = 0.45; G*T: p = 0.62), 6MWD (T: p < 0.05; G: p = 0.36; G*T: p = 0.31), VQ-11 (T: p < 0.001; G: p = 0.16; G*T: p = 0.09) and plasma HCO3- (T: p < 0.05; G: p = 0.93; G*T; p = 0.36), Yet, Nijmegen score (T: p < 0.01; G: p = 0.32; G*T: p < 0.05) improvement was larger in NV+PR group. The exercise oronasal breathing shift during the 6MWT was significantly delayed in all patients (T: p < 0.05; G: p = 0.30; G*T: p = 0.32) and positively correlated with plasma HCO3-(r = 0.42; p < 0.05). Nasal exercise was not superior versus voluntary hypoventilation during PR in HVS patients. Yet, nasal exercise appeared feasible, leading to acquisition of a nasal breathing pattern during walking, improvement of PR outcomes and ventilatory alkalosis. The link between nasal breathing and hyperventilation is discussed in the light of the nasal ventilation rhythm in the limbic system and its role on the limbic emotional and ventilatory functions.
Collapse
Affiliation(s)
- F Gouzi
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France.
| | - A S Dubois-Gamez
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - P Lacoude
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - A Abdellaoui
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - C Hédon
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - J Charriot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - C Boissin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - I Vachier
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - M Hayot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - N Molinari
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - A Bourdin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| |
Collapse
|
4
|
Peiffer C, Pautrat J, Benzouid C, Fuchs-Climent D, Buridans-Travier N, Houdouin V, Bokov P, Delclaux C. Diagnostic tests and subtypes of dysfunctional breathing in children with unexplained exertional dyspnea. Pediatr Pulmonol 2022; 57:2428-2436. [PMID: 35773227 DOI: 10.1002/ppul.26052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inappropriate hyperventilation during exercise may be a specific subtype of dysfunctional breathing (DB). OBJECTIVE To assess whether Nijmegen questionnaire and hyperventilation provocation test (HVPT) are able to differentiate inappropriate hyperventilation from other DB subtypes in children with unexplained exertional dyspnea, and normal spirometry and echocardiography. METHODS The results were compared between a subgroup of 25 children with inappropriate hyperventilation (increased V'E/V'CO2 slope during a cardiopulmonary exercise test (CPET)) and an age and sex matched subgroup of 25 children with DB without hyperventilation (median age, 13.5 years; 36 girls). Anxiety was evaluated using State-Trait Anxiety Inventory for Children questionnaire. RESULTS All children were normocapnic (at rest and peak exercise) and the children with hyperventilation had lower tidal volume/vital capacity on peak exercise (shallow breathing). The Nijmegen score correlated positively with dyspnea during the CPET and the HVPT (p = 0.001 and 0.010, respectively) and with anxiety score (p = 0.022). The proportion of children with a positive Nijmegen score (≥19) did not differ between hyperventilation (13/25) and no hyperventilation (14/25) groups (p = 0.777). Fractional end-tidal CO2 (FETCO2 ) at 5-min recovery of the HVPT was < 90% baseline in all children (25/25) of both subgroups. Likewise, there was no significant difference between the two subgroups for other indices of HVPT (FETCO2 at 3-min recovery and symptoms during the test). CONCLUSION The validity of the Nijmegen questionnaire and the HVPT to discriminate specific subtypes of dysfunctional breathing, as well as the relevance of the inappropriate hyperventilation subtype itself may both be questioned.
