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Relief of Dyspnea Involves a Characteristic Brain Activation and a Specific Quality of Sensation

¹ Laboratoire de Physiologie–Explorations Fonctionnelles Respiratoires, Hôpital Saint-Vincent-de-Paul, Paris, France; ² Centre Chirurgical Marie-Lannelongue, Le Plessis Robinson, France; ³ Centre d'Etude et de Recherche Médicale en Positons, Hôpital Neurologique P. Wertheimer, Lyon, France; and ⁴ INSERM EMI-342, and Université Lyon 1, Lyon, France

Correspondence and requests for reprints should be addressed to Dr. Claudine Peiffer, M.D., Ph.D., Laboratoire de Physiologie–EFR, Hôpital Saint-Vincent-de-Paul 82, Avenue Denfert Rochereau, 75014 Paris, France. E-mail: claudinepeiffer{at}yahoo.fr

Rationale: Central processing of dyspnea relief remains largely unknown.

Objectives: To identify physiologic determinants, quality of sensation, and brain activation associated with dyspnea relief.

Methods: Dyspnea relief was induced in 10 healthy volunteers by decreasing an adjustable external resistive load (15–50 cm H₂O/L/s). Brain imaging (positron emission tomography) was performed during either dyspnea or relief.

Measurements and Main Results: Perceived intensity of moderate and high relief was similar to that of its preceding dyspnea (Borg scores = 5.10 ± 1.49 vs. 5.3 ± 1.4, and 2.78 ± 0.94 vs. 2.99 ± 0.94, respectively; P 0.05) and was predominantly related to reversal of dyspnea-induced increased mouth pressure/ventilation ratio (r² = 0.88, P < 0.001). Dyspnea relief involved specific, mostly positively valenced descriptors (i.e., breathing-related pleasure and/or reward). Most significant relief-associated brain activation was detected in the left anterior cingulate cortex (Z score = 4.7, corrected P < 0.05) and additional activation (uncorrected P < 0.0001) in the posterior cerebellum and in the temporal and prefrontal cortices. For dyspnea, significant activation was located in the right caudate nucleus, the anterior cerebellum (Z = 5 and 4.65, respectively; corrected P < 0.05), and the premotor cortex, whereas deactivation occurred in the left prefrontal cortex (Z = 4.11).

Conclusions: Relief of acute load-induced dyspnea is not simply the neutral perception of dyspnea decrease but rather a strong, positively valenced sensation that is associated with characteristic brain activation distinct from that subserving dyspnea perception and possibly reflecting activation of a dyspnea modulation network.

Key Words: breathlessness • relief • perception • functional brain imaging • qualitative word descriptors

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Although relief of dyspnea is a very common sensory experience, its general characteristics and especially its central processing remain largely unknown. What This Study Adds to the Field This study shows that relief of dyspnea is a predominantly rewarding sensation, and identifies that dyspnea relief involves characteristic brain activation and that the latter is distinct from areas subserving dyspnea perception.