Original Article
Chemosensitivity and Perception of Dyspnea in Patients with a History of Near-Fatal Asthma
N Engl J Med 1994; 330:1329-1334May 12, 1994
- Abstract
Background
Many deaths from attacks of asthma may be preventable. However, the difficulty in preventing fatal attacks is that not all the pathophysiologic risk factors have been identified.
Methods
To examine whether dyspnea and chemosensitivity to hypoxia and hypercapnia are factors in fatal asthma attacks, we studied 11 patients with asthma who had had near-fatal attacks, 11 patients with asthma who had not had near-fatal attacks, and 16 normal subjects. Their respiratory responses to hypoxia and hypercapnia, determined by the standard rebreathing technique while the patients were in remission, were assessed in terms of the slopes of ventilation and airway occlusion pressure as a function of the percentage of arterial oxygen saturation and end-tidal carbon dioxide tension, respectively. The perception of dyspnea was scored on the Borg scale during breathing through inspiratory resistances ranging from 0 to 30.9 cm of water per liter per second.
Results
The mean (±SD) hypoxic ventilatory response (0.14 ±0.12 liter per minute per percent of arterial oxygen saturation) and airway occlusion pressure (0.05 ±0.05 cm of water per percent of arterial oxygen saturation) were significantly lower in the patients with near-fatal asthma than in the normal subjects (0.60 ±0.35, P<0.001, and 0.16 ±0.08, P<0.001, respectively) and the patients with asthma who had not had near-fatal attacks (0.46 ±0.29, P = 0.003, and 0.15 ±0.09, P = 0.004). The Borg score was also significantly lower in the patients with near-fatal asthma than in the normal subjects, and their lower hypoxic response was coupled with a blunted perception of dyspnea.
Conclusions
Reduced chemosensitivity to hypoxia and blunted perception of dyspnea may predispose patients to fatal asthma attacks.
Media in This Article
Figure 1
Hypoxic Responses Expressed in Terms of the Minute Ventilation Slope (Change in Minute Ventilation/Change in SaO2) and P0.1 Slope (Change in P0.1/Change in SaO2) in 16 Normal Subjects, 11 Patients with Asthma but No Near-Fatal Attacks, and 11 Patients with Near-Fatal Asthma.Figure 2
Hyperoxic Hypercapnic Responses Expressed in Terms of the Minute Ventilation Slope (Change in Minute Ventilation/Change in PETCO2) and the P0.1 Slope (Change in P0.1/Change in PETCO2) in All Subjects.Article Activity
- Article
Concern about deaths from asthma is increasing1-3. Most of the deaths are avoidable if patients are adequately treated3,4. However, adequate treatment requires clarification of the mechanisms by which fatal or near-fatal attacks develop and identification of the risk factors for these attacks.
Although there have been many epidemiologic studies of fatal or near-fatal asthma,4-7 there have been few studies of the mechanisms underlying life-threatening attacks1. One report8 suggested that respiratory arrest, not cardiac arrest, may be the principal cause of death during an attack. The precise mechanisms of life-threatening attacks, however, were not elucidated in this study, and one is left with the impression that the patients were suffocating as a result of a narrowing of the airway. Although this may have been the case, other explanations are possible, such as rapidly progressive airflow obstruction, reduced chemosensitivity to hypercapnia and hypoxia, or a decreased perception of dyspnea1.
The purpose of this study was to examine two of these possible underlying causes of life-threatening attacks in patients with asthma. We examined the perception of dyspnea during resistive loading and chemosensitivity to hypercapnia and hypoxia in patients with a history of near-fatal attacks.
Methods
Subjects
We studied 11 patients who had had near-fatal attacks of asthma, 11 patients with asthma but no near-fatal attacks, and 16 normal subjects (Table 1Table 1
Demographic and Clinical Characteristics of the Patients with Near-Fatal Asthma, Patients with Asthma but No Near-Fatal Attacks, and Normal Subjects.). All patients with asthma met the American Thoracic Society's diagnostic criteria12. Near-fatal attacks were defined as attacks of asthma requiring treatment with mechanical ventilation (in eight patients) or resulting in unconsciousness and severe respiratory failure (in three patients). All the patients with near-fatal attacks had had severe respiratory failure with retention of carbon dioxide during their most recent near-fatal attack (Table 2Table 2
Values of Arterial-Blood Gases during Spontaneous Breathing at the Time of the Most Recent Near-Fatal Asthma Attack and the Outcome of the Attack.). Three patients had recovered from unconsciousness without mechanical ventilation after initial intensive therapy; the duration of unconsciousness was estimated to have been from 20 to 60 minutes. Eight patients had been treated with mechanical ventilation for two to eight days. Five of the 11 patients had had more than one near-fatal attack.To exclude the effect of airway obstruction on chemosensitivity and the perception of dyspnea, the patients were enrolled in the study when their disease was in clinical remission and the forced expiratory volume in one second (FEV1) was greater than 80 percent of the predicted value9. None of the patients with asthma and only five of the normal subjects had had measurements of chemosensitivity or perception of dyspnea before this study; dyspnea was not measured in four of these five normal subjects because they were familiar with the purpose of the study. The study protocol was approved by the instititutional ethics committee, and informed consent was obtained from all the subjects.
Protocols and Measurements
The patients did not use any medications after their regular treatment in the morning; the measurements were obtained in the afternoon. After spirometric and plethysmographic measurements of airway resistance and thoracic gas volume had been obtained, the perception of dyspnea during inspiratory resistive loading and then chemosensitivity to hypoxia and hypercapnia were measured with the use of a previously described apparatus consisting of a unidirectional Hans-Rudolph valve and a rebreathing circuit13,14. Mouth pressure was measured with a Validyne pressure transducer (Northridge, Calif.), which was used with a device to measure airway occlusion pressure (P0.1, mouth pressure 0.1 second after the start of inspiration against an occluded airway)15,16. Minute ventilation was measured by electrically integrating the expiratory flow signal obtained with a heated (37 °C) pneumotachygraph. End-tidal carbon dioxide tension (PETCO2) and end-tidal oxygen tension (PETO2) were monitored at the Hans-Rudolph valve with a mass spectrometer. Arterial oxygen saturation (SaO2) was measured continuously with a finger-pulse oximeter.