Collapse
Affiliation(s)
- Claudine Peiffer
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, Paris, France
| | - Jade Pautrat
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, Paris, France
| | - Chérine Benzouid
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, Paris, France
| | | | | | | | - Plamen Bokov
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris Cité, Paris, France
| | - Christophe Delclaux
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris Cité, Paris, France
| |
Collapse
|
5
|
Oku Y. Temporal variations in the pattern of breathing: techniques, sources, and applications to translational sciences. J Physiol Sci 2022; 72:22. [PMID: 36038825 DOI: 10.1186/s12576-022-00847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022]
Abstract
The breathing process possesses a complex variability caused in part by the respiratory central pattern generator in the brainstem; however, it also arises from chemical and mechanical feedback control loops, network reorganization and network sharing with nonrespiratory motor acts, as well as inputs from cortical and subcortical systems. The notion that respiratory fluctuations contain hidden information has prompted scientists to decipher respiratory signals to better understand the fundamental mechanisms of respiratory pattern generation, interactions with emotion, influences on the cortical neuronal networks associated with cognition, and changes in variability in healthy and disease-carrying individuals. Respiration can be used to express and control emotion. Furthermore, respiration appears to organize brain-wide network oscillations via cross-frequency coupling, optimizing cognitive performance. With the aid of information theory-based techniques and machine learning, the hidden information can be translated into a form usable in clinical practice for diagnosis, emotion recognition, and mental conditioning.
Collapse
Affiliation(s)
- Yoshitaka Oku
- Division of Physiome, Department of Physiology, Hyogo Medical University, Nishinomiya, Hyogo, 663-8501, Japan.
| |
Collapse
|
6
|
Mancini DM, Brunjes DL, Lala A, Trivieri MG, Contreras JP, Natelson BH. Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post-Coronavirus Disease. JACC. HEART FAILURE 2021; 9:927-937. [PMID: 34857177 PMCID: PMC8629098 DOI: 10.1016/j.jchf.2021.10.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022]
Abstract
Objectives The authors used cardiopulmonary exercise testing (CPET) to define unexplained dyspnea in patients with post-acute sequelae of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection (PASC). We assessed participants for criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Background Approximately 20% of patients who recover from coronavirus disease (COVID) remain symptomatic. This syndrome is named PASC. Its etiology is unclear. Dyspnea is a frequent symptom. Methods The authors performed CPET and symptom assessment for ME/CFS in 41 patients with PASC 8.9 ± 3.3 months after COVID. All patients had normal pulmonary function tests, chest X-ray, and chest computed tomography scans. Peak oxygen consumption (peak VO2), slope of minute ventilation to CO2 production (VE/VCO2 slope), and end tidal pressure of CO2 (PetCO2) were measured. Ventilatory patterns were reviewed with dysfunctional breathing defined as rapid erratic breathing. Results Eighteen men and 23 women (average age: 45 ± 13 years) were studied. Left ventricular ejection fraction was 59% ± 9%. Peak VO2 averaged 20.3 ± 7 mL/kg/min (77% ± 21% predicted VO2). VE/VCO2 slope was 30 ± 7. PetCO2 at rest was 33.5 ± 4.5 mm Hg. Twenty-four patients (58.5%) had a peak VO2 <80% predicted. All patients with peak VO2 <80% had a circulatory limitation to exercise. Fifteen of 17 patients with normal peak VO2 had ventilatory abnormalities including peak respiratory rate >55 (n = 3) or dysfunctional breathing (n = 12). For the whole cohort, 88% of patients (n = 36) had ventilatory abnormalities with dysfunctional breathing (n = 26), increased VE/VCO2 (n = 17), and/or hypocapnia PetCO2 <35 (n = 25). Nineteen patients (46%) met criteria for ME/CFS. Conclusions Circulatory impairment, abnormal ventilatory pattern, and ME/CFS are common in patients with PASC. The dysfunctional breathing, resting hypocapnia, and ME/CFS may contribute to symptoms. CPET is a valuable tool to assess these patients.
