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Is There a Link Between the Qualitative Descriptors and the Quantitative Perception of Dyspnea in Asthma?

^* From the Department of Internal Medicine (Drs. Coli, Picariello, Scano, and Duranti), Section of Immunology and Respiratory Medicine, University of Florence; and Fondazione Don C. Gnocchi (Drs. Stendardi, Grazzini, and Binazzi), Section of Respiratory Rehabilitation, Pozzolatico (Firenze), Firenze, Italy.

Correspondence to: Giorgio Scano, MD, Department of Internal Medicine, Section of Respiratory Medicine, Clinica Medica 3, Policlinico di Careggi, Careggi, Viale Morgagni 87, 50134 Firenze, Italy; e-mail: gscano{at}unifi.it

Abstract

Background: There is no obvious link between qualitative descriptors and overall intensity of dyspnea during bronchoconstriction in patients with asthma.

Aims: To determine whether qualitative and quantitative perception of methacholine-induced bronchoconstriction independently contribute to characterizing clinically stable asthma.

Material and methods: We assessed changes in inspiratory capacity, and quantitative (by Borg scale) and qualitative (by a panel of eight dyspnea descriptors) sensations of dyspnea at 20 to 30% fall in FEV₁ during methacholine inhalation in 49 asthmatics. Furthermore, we calculated the level of perception of bronchoconstriction at 20% fall in FEV₁ (PB₂₀).

Results: Descriptors selected by patients during methacholine inhalation allowed us to define three language subgroups: (1) chest tightness (subgroup A, n = 21); (2) work/effort (subgroup B, n = 7); and (3) both descriptors (subgroup C, n = 13). Eight of the 49 patients (subgroup D) were not able to make a clear-cut distinction among descriptors. The subgroups exhibited similar function at baseline and during methacholine inhalation. Most importantly, patients selected chest tightness to a greater extent (42.85%), and work/effort (14.3%) and both descriptors (26.5%) to a lesser extent at the lowest level of bronchoconstriction (FEV₁ fall < 10%) as at 20% fall in FEV₁. Thirty-two patients were normoperceivers (PB₂₀ 1.4 to < 5 arbitrary units [au]), 7 patients were hyperperceivers (PB₂₀ 5 au), and 10 patients were hypoperceivers (PB₂₀ < 1.4 au). Language subgroups were equally distributed across the perceiver subgroups.

Conclusions: In patients with clinically stable asthma, PB₂₀ and language of dyspnea independently contribute to defining the condition of the disease. However, the possibility that this independence may be due to a ß-error should be taken into account.

Key Words: bronchoconstriction • chest tightness • dyspnea • respiratory work/effort

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