The sensation of dyspnea was measured while the subject breathed through the Hans-Rudolph valve with linear inspiratory resistances of 0 (control), 2.3, 5.0, 10.1, 20.0, and 30.9 cm of water per liter per second. Neither ventilation nor breathing pattern was controlled during the test. After breathing for one minute at each level of resistance, the subject rated the sensation of difficulty in breathing (dyspnea) using a modified Borg scale17. This is a linear scale of numbers ranking the magnitude of difficulty in breathing, ranging from 0 (none) to 10 (maximal). The phrase “difficulty in breathing” was not defined,18 but the subjects were instructed to avoid rating nonrespiratory sensations, such as headache or irritation of the pharynx.
Respiratory responses to progressive isocapnic hypoxia and progressive hyperoxic hypercapnia were measured with standard rebreathing methods19,20 and assessed in terms of the slopes of minute ventilation and P0.1 as a function of PETCO2 and SaO2. After an equilibration period during which the subjects breathed room air, they rebreathed through a bag containing the initial gas mixture: 21 percent oxygen in nitrogen for the hypoxic response and 7 percent carbon dioxide in oxygen for the hypercapnic response. In the hypoxic test, a bypass circuit consisting of a carbon dioxide absorber and a variable fan was connected between the inspiratory and expiratory lines, and PETCO2 was held constant (within 1 mm Hg) at the level of each subject's resting PETCO2 during the procedure by varying the flow of the carbon dioxide absorber. The trials of hypoxic and hypercapnic responses were terminated when the subjects reached 70 percent SaO2 and 64 mm Hg PETCO2, respectively.
Statistical Analysis
The results are expressed as means ±SD, unless otherwise indicated. The slopes of the minute ventilation and P0.1 responses to hypercapnia and hypoxia were calculated by a least-squares regression analysis with PETCO2 and SaO2, respectively14,21,22. Differences were tested for significance with a two-tailed Student's t-test in a one-way analysis of variance and a post hoc Scheffe's test in a two-way analysis of variance. Correlations were assessed by calculating Spearman correlation coefficients (rs). P values less than 0.05 were considered to indicate statistical significance.
Results
The mean age of the subjects did not differ significantly among the three groups (Table 1). The mean height and body weight of the patients with near-fatal asthma did not differ significantly from those of the patients without near-fatal attacks but were significantly lower than the mean height and weight of the normal subjects. Pulmonary function was similar in the three groups of subjects except for vital capacity and FEV1. The mean vital capacity was slightly but significantly larger in the patients with near-fatal asthma than in the other two groups, and FEV1 was significantly larger in the patients with near-fatal asthma than in the patients without near-fatal attacks. The duration and severity of asthma, airway hyperreactivity as measured by methacholine provocation testing,10 and use of medications at the time of the study did not differ significantly between the two groups of patients with asthma.
Figure 1Figure 1
Hypoxic Responses Expressed in Terms of the Minute Ventilation Slope (Change in Minute Ventilation/Change in SaO2) and P0.1 Slope (Change in P0.1/Change in SaO2) in 16 Normal Subjects, 11 Patients with Asthma but No Near-Fatal Attacks, and 11 Patients with Near-Fatal Asthma. shows the hypoxic responses, expressed in terms of the minute ventilation slope (change in minute ventilation/change in SaO2) and the P0.1 slope (change in P0.1/change in SaO2), in all the subjects. There were no significant differences in the minute ventilation or P0.1 slope between the normal subjects and the patients without near-fatal attacks. However, the mean values of the minute ventilation and P0.1 slopes were significantly lower in the patients with near-fatal asthma than in the normal subjects or the patients with asthma but no near-fatal attacks. Figure 2Figure 2Hyperoxic Hypercapnic Responses Expressed in Terms of the Minute Ventilation Slope (Change in Minute Ventilation/Change in PETCO2) and the P0.1 Slope (Change in P0.1/Change in PETCO2) in All Subjects. shows the hypercapnic responses in all the subjects. The mean value of the minute ventilation slope (change in minute ventilation/change in PETCO2) in the patients with near-fatal asthma was significantly lower than that in the normal subjects but was not significantly lower than that in the patients without near-fatal attacks. There were no significant differences in the mean value of the P0.1 slope (change in P0.1/change in PETCO2) among the three groups.The mean Borg score during resistive loaded breathing was significantly lower in the patients with near-fatal asthma than in the normal subjects (Figure 3Figure 3
Mean (±SE) Perception of Dyspnea (Borg Score) during Breathing at Six Levels of Resistance in 12 Normal Subjects, 11 Patients with Asthma but No Near-Fatal Attacks, and 11 Patients with Near-Fatal Asthma.). There were no significant differences in breathing pattern or P0.1 during quiet breathing at any level of resistance among the three groups. The Borg scores of individual patients during breathing with a resistance of 20.0 cm of water per liter per second are shown in Figure 4Figure 4
Perception of Dyspnea (Borg Score) during Breathing with a Resistance of 20.0 cm of Water per Liter per Second in Individual Subjects.. The mean score for the patients with near-fatal asthma was significantly lower than that for the normal subjects but was not significantly lower than the mean score for the patients without near-fatal attacks.Figure 5Figure 5
Relation between the Perception of Dyspnea (Borg Score) during Breathing with a Resistance of 20.0 cm of Water per Liter per Second and the Hypoxic Response (Minute Ventialtion and P0.1 Slopes). shows the relation between the perception of dyspnea and hypoxic chemosensitivity. There was a significant relation between the Borg score with a resistance of 20.0 cm of water per liter per second and both the minute ventilation slope (rs = 0.61, P<0.001) and the P0.1 slope (rs = 0.70, P<0.001) of the hypoxic response in all the subjects. There was also a significant relation among these values when calculated separately in the normal subjects (rs = 0.69, P = 0.013 for the minute ventilation slope; rs = 0.89, P<0.001 for the P0.1 slope). The Borg score with a resistance of 30.9 cm of water per liter per second was also significantly related to the minute ventilation slope (rs =0.57, P<0.001) and the P0.1 slope (rs = 0.65, P<0.001). Most of the subjects with a decreased sensitivity to hypoxia, whether they were patients with asthma or normal subjects, had a blunted perception of dyspnea as well (Figure 5). The Borg score was not correlated with the hypercapnic response.Discussion
Most of the patients with near-fatal asthma had a decreased chemosensitivity to hypoxia as well as a blunted perception of dyspnea during resistive loading, and there was a significant positive relation between hypoxic chemosensitivity and the perception of dyspnea during resistive loading.
