Published ahead of print on March 12, 2004, doi:10.1164/rccm.200305-630OC
Am. J. Respir. Crit. Care Med., Volume 169, Number 11, June 2004, 1224-1230
A more recent version of this article appeared on June 1, 2004
Submitted on May 12, 2003
Accepted on March 11, 2004
Hypoxia Suppresses Symptom Perception in Asthma
Danny J Eckert1*, Peter G Catcheside1, Janet H Smith1, Peter A Frith2, and R. Doug McEvoy2
1 Adelaide Institute for Sleep Health and Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia; School of Molecular and Biomedical Science, Discipline of Physiology, University of Adelaide, Adelaide, South Australia, Australia,
2 Adelaide Institute for Sleep Health and Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia
* To whom correspondence should be addressed. E-mail: danny.eckert{at}rgh.sa.gov.au.
Any factor that inhibits an asthmatic's ability to appropriately recognise their symptoms may contribute to treatment delay, 'near miss' events and death during acute severe asthma. The purpose of this study was to investigate the effects of two common features of acute severe asthma, hypoxia and hypercapnia, upon respiratory sensation. 16-stable asthmatics were exposed to 3 gas conditions (34-mins each): isocapnic hypoxia (arterial blood O2 saturation ~80%), hypercapnia (increase in end-tidal CO2~5-10 Torr) or isocapnic normoxia on 3 separate days. The perceived magnitude of externally applied resistive loads, measured during each gas condition, was reduced throughout hypoxia compared with normoxia and there was a trend for a progressive decline during hypercapnia. Within the 15-min post gas inhalation period, methacholine-induced symptoms of difficult breathing, chest tightness and breathlessness, measured using modified Borg scales, were 25-30% lower after hypoxia compared with normoxia, but were not reduced following hypercapnia. We conclude that 30 minutes of sustained hypoxia and possibly hypercapnia impair sensations of respiratory load and that the effects of hypoxia persist for at least 10-minutes after returning to normoxia.
Key words: hypercapnia, bronchoconstriction, methacholine, dyspnea
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