Am. J. Respir. Crit. Care Med., Volume 165, Number 1, January 2002, 78-82

"Tightness" Sensation of Asthma Does Not Arise from the Work of Breathing

ANDREW P. BINKS, SHAKEEB H. MOOSAVI, ROBERT B. BANZETT, and RICHARD M. SCHWARTZSTEIN

Physiology Program, Harvard School of Public Health; Department of Medicine, Harvard Medical School; and Beth Israel Deaconess Medical Center, Boston, Massachusetts

Asthma evokes several uncomfortable sensations including increased "effort to breathe" and chest "tightness." We have tested the hypotheses that "effort" and "tightness" are due to perception of increased work performed by the respiratory muscles. Bronchoconstriction was induced by inhaled methacholine in 15 subjects with mild asthma (FEV₁/FVC baseline = 81.9% ± 5.8; bronchoconstriction = 64.0% ± 8.6). To relieve the work of breathing, and thereby minimize activation of respiratory muscle afferents and motor command, subjects were mechanically ventilated. Subjects separately rated effort to breathe and tightness during mechanical ventilation and during spontaneous breathing. Bronchoconstriction produced elevated end-expiratory lung volume (279 ± 62 ml); in a control study, end-expiratory lung volume was increased equally in the absence of bronchoconstriction by increasing end-expiratory pressure. During bronchoconstriction, ratings of effort were greater during spontaneous breathing than during mechanical ventilation (p < 0.05). Ratings of tightness were unchanged by the absence of respiratory muscle activity (p = 0.12). Hyperinflation alone did not produce tightness or effort. We conclude that tightness is not related to the increase in respiratory work during bronchoconstriction.

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