Several methodologic issues should be considered. Because ventilatory responses are affected by the degree of airway obstruction,23 we chose patients whose predicted values of FEV1 were more than 80 percent. Furthermore, we measured not only minute ventilation but also P0.1, which is known to reflect respiratory neuromuscular function more directly than minute ventilation does16,24. Therefore, the decreased minute ventilation during hypercapnia in the patients with near-fatal asthma, as compared with minute ventilation in normal subjects, may have been attributable to mild residual airway obstruction rather than to decreased chemosensitivity to hypercapnia. The decreased sensation of dyspnea in the patients with near-fatal asthma is unlikely to have been caused by their acclimation to dyspnea or chronic airway obstruction, because dyspnea during the hypercapnic response did not differ significantly among the three groups (data not shown).
Our finding that most of the patients with near-fatal asthma had a decreased hypoxic response accompanied by a blunted perception of dyspnea during resistive loading suggests that, in addition to severe bronchoconstriction, a dysfunction of the defense mechanisms against profound hypoxemia and airway narrowing may play an important part in causing life-threatening attacks of asthma. If chemosensitivity is blunted in patients with asthma, severe respiratory failure may develop, leading to death1,25. However, this speculation has not been systematically examined. In one report, a patient with profound hypercapnia and hypoxia during asthma attacks had a markedly decreased ventilatory response to hypoxia but a normal response to hypercapnia26. The same investigators27 also reported that the hypoxic response was severely decreased in some patients with asthma and a history of severe respiratory failure. These observations are consistent with our finding that hypoxic chemosensitivity was decreased in patients with near-fatal asthma.
The perception of airway obstruction is blunted in some patients with asthma28. Although such a decreased perception is potentially dangerous because the severity of an exacerbation of asthma may be underestimated,1,25,28,29 this possibility has not been thoroughly examined. Most of our patients with near-fatal asthma had a markedly depressed perception of dyspnea during resistive loading, suggesting that when they did experience dyspnea, the degree of airway obstruction may already have been severe.
We were surprised that hypoxic chemosensitivity was related to dyspnea during resistive loading and that a decreased hypoxic response was coupled with a blunted perception of dyspnea in both groups of patients with asthma as well as in the normal subjects. The mechanisms responsible for the relation between these two factors are not known. In patients with asthma who had had both carotid bodies removed, no discomfort or increase in ventilation was reported, even when the patients were anoxic30. The hypoxic response was greatly impaired and there was no perception of dyspnea in a boy with asthma who had repeated episodes of severe respiratory failure with loss of consciousness after carotid-body resection31. These two reports suggest that a decreased hypoxic response and a blunted sensation of dyspnea may coexist if the function of the carotid chemoreceptors is impaired. Most of our patients with near-fatal asthma were quite similar to the patients described above. Therefore, a dysfunction of the carotid chemoreceptors may account for the coexistence of decreased hypoxic chemosensitivity and blunted dyspnea in patients with near-fatal asthma.
The ability to respond to hypoxia may be influenced by a hereditary factor, presumably genetic,26,32-34 and even some normal subjects have a very low hypoxic response. Because the role of the hypoxic stimulus in the control of ventilation is limited,35 it is not surprising that patients with near-fatal asthma usually have a normal response to hypoxia between attacks of asthma. However, in unusual conditions in which hypoxemia is progressive -- for example, at high altitude36 -- hypoxic chemosensitivity may have a critical role in maintaining breathing. We speculate that this may be the case during life-threatening asthma attacks when hypoxemia worsens rapidly.
Our results have several clinical implications for preventing death from asthma. First, measurements of chemosensitivity and perception of dyspnea are needed to identify patients at high risk for a fatal attack of asthma. Second, because some patients have a blunted perception of dyspnea, measurements of airway narrowing, such as peak-flow monitoring, are required to assess a patient's actual condition. Finally, education of physicians is important to prevent death from asthma. Physicians should know that reliance on a patient's own assessment of his or her condition without an objective determination of airway narrowing carries a risk of undertreatment, which may lead to death.
We are indebted to Dr. James P. Butler for his helpful suggestions; to Drs. Jun Midorikawa, Akiko Mizusawa, and Hiromasa Ogawa for their expert technical assistance; and to Mr. Brent Bell for reading the manuscript.
Source Information
From the First Department of Internal Medicine, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980, Japan, where reprint requests should be addressed to Dr. Shirato.