Collapse
Affiliation(s)
- Donna M Mancini
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Danielle L Brunjes
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anuradha Lala
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Johanna P Contreras
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin H Natelson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
7
|
Stewart JM, Pianosi PT. Postural orthostatic tachycardia syndrome: A respiratory disorder? Curr Res Physiol 2021; 4:1-6. [PMID: 34746821 PMCID: PMC8562237 DOI: 10.1016/j.crphys.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/28/2022] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) is a disorder epitomized by the story of the blind men and the elephant. Patients may see primary care internists or pediatricians due to fatigue, be referred to neurologists for “spells”, to cardiologists for evaluation of pre-syncope or chest pain, to gastroenterologists for nausea or dyspepsia, and even pulmonologists for dyspnea. Adoption of a more systematic approach to their evaluation and better characterization of patients has led to greater understanding of comorbidities, hypotheses prompting mechanistic investigations, and pharmacologic trials. Recent work has implicated disordered sympathetic nervous system activation in response to central (thoracic) hypovolemia. It is this pathway that leads one zero in on a putative focal point from which many of the clinical manifestations can be explained – specifically the carotid body. Despite heterogeneity in etiopathogenesis of a POTS phenotype, we propose that aberrant activation and response of the carotid body represents one potential common pathway in evolution. To understand this postulate, one must jettison isolationist or reductionist ideas of chemoreceptor and baroreceptor functions of the carotid body or sinus, respectively, and consider their interaction and interdependence both locally and centrally where some of its efferents merge. Doing so enables one to connect the dots and appreciate origins of diverse manifestations of POTS, including dyspnea for which the concept of neuro-mechanical uncoupling is wanting, thereby expanding our construct of this symptom. This perspective expounds our premise that POTS has a prominent respiratory component. Dyspnea affects ~⅓ patients with postural orthostatic tachycardia syndrome (POTS). POTS is characterized by thoracic hypovolemia and compromised cephalad perfusion when upright. Carotid body and adjacent carotid sinus mediate chemo- and baro- reflexes, respectively. These are not independent and stimulation of either activates sympathetic discharge. We speculate that carotid body mediates hyperventilation and dyspnea in POTS.
Collapse
Affiliation(s)
- Julian M Stewart
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA.,Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Paolo T Pianosi
- Department of Pediatrics, Division of Pulmonary & Sleep Medicine, University of Minnesota, VCRC, 401 E River Parkway Rm 413, Minneapolis, UK
| |
Collapse
|
8
|
van den Bosch OFC, Alvarez-Jimenez R, de Grooth HJ, Girbes ARJ, Loer SA. Breathing variability-implications for anaesthesiology and intensive care. Crit Care 2021; 25:280. [PMID: 34353348 PMCID: PMC8339683 DOI: 10.1186/s13054-021-03716-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
The respiratory system reacts instantaneously to intrinsic and extrinsic inputs. This adaptability results in significant fluctuations in breathing parameters, such as respiratory rate, tidal volume, and inspiratory flow profiles. Breathing variability is influenced by several conditions, including sleep, various pulmonary diseases, hypoxia, and anxiety disorders. Recent studies have suggested that weaning failure during mechanical ventilation may be predicted by low respiratory variability. This review describes methods for quantifying breathing variability, summarises the conditions and comorbidities that affect breathing variability, and discusses the potential implications of breathing variability for anaesthesia and intensive care.
Collapse
Affiliation(s)
- Oscar F C van den Bosch
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ricardo Alvarez-Jimenez
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Harm-Jan de Grooth
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Stephan A Loer
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Tiotiu A, Ioan I, Poussel M, Schweitzer C, Kafi SA. Comparative analysis between available challenge tests in the hyperventilation syndrome. Respir Med 2021; 179:106329. [PMID: 33610050 DOI: 10.1016/j.rmed.2021.106329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The hyperventilation syndrome (HVS) is characterized by somatic/ psychological symptoms due to sustained hypocapnia and respiratory alkalosis without any organic disease. OBJECTIVE The purpose of this study was to compare ventilatory parameters and symptoms reproducibility during the hyperventilation provocation test (HVPT) and cardiopulmonary exercise test (CPET) as diagnostic tools in patients with HVS, and to identify the most frequent etiologies of the HVS by a systematic assessment. METHODS After exclusion of organic causes, 59 patients with HVS according to Nijmegen's questionnaire (NQ) score ≥23 with associated hypocapnia (PaCO2/PETCO2<35 mm Hg) were studied. RESULTS The most frequent comorbidities of HVS were anxiety and asthma (respectively 95% and 73% of patients). All patients described ≥3 symptoms of NQ during the HVPT vs 14% of patients during the CPET (p<0.01). For similar maximal ventilation (61 L/min during HVPT vs 60 L/min during CPET), the median level of PETCO2 decreased from 30 mmHg at baseline to 15 mmHg during hyperventilation and increased from 31 mmHg at baseline to 34 mmHg at peak exercise (all p<0.01). No significant difference for the ventilatory parameters was found between patients with HVS (n = 16) and patients with HVS + asthma (n = 43). CONCLUSIONS In term of symptoms reproducibility, HVPT is a better diagnostic tool than CPET for HVS. An important proportion of patients with HVS has an atypical asthma previously misdiagnosed. The exercise-induced hyperventilation did not induce abnormal reduction in PETCO2, suggesting that the exercise could be a therapeutic tool in HVS.
