Lower airway receptors

The major receptors that reside in the lung parenchyma are characterized as stretch receptors and C-fibers (unmeyelinated nerve endings). These receptors are responsible for detecting a wide variety of pathophysiologic derangements in the lung and transmit information to the CNS via the vagus nerve. Several studies have explored the importance of these receptors in the production of breathlessness. Stretch receptors are thought to modulate breathlessness by altering effer-ent-reafferent...

References

Mechanisms, assessment, and management A consensus statement. Am J Respir Crit Care Med 1999 159 321-40. 2. Dudgeon D. Multidimensional assessment of dyspnea. In Portenoy RK, Bruera E, eds Issues in Palliative Care Research, pp. 83-96. New York Oxford University Press, 2003. 3. Swartz MH. Textbook of Physical Diagnosis History and Examination, 4th edn. Philadelphia W. B. Saunders Company, 2002. 4. Man GCW, Hsu K, Sproule BJ. Effect of Alprazolam on exercise...

Managing dyspnea in COPD

Recent national guidelines have recommended a dyspnea disability driven paradigm for managing COPD.81-83 Thus, therapy is escalated on an individual basis with the goal being maximum possible symptom relief. Education and smoking cessation are the first steps in symptom management (Figure 4.6) and are regarded as one of the best strategies to reduce mortality in COPD patients. Treatment with bronchodilators is another initial approach to therapy as they provide symptomatic relief by improving...

Language of breathlessness

Patients who present to their physician complaining of chest pain are routinely asked to describe the quality of the pain. Is it a burning sensation, a pressure, or a sharp pain Clinicians quickly learn to use these qualitative descriptions of pain to gain insight into the pathophysiologic mechanisms underlying the discomfort. For example, burning chest pain may indicate acid reflux into the esophagus, while pressure-like pain is in suggestive of ischemia of the myocardium, and sharp, stabbing...

Hypnosis

Hypnosis is a trance state that combines a heightened inner awareness with a diminished awareness of one's surroundings. It is suggested that hypnosis may modify the cortical centers and the perception of dyspnea, however, the available studies are primarily with asthma patients. Dyspnea decreased in one patient with severe COPD who received hypnotically-induced relaxation and biofeedback in an effort to decrease his dyspnea during periods of anxiety.83 Another 16 patients with asthma had a...

Affective dimension of dyspnea

The theoretical perspectives of symptom perception outlined above inform the non-pharmacological strategies for breathlessness discussed in this chapter. The prescription and use of non-pharmacological strategies also assumes that the dyspnea experience is similar to other symptoms, such as pain, and includes sensory and affective dimensions, both of which influence each other.22-24 Evidence for an 'unpleasant' or 'distressing' dimension of dyspnea is derived from clinical and research...

Increased ventilatory demand

An increase in ventilatory demand can occur when there is interruption of perfusion of the lung secondary to thrombo- or tumor emboli, vascular obstruction, or chemo- or radiation therapy. Other conditions that increase ventilatory demand are severe deconditioning with subsequent early and Table 5.1 Pathophysiological and clinical mechanisms of dyspnea in the cancer patient (a) Restrictive ventilatory deficit (i) Pleural or parenchymal disease (ii) Reduced movement of diaphragm (iii) Reduced...

Causes of dyspnea in advanced disease in children

There are myriad causes of dyspnea in a child which involve many of the branches of general paediatric medicine and paediatric respiratory medicine in particular. It is not within the scope of this chapter to address the aetiology and management of all causes of dyspnea with which a child with advanced disease might present. For example a child may have asthma in addition to the diagnosis of a brain tumour. At the end of life for this child it is possible that his asthma may be a significant...

Exercise as a strategy for changing central perception of dyspnea

One of the most powerful strategies for improving dyspnea with activity is exercise. The major benefits of exercise are attributed to the physiological effects of 'conditioning' or other physiological factors, including improvement in respiratory and peripheral muscle strength and changes in the pattern of breathing resulting in less dynamic hyperinflation with exer-cise.50,101 Others have found decreases in dyspnea despite little change in outcomes that reflect physiological effects.102-104...

Acupuncture and acupressure

Acupuncture and acupressure have shown early positive findings for their use in the management of dyspnea. Jobst compared the effects of 'traditional' and 'placebo' acupuncture in 24 COPD patients with 'disabling breathlessness'.71 During 13 treatment sessions administered over three weeks acupuncture needles were inserted according to 'traditional acupuncture points', while in the other group the placebo needles were inserted in non-acupuncture 'dead points'. Both groups did improve their...

Azopirones buspirone

As with most medications in the therapy of dyspnoea, there are limited data to inform the use of buspirone in clinical practice. Buspirone is a non-sedating anxiolytic with a gradual onset of action after it is commenced. There are two double-blind, RCTs that explore the effect of buspirone in people with COPD. The first of these explored in a placebo-controlled study the use of 10-20mg of buspirone three times daily on dyspnoea measured on Borg scale and physiological parameters of exercise....