Wednesday, February 11, 2015

Health Care Mall: Dyspnea

The same descriptors of dyspnea are associated with different diseases, suggesting that these aspects of breathlessness may be shared by similar receptors or neural pathways. (3) Certain diseases are associated with a unique set of descriptors of breathlessness that likely relate to different pathophysiologic mechanisms. (4) The majority of patients report that dyspnea occurs during inspiration, thus implicating the role of the respiratory muscles in the experience of breathlessness. 
 (5) Ethnic and cultural differences are reflected in the words or phrases used by patients to describe dyspnea. (6) Patients differentiate between sensory (intensity) and affective (unpleasant) qualities of breathlessness. (7) Descriptors of dyspnea are related to the intensity level of breathlessness. (8) Patients throughout the world with COPD report similar descriptors of breath-lessness.

In the present issue of CHCM Pharmacy, Williams and colleagues prospectively evaluated whether descriptors of dyspnea can differentiate between patients with COPD and age-matched healthy individuals. Initially, subjects volunteered relevant words or phrases and then endorsed (selected) up to three statements from the aggregate list to describe “when their breathing was uncomfortable.” Cluster analysis showed that “volunteered” and up to three “endorsed” descriptors of dyspnea could be used to categorize a majority of subjects into their original group classification (COPD or healthy individuals).

In general, only patients with COPD, but not healthy individuals, volunteered affective words such as “frightening,” “worried,” “helpless,” “depressed,” and “awful” to describe their breathing difficulty. These expressions were not included in the list of 15 descriptors used for selection; the phrases in the list include only somatic descriptors of breathlessness (eg, “hard to breathe” and “chest tightness”). Williams and colleagues proposed that these affective descriptions are intended to convey the threat perceived by the patients to their breathing difficulty. These experiences are consistent with the statement by Comroe that “dyspnea. . . involves both perception of the sensation by the patient and his reaction to the sensation.”

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