Collapse
Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, 9 Rue du Morvan, 54511, Vandoeuvre-lès-Nancy, France; Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH) Research Unit, University of Lorraine, 9 Avenue de la Forêt de Haye, 54505, Vandoeuvre-lès-Nancy, France.
| | - Iulia Ioan
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH) Research Unit, University of Lorraine, 9 Avenue de la Forêt de Haye, 54505, Vandoeuvre-lès-Nancy, France; Lung Function Testing Lab, Children's University Hospital, 8 Rue du Morvan, 54511, Vandoeuvre-lès-Nancy, France
| | - Mathias Poussel
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH) Research Unit, University of Lorraine, 9 Avenue de la Forêt de Haye, 54505, Vandoeuvre-lès-Nancy, France; University Centre of Sports Medicine and Adapted Physical Activity, Department of Pulmonary Function Testing and Exercise Physiology, 9 Rue du Morvan, 54511, Vandoeuvre-lès-Nancy, France
| | - Cyril Schweitzer
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH) Research Unit, University of Lorraine, 9 Avenue de la Forêt de Haye, 54505, Vandoeuvre-lès-Nancy, France; Lung Function Testing Lab, Children's University Hospital, 8 Rue du Morvan, 54511, Vandoeuvre-lès-Nancy, France
| | - Sophia Abdel Kafi
- Department of Pulmonology, Jolimont Hospital, 159 Rue Ferrer, 7100, La Louvière, Belgium
| |
Collapse
|
10
|
Castro RR, Sales ARK, Nóbrega AC. Lifestyle interventions reduce exercise ventilatory variability in healthy individuals: a randomized intervention study. Future Cardiol 2020; 16:439-446. [PMID: 32323560 DOI: 10.2217/fca-2019-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Variation of exercise ventilation confers poor prognosis in heart failure. Sedentary men have higher exercise ventilatory variability than athletes. However, the impact of lifestyle intervention on exercise ventilatory variability in sedentary people is unknown and this is the aim of this study. Materials & methods: Prospective controlled single-blinded interventional study that randomly assigned healthy sedentary individuals to diet and exercise (intervention group, n = 12) or no intervention (control group, n = 12) for 12 weeks. Exercise ventilatory variability was accessed before and after intervention. Results: Despite similar values at baseline, there was a 15% reduction in respiratory rate variability (root mean square of the successive differences/n) in intervention group. Conclusion: Diet and exercise training reduced exercise ventilatory variability.
Collapse
Affiliation(s)
- Renata Rt Castro
- Medicine School, Iguaçu University, Nova Iguaçu, Brazil.,Hospital Naval Marcílio Dias, Marinha do Brasil, Rio de Janeiro, Brazil
| | - Allan Robson Kluser Sales
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil.,D'Or Institute for Research and Education, São Paulo, Brazil
| | - Antonio Cl Nóbrega
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| |
Collapse
|
11
|
Non-linear regulation of cardiac autonomic modulation in obese youths: interpolation of ultra-short time series. Cardiol Young 2019; 29:1196-1201. [PMID: 31451125 DOI: 10.1017/s1047951119001951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND In this study, we applied ultra-short time series of interbeat intervals (RR-intervals) to evaluate heart rate variability through default chaotic global techniques with the purpose of discriminating obese youths from non-obese youth patients. METHOD Chaotic global analysis of the RR-intervals from the electrocardiogram and pre-processing adjustments was undertaken. The effect of cubic spline interpolations was assessed, while the spectral parameters remained fixed. Exactly, 125 RR-intervals of data were recorded. RESULTS CFP1, CFP3, and CFP6 were the only significant combinations of chaotic globals when the standard conditions were enforced and at the level p<0.01 (or <1%). These significances were acheived via Kruskal-Wallis and Cohen's ds effects sizes tests of significance after Anderson-Darling and Lilliefors statistical tests indicated non-normal distributions in the majority of cases. Adjustments of the cubic spline interpolation from 1 to 13 Hz were revealed to be inconsequential when measured by Kruskal-Wallis and Cohen's ds, regarding the outcome between the two datasets. CONCLUSION Chaotic global analysis was offered as a robust technique to distinguish autonomic dysfunction in obese youths. It can discriminate the two different groups using ultra-short data lengths, and no cubic spline interpolations need be applied.