- References
References
1
McFadden ER Jr . Fatal and near-fatal asthma. N Engl J Med 1991;324:409-411
Full Text | Web of Science | Medline2
Drazen JM ,Boushey HA ,Holgate ST , et al. The pathogenesis of severe asthma: a consensus report from the Workshop on Pathogenesis. J Allergy Clin Immunol 1987;80:428-437
CrossRef | Web of Science | Medline3
Benatar SR . Fatal asthma. N Engl J Med 1986;314:423-429
Full Text | Web of Science | Medline4
British Thoracic Association
CrossRef | Web of Science5
Sears MR ,Rea HH . Patients at risk for dying of asthma: New Zealand experience. J Allergy Clin Immunol 1987;80:477-481
CrossRef | Web of Science | Medline6
Spitzer WO ,Suissa S ,Ernst P , et al. The use of β-agonists and the risk of death and near death from asthma. N Engl J Med 1992;326:501-506
Full Text | Web of Science | Medline7
Rea HH ,Scragg R ,Jackson R ,Beaglehole R ,Fenwick J ,Sutherland DC . A case-control study of deaths from asthma. Thorax 1986;41:833-839
CrossRef | Web of Science | Medline8
Molfino NA ,Nannini LJ ,Martelli AN ,Slutsky AS . Respiratory arrest in near-fatal asthma. N Engl J Med 1991;324:285-288
Full Text | Web of Science | Medline9
Cotes JE. Lung function: assessment and application in medicine. 4th ed. Oxford, England: Blackwell Scientific, 1979:365-87.
10
Takishima T ,Hida W ,Sasaki H ,Suzuki S ,Sasaki T . Direct-writing recorder of the dose-response curves of the airway to methacholine: clinical application. Chest 1981;80:600-606
CrossRef | Web of Science | Medline11
Guidelines for the diagnosis and management of asthma: National Heart, Lung, and Blood Institute: National Asthma Education Program: expert panel report
CrossRef12
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthmaAm Rev Respir Dis 1987;136:225-244
CrossRef | Web of Science | Medline13
Taguchi O ,Kikuchi Y ,Hida W , et al. Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea. J Appl Physiol 1991;71:2183-2190
Web of Science | Medline14
Okabe S ,Chonan T ,Hida W ,Satoh M ,Kikuchi Y ,Takishima T . Role of chemical drive in recruiting upper airway and inspiratory intercostal muscles in patients with obstructive sleep apnea. Am Rev Respir Dis 1993;147:190-195
CrossRef | Web of Science | Medline15
Hida W ,Susuki R ,Kikuchi Y , et al. Effect of local vibration on ventilatory response to hypercapnia in normal subjects. Bull Eur Physiopathol Respir 1987;23:227-232
Medline16
Whitelaw WA ,Derenne JP ,Milic-Emili J . Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol 1975;23:181-199
CrossRef | Medline17
el-Manshawi A ,Killian KJ ,Summers E ,Jones NL . Breathlessness during exercise with and without resistive loading. J Appl Physiol 1986;61:896-905
Web of Science | Medline18
Chonan T ,Mulholland MB ,Altose MD ,Cherniack NS . Effects of changes in level and pattern of breathing on the sensation of dyspnea. J Appl Physiol 1990;69:1290-1295
Web of Science | Medline19
Read DJC . A clinical method for assessing the ventilatory response to carbon dioxide. Australas Ann Med 1967;16:20-32
Medline20
Rebuck AS ,Campbell EJM . A clinical method for assessing the ventilatory response to hypoxia. Am Rev Respir Dis 1974;109:345-350
Web of Science | Medline21
Onal E ,Lopata M ,O'Connor TD . Diaphragmatic and genioglossal electromyogram responses to isocapnic hypoxia in humans. Am Rev Respir Dis 1981;124:215-217
Web of Science | Medline22
Onal E ,Lopata M ,O'Connor TD . Diaphragmatic and genioglossal electromyogram responses to CO2 rebreathing in humans. J Appl Physiol 1981;50:1052-1055
Web of Science | Medline23
Kelsen SG ,Fleegler B ,Altose MD . The respiratory neuromuscular response to hypoxia, hypercapnia, and obstruction to airflow in asthma. Am Rev Respir Dis 1979;120:517-527
Web of Science | Medline24
Altose MD ,Kelsen SG ,Stanley NN ,Levinson RS ,Cherniack NS ,Fishman AP . Effects of hypercapnia on mouth pressure during airway occlusion in conscious man. J Appl Physiol 1976;40:338-344
Web of Science | Medline25
Hudgel DW. Control of breathing in asthma. In: Weiss EB, Segal MS, Stein M, eds. Bronchial asthma: mechanisms and therapeutics. 2nd ed. Boston: Little, Brown, 1985:193-8.
26
Hudgel DW ,Weil JV . Asthma associated with decreased hypoxic ventilatory drive: a family study. Ann Intern Med 1974;80:623-625
Medline27
Hudgel DW ,Weil JV . Depression of hypoxic and hypercapnic ventilatory drives in severe asthma. Chest 1975;68:493-497
CrossRef | Web of Science | Medline28
Rubinfeld AR ,Pain MC . Perception of asthma. Lancet 1976;1:882-884
CrossRef | Web of Science | Medline29
Barnes PJ . Poorly perceived asthma. Thorax 1992;47:408-409
CrossRef | Web of Science | Medline30
Nakayama K . The surgical significance of the carotid body in relation to bronchial asthma. J Int Coll Surg 1963;39:374-38931
Chang KC ,Morrill CG ,Chai H . Impaired response to hypoxia after bilateral carotid body resection for treatment of bronchial asthma. Chest 1978;73:667-669
CrossRef | Web of Science | Medline32
Collins DD ,Scoggin CH ,Zwillich CW ,Weil JV . Hereditary aspects of decreased hypoxic response. J Clin Invest 1978;62:105-110
CrossRef | Web of Science | Medline33
Moore GC ,Zwillich CW ,Battaglia JD ,Cotton EK ,Weil JV . Respiratory failure associated with familial depression of ventilatory response to hypoxia and hypercapnia. N Engl J Med 1976;295:861-865
Full Text | Web of Science | Medline34
Kawakami Y ,Yoshikawa T ,Shida A ,Asanuma Y ,Murao M . Control of breathing in young twins. J Appl Physiol 1982;52:537-542
Web of Science | Medline35
West JB. Respiratory physiology -- the essentials. 3rd ed. Baltimore: Williams & Wilkins, 1985:113-27.
