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Dyspnea and Decreased Variability of Breathing in Patients with Restrictive Lung Disease

Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., Veterans Affairs Hospital; and Loyola University of Chicago, Stritch School of Medicine, Hines, Illinois

Correspondence and requests for reprints should be addressed to Martin J. Tobin, M.D., Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., Veterans Affairs Hospital, Route 111N, Hines, IL 60141. E-mail: mtobin2{at}lumc.edu

Patients with restrictive lung disease are typically dyspneic and have an increase in overall respiratory center drive, as a result of increased lung elasticity. When we subjected healthy volunteers to external elastic loads, their variability of breathing was lessened. Accordingly, we hypothesized that patients with restrictive lung disease display decreased variability of breathing and, also, that decreased variability of breathing is related to dyspnea. Breathing pattern was measured nonobtrusively over 1 hour in 10 patients with restrictive lung disease and in 7 healthy subjects. On a separate occasion, dyspnea was measured while all subjects copied different tidal volumes and frequencies. Compared with healthy subjects, the random fraction of breath variability was reduced in patients with restrictive lung disease: 27 times for expiratory time, 12 times for tidal volume, and 6 times for inspiratory time (p < 0.01 in each instance). Conversely, the nonrandom, correlated fraction for tidal volume was increased almost 3-fold in the patients (p < 0.01). Small variations from average resting tidal volume caused marked increases in dyspnea in patients, and the relationship was parabolic (r ² = 0.97; p < 0.001). In conclusion, patients with restrictive lung disease adopt a tightly constrained breathing pattern, probably as a strategy for avoiding dyspnea.

Key Words: control of breathing • respiratory sensation • pulmonary fibrosis

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