Collapse
|
12
|
Muller PDT, Barbosa GW, O'Donnell DE, Neder JA. Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease. Front Physiol 2019; 10:859. [PMID: 31354517 PMCID: PMC6635481 DOI: 10.3389/fphys.2019.00859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
Smoking and physical inactivity are important preventable causes of disability and early death worldwide. Reduced exercise tolerance has been described in smokers, even in those who do not fulfill the extant physiological criteria for chronic obstructive pulmonary disease (COPD) and are not particularly sedentary. In this context, it is widely accepted that exercise capacity depends on complex cardio-pulmonary interactions which support oxygen (O2) delivery to muscle mitochondria. Although peripheral muscular factors, O2 transport disturbances (including the effects of increased carboxyhemoglobin) and autonomic nervous system unbalance have been emphasized, other derangements have been more recently described, including early microscopic emphysema, pulmonary microvascular disease, ventilatory and gas exchange inefficiency, and left ventricular diastolic dysfunction. Using an integrative physiological approach, the present review summarizes the recent advances in knowledge on the effects of smoking on the lung-heart-muscle axis under the stress of exercise. Special attention is given to the mechanisms connecting physiological abnormalities such as early cardio-pulmonary derangements, inadequate oxygen delivery and utilization, and generalized bioenergetic disturbances at the muscular level with the negative sensations (sense of heightened muscle effort and breathlessness) that may decrease the tolerance of smokers to physical exercise. A deeper understanding of the systemic effects of smoking in subjects who did not (yet) show evidences of COPD and ischemic heart disease - two devastating smoking related diseases - might prove instrumental to fight their ever-growing burden.
Collapse
Affiliation(s)
- Paulo de Tarso Muller
- Laboratory of Respiratory Pathophysiology, Respiratory Division, Department of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Gisele Walter Barbosa
- Laboratory of Respiratory Pathophysiology, Respiratory Division, Department of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology, Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
13
|
Delclaux C, Laveneziana P, Garcia G, Ninot G, Roche N, Morelot-Panzini C. [Pulmonary function testing of dyspnea complaint by the pulmonologist]. Rev Mal Respir 2019; 36:484-494. [PMID: 31010751 DOI: 10.1016/j.rmr.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 06/11/2018] [Indexed: 12/01/2022]
Abstract
Dyspnea results from an imbalance between ventilatory demand (linked to CO2 production, PaCO2 set-point and wasted ventilation-physiological dead space) and ventilatory capacity (linked to passive-compliance, resistance-and active-respiratory muscles-components of the respiratory system). Spirometry and static lung volumes investigate ventilatory capacity only. Ventilatory demand (increased for instance in all pulmonary vascular diseases due to increased physiological dead space) is not evaluated by these routine measurements. DLCO measurement, which evaluates both demand and capacity, depicts the best statistical correlation to dyspnea, for instance in obstructive and interstitial pulmonary diseases. Dyspnea has multiple domains and is inherently complex and weakly explained by resting investigations: explained variance is below 50%. The diagnostic strategy investigating dyspnea has to distinguish complaints related or not to exercise because dyspnea can occur independently from any effort. Cardiopulmonary exercise testing (V'O2, V'CO2, V'E and operating lung volumes measurements) allows the assessment of underlying pathophysiological mechanisms leading to functional impairment and can contribute to unmask potential underlying mechanisms of unexplained dyspnea although its "etiological diagnostic value" for dyspnea remains a challenging issue.