36
Lakshminarayan S ,Pierson DJ . Recurrent high altitude pulmonary edema with blunted chemosensitivity. Am Rev Respir Dis 1975;111:869-872
Web of Science | Medline
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Marc H. Lavietes, Joseph Ameh, Neil S. Cherniack. (2008) Dyspnea and Symptom Amplification in Asthma. Respiration 75:2, 158-162
CrossRef33
Shigeki Shibahara, Feng Han, Bin Li, Kazuhisa Takeda. (2007) Hypoxia and Heme Oxygenases: Oxygen Sensing and Regulation of Expression. Antioxidants & Redox Signaling 9:12, 2209-2226
CrossRef34
S. Kleis, P. Chanez, M. Delvaux, R. Louis. (2007) Perception of dyspnea in mild smoking asthmatics. Respiratory Medicine 101:7, 1426-1430
CrossRef35
Andreas von Leupoldt, Frank Kanniess, Bernhard Dahme. (2007) The influence of corticosteroids on the perception of dyspnea in asthma. Respiratory Medicine 101:6, 1079-1087
CrossRef36
Andreas von Leupoldt, Nadine Seemann, Tatiana Gugleva, Bernhard Dahme. (2007) Attentional distraction reduces the affective but not the sensory dimension of perceived dyspnea. Respiratory Medicine 101:4, 839-844
CrossRef37
Vaidehi Kaza, Venkata Bandi, Kalpalatha K Guntupalli. (2007) Acute severe asthma: recent advances. Current Opinion in Internal Medicine 6:2, 189-195
CrossRef38
Jonathan M. Feldman, Elizabeth L. McQuaid, Robert B. Klein, Sheryl J. Kopel, Jack H. Nassau, Daphne Koinis Mitchell, Marianne Z. Wamboldt, Gregory K. Fritz. (2007) Symptom perception and functional morbidity across a 1-year follow-up in pediatric asthma. Pediatric Pulmonology 42:4, 339-347
CrossRef39
Andreas von Leupoldt, Bernhard Dahme. (2007) Psychological aspects in the perception of dyspnea in obstructive pulmonary diseases. Respiratory Medicine 101:3, 411-422
CrossRef40
Laurent Laforest, Eric Van Ganse, Gilles Devouassoux, Liesl M. Osman, Kitio Brice, Jacques Massol, Gisele Bauguil, Genevieve Chamba. (2007) Asthmatic patients’ poor awareness of inadequate disease control: a pharmacy-based survey. Annals of Allergy, Asthma & Immunology 98:2, 146-152
CrossRef41
L.J. Nannini, G.A. Zaietta, A.J. Guerrera, J.A. Varela, O.M. Fernández, D.M. Flores. (2007) Breath-holding test in subjects with near-fatal asthma. A new index for dyspnea perception. Respiratory Medicine 101:2, 246-253
CrossRef42
Kazuhisa Takeda, Na-Ho Takahashi, Shigeki Shibahara. (2007) Neuroendocrine Functions of Melanocytes: Beyond the Skin-Deep Melanin Maker. The Tohoku Journal of Experimental Medicine 211:3, 201-221
CrossRef43
G.G. Alvarez, J.M. FitzGerald. (2007) A Systematic Review of the Psychological Risk Factors Associated with Near Fatal Asthma or Fatal Asthma. Respiration 74:2, 228-236
CrossRef44
M. Diane Lougheed. (2007) Variability in asthma: symptom perception, care, and outcomesThis paper is one of a selection of papers published in this Special Issue, entitled Young Investigators' Forum.. Canadian Journal of Physiology and Pharmacology 85:1, 149-154
CrossRef45
Andreas Von Leupoldt, Frank Riedel, Bernhard Dahme. (2006) The impact of emotions on the perception of dyspnea in pediatric asthma. Psychophysiology 43:6, 641-644
CrossRef46
Jean G. Ford, Lee McCaffrey. (2006) Understanding Disparities in Asthma Outcomes Among African Americans. Clinics in Chest Medicine 27:3, 423-430
CrossRef47
Hope E Uronis, David C Currow, Amy P Abernethy. (2006) Palliative management of refractory dyspnea in COPD. International Journal of COPD 1:3, 289-304
CrossRef48
Sally E Wenzel. (2006) Asthma: defining of the persistent adult phenotypes. The Lancet 368:9537, 804-813
CrossRef49
Andreas von Leupoldt, Corinna Mertz, Sarah Kegat, Swantje Burmester, Bernhard Dahme. (2006) The impact of emotions on the sensory and affective dimension of perceived dyspnea. Psychophysiology 43:4, 382-386
CrossRef50
D. Stein, O. Luria, R. Tarrasch, L. Goldstein, G. Raviv, A. Weizman, Y. Schwarz. (2006) Factors Associated with Self-evaluated Severity of Illness and Quality of Life in Male Israeli Asthmatic Soldiers. Quality of Life Research 15:5, 915-924
