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Overall Contribution of Chest Wall Hyperinflation to Breathlessness in Asthma^*

^* From the Department of Internal Medicine, Section of Respiratory Disease, University of Florence, and Fondazione Don C.Gnocchi, IRCCS, Pozzolatico, Florence, Italy.

Correspondence to: Giorgio Scano, MD, FCCP, Department of Internal Medicine, Section of Clinical Immunology, Allergology and Respiratory Disease, University of Florence, Viale Morgagni 87, 50134 Firenze, Italy; e-mail: g.scano{at}dmi.unifi.it

Background: Studies suggest that the increased volume of both abdominal and rib cage compartments of the chest wall contribute to dyspnea during methacholine-induced airway narrowing.

Material: Eight male patients with asthma aged 34 ± 13 years (mean ± SD) before and during methacholine challenge.

Methods: The volume of the chest wall (Vcw), volume of the abdomen (Vab), and volume of the rib cage (Vrc) were measured by using a three-dimensional optoelectronic plethysmography.

Results: During methacholine challenge, the increase in end-expiratory Vcw (Vcw,ee) [0.55 ± 0.23 L, p < 0.001] was due to increased Vrc (0.37 ± 0.20 L, p < 0.01) and, to a lesser extent, Vab (0.18 ± 0.10 L, p < 0.005). Linear univariate regression analysis showed that changes in dyspnea (Borg scale) with the highest methacholine dose correlated with both FEV₁ and Vcw,ee. Multiple regression analysis with the Borg score as dependent variable and all other ventilatory indexes as independent variables showed that Vcw,ee and FEV₁ were the only significant contributors to the Borg score. Taken together Vcw,ee and FEV₁ explained 56% of variance in the Borg score (r² = 0.56), although Vcw,ee explained 48% of it.

Conclusions: During methacholine challenge in patients with asthma, the overall increase in Vcw,ee is a better predictor of dyspnea that the reduction in FEV₁.

Key Words: asthma • chest wall • dyspnea • hyperinflation

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