Collapse
Affiliation(s)
- C Delclaux
- AP-HP, hôpital Robert-Debré, service de physiologie pédiatrique, Paris, France; Inserm UMR1141, université Paris-Diderot, France.
| | - P Laveneziana
- Sorbonne universités, UPMC Université Paris 06, Inserm, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service des explorations fonctionnelles de la respiration, de l'exercice et de la dyspnée (département «R3S», pôle PRAGUES), Paris, France
| | - G Garcia
- AP-HP, service de Physiologie, explorations fonctionnelles respiratoires, hôpital Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Inserm UMR S 999, hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - G Ninot
- CEPS Platform, université de Montpellier, France
| | - N Roche
- AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital Cochin, Paris; Université Paris Descartes (EA2511), Paris, France
| | - C Morelot-Panzini
- Sorbonne universités, UPMC Université Paris 06, Inserm, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale (département «R3S»), 75013, Paris, France
| | | |
Collapse
|
14
|
Bokov P, Matrot B, Gallego J, Delclaux C. Comparison of methods of chemical loop gain measurement during tidal ventilation in awake healthy subjects. J Appl Physiol (1985) 2018; 125:1681-1692. [DOI: 10.1152/japplphysiol.00010.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The loop gain (LG) is defined as the ratio of a ventilatory response over the perturbation in ventilation, and it is used to analyze ventilatory control stability. The LG can be derived from minute ventilation (V̇e), end-tidal Pco2 ([Formula: see text]), and end-tidal Po2 ([Formula: see text]) values. Several methods of LG assessment have been developed, which have never been compared. We evaluated the computability, the short-term repeatability, and the agreement of six published (or slightly modified) models for LG determination. These models included three unconstrained autoregressive models, univariate (V̇e), bivariate (V̇e, [Formula: see text]), and trivariate (V̇e, [Formula: see text], and [Formula: see text]), and three analytical transfer function constrained models based on V̇e, V̇e and CO2-sensitivity, and V̇e and central and peripheral CO2 sensitivities, respectively. The models were tested with tidal breathing data in 37 awake healthy subjects (median age 35 yr; 23 women, 14 men). Modeling failed in 11, 0, and 0 subjects for the three unconstrained models, respectively, and 4, 1, and 9 subjects for the three constrained models, respectively. Bland and Altman analyses of the LG values in the medium frequency range of two separate recordings demonstrated good repeatability for four models, excluding univariate and trivariate unconstrained models. The four repeatable models gave LG values that were in agreement (medium frequency LG, median 0.100–0.210), although the constrained model based on V̇e systematically overestimated LG values. The variances explained by these models were ∼20%. In conclusion, model-based analyses of tidal breathing were performed with different approaches that gave comparable results for chemical LG and explained variance. NEW & NOTEWORTHY Several methods of chemical loop gain measurement have been published but never compared. We show that a better repeatability is obtained with analytical constrained models compared with autoregressive unconstrained models and that the repeatable models gave comparable results of loop gain, even if the calculation based on ventilation-only recording gave higher values than those obtained with both ventilation and end-tidal Pco2 recording. The explained variance of ventilation was similar whatever the model.
Collapse
Affiliation(s)
- Plamen Bokov
- INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France
- Service de Physiologie Pédiatrique, Hôpital Universitaire Robert Debré, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Boris Matrot
- INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France
| | - Jorge Gallego
- INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France
| | - Christophe Delclaux
- INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France
- Service de Physiologie Pédiatrique, Hôpital Universitaire Robert Debré, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
15
|
Abstract
This essay expounds on fundamental, quantitative elements of the exercise ventilation in children, which was the subject of the Tom Rowland Lecture given at the NASPEM 2018 Conference. Our knowledge about how much ventilation rises during aerobic exercise is reasonably solid; our understanding of its governance is a work in progress, but our grasp of dyspnea and ventilatory limitation in children (if it occurs) remains embryonic. This manuscript summarizes ventilatory mechanics during dynamic exercise, then proceeds to outline our current understanding of mechanisms of dyspnea, particularly during exercise (exertional dyspnea). Most research in this field has been done in adults, and the vast majority of these studies in patients with chronic obstructive pulmonary disease. To what extent conclusions drawn from this literature apply to children and adolescents-both healthy and those with cardiopulmonary disease-will be discussed. The few, recent, pertinent, pediatric studies will be reviewed in an attempt to provide an empirical basis for proposing a hypothetical model to study exertional dyspnea in youth. Just as somatic growth will have consequences for ventilatory and exercise capacity, so too will neural developmental plasticity and experience affect perception of dyspnea. Our path to understand how these evolving inputs and influences summate during a child's life will be Columbus' India.