CrossRef51
Inseon S. Choi, Se-Woong Chung, Eu-Ryeong Han, Jeong-Hwan Lim, Jeong-Seon Cho, Yoon-Cheol Lee, Seok Cho, An-Soo Jang. (2006) Effects of anti-asthma therapy on dyspnea perception in acute asthma patients. Respiratory Medicine 100:5, 855-861
CrossRef52
Mehmet Ekici, Aydanur Ekici, Turkan Kara, Hatice Keles, Ali Karlidag, Volkan Altunkaya, Emel Bulcun. (2006) Perception of dyspnea during exacerbation and histamine-related bronchoconstriction in patients with asthma. Annals of Allergy, Asthma & Immunology 96:5, 707-712
CrossRef53
Sally Wenzel. (2006) Physiologic and Pathologic Abnormalities in Severe Asthma. Clinics in Chest Medicine 27:1, 29-40
CrossRef54
Tetsuya Adachi, Hiromasa Ogawa, Shinichi Okabe, Tomomi Kitamuro, Yoshihiro Kikuchi, Shigeki Shibahara, Kunio Shirato, Wataru Hida. (2006) Mice with Blunted Hypoxic Ventilatory Response are Susceptible to Respiratory Disturbance during Hypoxia. The Tohoku Journal of Experimental Medicine 209:2, 125-134
CrossRef55
Edith Chen, Cathy Hermann, Denise Rodgers, Tina Oliver-Welker, Robert C. Strunk. (2006) Symptom Perception in Childhood Asthma: The Role of Anxiety and Asthma Severity.. Health Psychology 25:3, 389-395
CrossRef56
(2006) Sensory and Affective Aspects of Dyspnea Contribute Differentially to the Borg Scale′s Measurement of Dyspnea. Respiration
CrossRef57
Sang-Heon Cho, Heung-Woo Park, Daniel M Rosenberg. (2006) The Current Status of Asthma in Korea. Journal of Korean Medical Science 21:2, 181
CrossRef58
(2005) Normativa para el asma de control difícil. Archivos de Bronconeumología 41:9, 513-523
CrossRef59
Fumitoshi YOSHIMINE, Takashi HASEGAWA, Eiichi SUZUKI, Masaki TERADA, Toshiyuki KOYA, Ariyoshi KONDOH, Masaaki ARAKAWA, Hirohisa YOSHIZAWA, Fumitake GEJYO. (2005) Contribution of aspirin-intolerant asthma to near fatal asthma based on a questionnaire survey in Niigata Prefecture, Japan. Respirology 10:4, 477-484
CrossRef60
E. Martínez-Moragón, M. Perpiñá, A. Belloch, A. de Diego, M.E. Martínez-Francés. (2005) Concordancia entre la percepción de disnea del asmático durante la obstrucción aguda y crónica. Archivos de Bronconeumología 41:7, 371-375
CrossRef61
Nicolas Roche, Hugues Morel, Philippe Martel, Philippe Godard. (2005) Clinical practice guidelines: Medical follow-up of patients with asthma—Adults and adolescents. Respiratory Medicine 99:7, 793-815
CrossRef62
(2005) Comment définir le contrôle de l’asthme et sur quels éléments l’évaluer ?. Revue des Maladies Respiratoires 22:2, 23-44
CrossRef63
(2005) Critères d’aggravation de la maladie asthmatique. Revue des Maladies Respiratoires 22:2, 45-51
CrossRef64
Gen Tamura. (2005) Recent Trends and Future Issues of Asthma Mortality in Japan. Allergology International 54:2, 223-227
CrossRef65
K.L. Letz, A.R. Schlie, W.L. Smits. (2004) A Randomized Trial Comparing Peak Expiratory Flow Versus Symptom Self-Management Plans for Children with Persistent Asthma. Pediatric Asthma, Allergy & Immunology 17:3, 177-190
CrossRef66
Amelia Cataldi, Giuseppina Bianchi, Cinzia Rapino, Nadia Sabatini, Lucia Centurione, Camillo Di Giulio, Domenico Bosco, Adriano Antonucci. (2004) Molecular and morphological modifications occurring in rat heart exposed to intermittent hypoxia: role for protein kinase C α. Experimental Gerontology 39:3, 395-405
CrossRef67
Simon Rietvelt, Jan H Houtveen. (2004) Acquired sensitivity to relevant physiological activity in patients with chronic health problems. Behaviour Research and Therapy 42:2, 137-153
CrossRef68
Paltiel Weiner, Marinella Beckerman, Noa Berar-Yanay, Rasmi Magadle. (2003) The perception of dyspnea after bronchoconstriction and bronchodilation in patients with asthma. Respiratory Medicine 97:10, 1120-1125
CrossRef69
Clarke G Tankersley. (2003) Genetic aspects of breathing: on interactions between hypercapnia and hypoxia. Respiratory Physiology & Neurobiology 135:2-3, 167-178
CrossRef70
Karen B. Schmaling, Paul M. Lehrer, Jonathan M. Feldman, Nicholas D. Giardino. 2003. Asthma. .
