Published ahead of print on March 27, 2008, doi:10.1164/rccm.200711-1675OC Am. J. Respir. Crit. Care Med., Volume 177, Number 12, June 2008, 1384-1390 A more recent version of this article appeared on June 15, 2008
Submitted on November 13, 2007 The Affective Dimension of Laboratory Dyspnea: Air Hunger is More Unpleasant Than Work/EffortRobert B Banzett1*,1 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Physiology Program, Harvard School of Public Health, Boston, MA, USA, 2 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA, 3 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA * To whom correspondence should be addressed. E-mail: rbanzett{at}bidmc.harvard.edu.
Rationale: It is hypothesized that the affective dimension of dyspnea (unpleasantness, emotional response) is not strictly dependent on the intensity of dyspnea. Objectives: We tested the hypothesis that the ratio of immediate unpleasantness (A1) to sensory intensity (SI) varies depending on the type of dyspnea. Methods: Twelve healthy subjects experienced three stimuli: Stimulus 1: maximal eucapnic voluntary hyperpnea against inspiratory resistance, requiring 15 times the work of resting breathing. Stimulus 2: PET CO2 6.1 Torr above resting with ventilation restricted to less than spontaneous breathing. Stimulus 3: PET CO2 7.7 Torr above resting with ventilation further restricted. After each trial, subjects rated SI, A1, and qualities of dyspnea (SQ) on the Multi-Dimensional Dyspnea Profile (MDP), a comprehensive instrument tested here for the first time. Results: Stimulus 1 was always limited by subjects failing to meet a higher ventilation target; none signaled severe discomfort; this evoked work and effort sensations, with relatively low unpleasantness (mean A1/SI=0.64); Stimulus 2, titrated to produce dyspnea ratings similar to those subjects gave during Stimulus 1, evoked air hunger and produced significantly greater unpleasantness (mean A1/SI = 0.95); Stimulus 3, increased until air hunger was intolerable, evoked the highest intensity and unpleasantness ratings and high unpleasantness ratio (mean A1/SI=1.09). When asked which they would prefer to repeat, all subjects chose Stimulus 1. Conclusions: 1) Maximal respiratory work is less unpleasant than moderately intense air hunger in this brief test; 2) Unpleasantness of dyspnea can vary independently from perceived intensity, consistent with the prevailing model of pain; 3) Separate dimensions of dyspnea can be measured with the MDP. Key words: Dyspnea; Signs and Symptoms, Respiratory; Pain; Psychophysiology
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