Collapse
|
16
|
Bansal T, Haji GS, Rossiter HB, Polkey MI, Hull JH. Exercise ventilatory irregularity can be quantified by approximate entropy to detect breathing pattern disorder. Respir Physiol Neurobiol 2018; 255:1-6. [PMID: 29730423 DOI: 10.1016/j.resp.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/25/2018] [Accepted: 05/02/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breathing pattern disorder (BPD) is a prevalent cause of exertional dyspnea and yet there is currently no reliable objective measure for its diagnosis. We propose that statistical analysis of ventilatory irregularity, quantified by approximate entropy (ApEn), could be used to detect BPD when applied to cardiopulmonary exercise test (CPET) data. We hypothesised that ApEn of ventilatory variables (tidal volume (VT), breathing frequency (Bf), minute ventilation (VE)) would be greater, i.e. more irregular, in patients with BPD than healthy controls. METHODS We evaluated ventilatory ApEn in 20 adults (14 female) with exertional dyspnoea, undergoing CPET and independently diagnosed with BPD by a specialist respiratory physiotherapist. Data were compared with 15 age- gender- and BMI-matched controls. ApEn for VT, Bf and VE were calculated for an incremental cycle exercise test. RESULTS Patients with BPD more frequently rated breathlessness as the reason for exercise limitation and had a lower mean (SD) peak oxygen uptake compared with controls: 80 (18) vs. 124 (27) % predicted (P < 0.001). ApEn was significantly greater for VT (p = .006) and VE (p = .002) in BPD than controls. ApEn VE was inversely related (r2 = 0.24, p = .03) to peak oxygen uptake in BPD but not controls. ROC analysis revealed that ApEn VE > 0.88, conferred a sensitivity and specificity of 70% and 87% respectively, for detection of BPD. CONCLUSIONS Non-linear statistical interrogation of CPET-acquired ventilatory data has utility in the detection of BPD. A simple calculation of approximate entropy of ventilation, during an incremental cardiopulmonary exercise test, provides a quantitative method to detect BPD.
Collapse
Affiliation(s)
- Taranpal Bansal
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - Gulam S Haji
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, USA; Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Mike I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - James H Hull
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK.
| |
Collapse
|
17
|
Todd S, Walsted ES, Grillo L, Livingston R, Menzies-Gow A, Hull JH. Novel assessment tool to detect breathing pattern disorder in patients with refractory asthma. Respirology 2017; 23:284-290. [PMID: 28905471 DOI: 10.1111/resp.13173] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Breathing pattern disorder (BPD) can co-exist with and mimic asthma, acting to amplify symptoms and confound assessment of disease control, resulting in inappropriate treatment escalation. The aim of this research was to report the utility of a novel breathing pattern assessment tool (BPAT) to detect BPD in treatment-refractory asthma. METHODS As a component of a multidisciplinary assessment, adult patients referred with treatment-refractory asthma underwent respiratory physiotherapy assessment to diagnose BPD. Based on this assessment, patients were classified as having asthma, asthma + BPD or BPD alone. BPAT data were collected in addition to questionnaire data (Asthma Quality of Life Questionnaire (AQLQ) and Nijmegen Questionnaire (NQ)), pulmonary function and an assessment of exercise capacity. RESULTS Data were retrospectively analysed for 150 (female; 69%) patients, mean (SD) age of 43 (14) years; characterized as asthma-only (n = 54, 36%), asthma + BPD (n = 63, 42%) and BPD-only (n = 33, 22%). Of the total population, 113 (76%) had an NQ score ≥23, but of these only 68% had physiotherapy evidence of BPD. Exercise capacity and AQLQ were lower in the asthma + BPD group than in the asthma-only group (P < 0.05), whilst lung function was similar between groups. Sensitivity analysis indicated that a BPAT score of ≥4 corresponded to a sensitivity of 0.92 and a specificity of 0.75 for diagnosis of BPD in this cohort. CONCLUSION Breathing pattern irregularities are highly prevalent in individuals referred with treatment-refractory asthma and can be characterized using the BPAT. Further work is needed to determine inter-observer and within-subject variability and ensure the BPAT is a robust clinical tool. Watch the video abstract.