CrossRef71
P. Demoly, L. Crampette, J.-P. Daures. (2003) National survey on the management of rhinopathies in asthma patients by French pulmonologists in everyday practice. Allergy 58:3, 233-238
CrossRef72
Steven M. Julius, Kathleen L. Davenport, Paul W. Davenport. (2002) Perception of intrinsic and extrinsic respiratory loads in children with life-threatening asthma. Pediatric Pulmonology 34:6, 425-433
CrossRef73
K. G. Lim. (2002) Management of Persistent Symptoms in Patients With Asthma. Mayo Clinic Proceedings 77:12, 1333-1339
CrossRef74
Takehide Tsuda, Hiroshi Onodera, Shinichi Okabe, Yoshihiro Kikuchi, Yasuto Itoyama. (2002) Impaired chemosensitivity to hypoxia is a marker of multiple system atrophy. Annals of Neurology 52:3, 367-371
CrossRef75
Taeru Kitabayashi, Yoji Iikura, Shogo Tokutome. (2002) A Study of 456 cases of death from asthma (1993-1997) from an investigation by the Tokyo Medical Examiner's Office. Allergology International 51:2, 93-100
CrossRef76
A.-S. JANG, I.S. CHOI. (2002) Relationship between the perception of dyspnoea and airway inflammatory markers. Respiratory Medicine 96:3, 150-154
CrossRef77
Yin Peigang, John J. Marini. (2002) Ventilation of patients with asthma and chronic obstructive pulmonary disease. Current Opinion in Critical Care 8:1, 70-76
CrossRef78
Marija Mitic-Milikic, Srboljub Sekulic, Miodrag Vukcevic. (2002) Dijagnostika i terapija bronhijalne astme kod starijih osoba. Srpski arhiv za celokupno lekarstvo 130:5-6, 222-225
CrossRef79
Satoru Ebihara, Takae Ebihara, Akio Kanda, Hidenori Takahashi, Hidetada Sasaki. (2002) Asthma severity and adequacy of management. The Lancet 359:9300, 75
CrossRef80
Paul Lehrer, Jonathan Feldman, Nicholas Giardino, Hye-Sue Song, Karen Schmaling. (2002) Psychological aspects of asthma.. Journal of Consulting and Clinical Psychology 70:3, 691-711
CrossRef81
ROBERT J. ADAMS, KAREN BOATH, SEAN HOMAN, DONALD A. CAMPBELL, RICHARD E. RUFFIN. (2001) A randomized trial of peak-flow and symptom-based action plans in adults with moderate-to-severe asthma. Respirology 6:4, 297-304
CrossRef82
R. G. Stirling, K. F. Chung. (2001) Severe asthma: definition and mechanisms. Allergy 56:9, 825-840
CrossRef83
David M. Lang. (2001) 2001: the asthma odyssey. Annals of Allergy, Asthma & Immunology 87:2, 91-95
CrossRef84
Barry E. Brenner, Kamal K. Chavda, Melodi B. Karakurum, David J. Karras, Carlos A. Camargo. (2001) Circadian differences among 4,096 emergency department patients with acute asthma. Critical Care Medicine 29:6, 1124-1129
CrossRef85
Desmond Bohn, Niranjan Kissoon. (2001) Acute asthma. Pediatric Critical Care Medicine 2:2, 151-163
CrossRef86
Simon Rietveld, Pier J. M. Prins, Vivian T. Colland. (2001) Accuracy of Symptom Perception in Asthma and Illness Severity. Children's Health Care 30:1, 27-41
CrossRef87
Fumiyoshi OJIMA, Hidenori NAKAMURA, Mitsuaki EBIHARA, Tohru SHOJI, Hitonobu TOMIKE, Yoshito NAKAGAWA. (2001) Clinical Characteristics of Asthmatic Patients Prescribed Various .BETA.-Agonist Metered-Dose Inhalers at Yamagata University Hospital.. YAKUGAKU ZASSHI 121:1, 79-84
CrossRef88
Younsuck Koh. (2001) Ventilatory Management of Patients with Severe Asthma. International Anesthesiology Clinics 39:1, 63-73
CrossRef89
T.K LIM, N.K CHIN, K.H LEE, A.M STEBBINGS. (2000) Early discharge of patients hospitalized with acute asthma: a controlled study. Respiratory Medicine 94:12, 1234-1240
CrossRef90
Simon Rietveld. (2000) Paradoxical breathlessness in asthma. Behaviour Research and Therapy 38:12, 1193-1203
CrossRef91
Peter G. Gibson. (2000) Monitoring the patient with asthma: An evidence-based approach. Journal of Allergy and Clinical Immunology 106:1, 17-26
CrossRef92
E.R. McFadden, Rana B. Hejal. (2000) THE PATHOBIOLOGY OF ACUTE ASTHMA. Clinics in Chest Medicine 21:2, 213-224
CrossRef93
Paul J Hannaway. (2000) Demographic characteristics of patients experiencing near-fatal and fatal asthma: results of a regional survey of 400 asthma specialists. Annals of Allergy, Asthma & Immunology 84:6, 587-593
CrossRef94
P. WEINER, N. BERAR-YANAY, A. DAVIDOVICH, R. MAGADLE, M. WEINER. (2000) The perception of dyspnoea in patients with asthma, before and following treatment with inhaled glucocorticosteroids. Respiratory Medicine 94:2, 161-165
CrossRef95
An-Soo Jang, Inseon-S Choi. (2000) Increased perception of dyspnea by inhalation of short acting β2 agonist in patients with asthma of varying severity. Annals of Allergy, Asthma & Immunology 84:1, 79-83
CrossRef96
R. Randall Baker, Shelley C. Mishoe, Fares H. Zaitoun, Chris B. Arant, Jason Lucas, Ned T. Rupp. (2000) Poor Perception of Airway Obstruction in Children with Asthma. Journal of Asthma 37:7, 613-624
CrossRef97
Karen L. Warman. (2000) Management of Asthma Exacerbations: Home Treatment. Journal of Asthma 37:6, 461-468
CrossRef98
Sergio Salmeron, M. Bard, F. X. Blanc, A. Ellrodt. (1999) Severe acute asthma. Clinical Reviews in Allergy & Immunology 17:4, 449-458
CrossRef99
DAVID GOZAL, PATRICE THIRIET. (1999) Respiratory muscle training in neuromuscular disease: long-term effects on strength and load perception. Medicine & Science in Sports & Exercise 31:11, 1522
CrossRef100
Wataru Hida. (1999) Role of ventilatory drive in asthma and chronic obstructive pulmonary disease. Current Opinion in Pulmonary Medicine 5:6, 339
CrossRef101