Collapse
Affiliation(s)
- Sarah Todd
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Emil S Walsted
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Lizzie Grillo
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Rebecca Livingston
- Department of Respiratory Medicine, University College Hospital, London, UK
| | | | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| |
Collapse
|
18
|
Porsbjerg C, Menzies-Gow A. Co-morbidities in severe asthma: Clinical impact and management. Respirology 2017; 22:651-661. [DOI: 10.1111/resp.13026] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine; Bispebjerg University Hospital; Copenhagen Denmark,
| | | |
Collapse
|
19
|
Sanchez O, Caumont-Prim A, Riant E, Plantier L, Dres M, Louis B, Collignon MA, Diebold B, Meyer G, Peiffer C, Delclaux C. Pathophysiology of dyspnoea in acute pulmonary embolism: A cross-sectional evaluation. Respirology 2016; 22:771-777. [PMID: 27886421 DOI: 10.1111/resp.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 08/30/2016] [Accepted: 10/02/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory-affective domain of dyspnoea would be influenced by other factors. METHODS We undertook a prospective study of 90 consecutive non-obese patients (mean ± SD age: 49 ± 16 years, 41 women) without cardiorespiratory disease. All patients were hospitalized with symptoms for <15 days and a confirmed PE (multi-detector computed tomography (MDCT) scan, n = 87 and high-probability ventilation/perfusion scan, n = 3). Patients underwent assessment of dyspnoea using the Borg score, modified Medical Research Council (mMRC) scale, assessment of psychological trait, state of anxiety and depression and chest pain via the Visual Analogical Scale at the time of maximum dyspnoea. Functional evaluations such as the quantitative ventilation-perfusion lung scan, echocardiography, alveolar dead space fraction and tidal ventilation measurements were completed within 48 h of admission. RESULTS Multivariate analyses demonstrated that dyspnoea was mainly linked to pulmonary vascular obstruction and/or its consequences such as raised pulmonary arterial pressure and chest pain. The sensory-affective domain of dyspnoea showed additional determinants such as age, depression and breathing variability. CONCLUSION Dyspnoea is mainly related to vascular consequences of PE such as increased pulmonary arterial pressure or chest pain. The sensory-affective domain of dyspnoea also correlates with age, depression and breathing variability.
Collapse
Affiliation(s)
- Olivier Sanchez
- Department of Pulmonology, AP-HP, Georges Pompidou European Hospital, Paris, France.,Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France
| | - Aurore Caumont-Prim
- Epidemiology and Clinical Research Unit, AP-HP, Georges Pompidou European Hospital, Paris, France.,Epidemiological Centre of Investigation 4, INSERM, Paris, France
| | - Elisabeth Riant
- Department of Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Laurent Plantier
- Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.,Department of Physiology - Dyspnea Clinic, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Martin Dres
- Department of Pulmonology, AP-HP, Georges Pompidou European Hospital, Paris, France
| | | | | | - Benoit Diebold
- Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.,Department of Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Guy Meyer
- Department of Pulmonology, AP-HP, Georges Pompidou European Hospital, Paris, France.,Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France
| | - Claudine Peiffer
- Department of Physiology - Dyspnea Clinic, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Christophe Delclaux
- Sorbonne Paris City, Medical School, Paris Descartes University, Paris, France.,Department of Physiology - Dyspnea Clinic, AP-HP, Georges Pompidou European Hospital, Paris, France.,Clinical Investigation Centre 9201, AP-HP/INSERM, Georges-Pompidou European Hospital, Paris, France
| |
Collapse
|