Arthur J. Barsky, E. John Orav, David K. Ahern, Malcolm P. Rogers, Shera D. Gruen, Matthew H. Liang. (1999) Somatic Style and Symptom Reporting in Rheumatoid Arthritis. Psychosomatics 40:5, 396-403
CrossRef102
Fran Lang Porter, Deborah White, Nola Attaway, J.Philip Miller, Robert C. Strunk. (1999) Absence of diurnal variability of airway reactivity and hypoxic ventilatory drive in adolescents with stable asthma. Journal of Allergy and Clinical Immunology 103:5, 804-809
CrossRef103
L CHOY, TONG, KO, LI, HO, CHAN, LEUNG, LAI. (1999) Evaluation of the efficacy of a hospital-based asthma education programme in patients of low socioeconomic status in Hong Kong. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 29:1, 84-90
CrossRef104
Ather Siddiqi, Venkata Bandi. (1999) Case discussions on the pathophysiology and clinical features of near-fatal asthma episodes. Current Opinion in Pulmonary Medicine 5:1, 47
CrossRef105
Al James, N. Carroll, N DE Klerk, J. Elliott, Aw Musk, G. Ryan. (1998) Increased perception of airway narrowing in patients with ild asthma. Respirology 3:4, 241-245
CrossRef106
Eva Millqvist, Olle Löwhagen. (1998) Methacholine Provocations Do Not Reveal Sensitivity to Strong Scents. Annals of Allergy, Asthma & Immunology 80:5, 381-384
CrossRef107
B. D. Levy, B. Kitch, C. H. Fanta. (1998) Medical and ventilatory management of status asthmaticus. Intensive Care Medicine 24:2, 105-117
CrossRef108
Tateo OGURA, Hirosuke KOBAYASHI, Michihiro SUZUKI, Tetsuya SATO, Tomoyuki TOMITA. (1998) Posthyperventilation Hypoxemia after Methacholine Inhalation.. The Japanese Journal of Physiology 48:1, 39-47
CrossRef109
Wataru Hida. (1998) New Strategies of Screening and Treatment for Sleep Apnea Syndrome.. The Tohoku Journal of Experimental Medicine 186:4, 225-241
CrossRef110
Tatsuya CHONAN, Shinichi OKABE, Wataru HIDA, Makoto SATOH, Yoshihiro KIKUCHI, Tamotsu TAKISHIMA, Kunio SHIRATO. (1998) Influence of Sustained Hypoxia on the Sensation of Dyspnea.. The Japanese Journal of Physiology 48:4, 291-295
CrossRef111
Susan Janson, Gay Becker. (1998) Reasons for Delay in Seeking Treatment for Acute Asthma: The Patient's Perspective. Journal of Asthma 35:5, 427-435
CrossRef112
Martyn R. Partridge. 1998. Education and Self-management. , 917-926.
CrossRef113
Neil B. Pride. 1998. Physiology. , 65-87.
CrossRef114
Marianne Z. Wamboldt. (1998) A Wheeze by Any Other Name Is (Not) the Same: The Role of Symptom Perception in Asthma. Journal of Asthma 35:2, 133-135
CrossRef115
J.Mark FitzGerald, Mark O Turner. (1997) Delivering asthma education to special high risk groups. Patient Education and Counseling 32, S77-S86
CrossRef116
Martyn R Partridge. (1997) Self-Management in Adults with Asthma. Patient Education and Counseling 32, S1-S4
CrossRef117
Scott Manaker, Gregory Tino. (1997) NATURAL HISTORY AND PROGNOSIS OF ADVANCED LUNG DISEASE. Clinics in Chest Medicine 18:3, 435-455
CrossRef118
N COHEN, H EIGEN, T SHAUGHNESSY. (1997) STATUS ASTHMATICUS. Critical Care Clinics 13:3, 459-476
CrossRef119
David M Lang. (1997) Trends in US Asthma Mortality: Good News and Bad News. Annals of Allergy, Asthma & Immunology 78:4, 333-337
CrossRef120
Tuan Peng Chua, Derek Harrington, Piotr Ponikowski, Katharine Webb-Peploe, Philip A Poole-Wilson, Andrew J.S Coats. (1997) Effects of Dihydrocodeine on Chemosensitivity and Exercise Tolerance in Patients With Chronic Heart Failure. Journal of the American College of Cardiology 29:1, 147-152
CrossRef121
(1997) Periodic Assessment and Monitoring: Essential for Asthma Management. Pediatric Asthma, Allergy & Immunology 11:3, 25-39
CrossRef122
Elizabeth L. McQuaid, Gregory K. Fritz, Albert Yeung, Patricia A. Biros, Anthony Mansell. (1996) Resistive-load detection in healthy school-aged children. Pediatric Pulmonology 22:6, 357-363
CrossRef123
GREGORY K. FRITZ, ELIZABETH L. McQUAID, ANTHONY SPIRITO, ROBERT B. KLEIN. (1996) Symptom Perception in Pediatric Asthma: Relationship to Functional Morbidity and Psychological Factors. Journal of the American Academy of Child & Adolescent Psychiatry 35:8, 1033-1041
CrossRef124
Ruzica Jokic, Michael F. Fitzpatrick. (1996) OBSTRUCTIVE LUNG DISEASE AND SLEEP. Medical Clinics of North America 80:4, 821-850
CrossRef125
J.M. FitzGerald, M.D, P. Macklem, M.D. (1996) FATAL ASTHMA. Annual Review of Medicine 47:1, 161-168
CrossRef126
James T.C. Li, Edward J. O'Connell. (1996) Clinical Evaluation of Asthma. Annals of Allergy, Asthma & Immunology 76:1, 1-15
CrossRef127
Robert B. Klein, Gregory K. Fritz, Albert Yeung, Elizabeth L.McQuaid, Anthony Mansell. (1995) Spirometric patterns in childhood asthma: Peak flow compared with other indices. Pediatric Pulmonology 20:6, 372-379
CrossRef128
T. P. CHUA, A. J. S. COATS. (1995) The reproducibility and comparability of tests of the peripheral chemoreflex: comparing the transient hypoxic ventilatory drive test and the single-breath carbon dioxide response test in healthy subjects. European Journal of Clinical Investigation 25:12, 887-892
CrossRef129
A. Noseda, J. Schmerber, T. Prigogine, V. de Maertelaer, J-C. Yernault. (1995) Perception of dyspnoea during acute changes in lung function in patients with either asthma or COPD. Respiratory Medicine 89:7, 477-485
CrossRef130
Barnes, Peter J., . (1994) Blunted Perception and Death from Asthma. New England Journal of Medicine 330:19, 1383-1384
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