Martínez-Moragón E, Perpiñá M, Belloch A, Serra B, Lloris A, Macián V
Servicio de Neumología, Hospital de Sagunto, Sagunto, Valencia, Spain.
Arch Bronconeumol. 2006 Mar;42(3):120-4. doi: 10.1016/s1579-2129(06)60129-8.
In previous studies we identified a subgroup of patients whose perception of breathlessness was exaggerated during acute bronchoconstriction and who were termed "over perceivers" or "hyperperceivers". In this study we aimed to determine whether such over perception is sporadic or stable over time. We also examined whether there is an association between over perception of dyspnea and hyperventilation syndrome.
The subjects were 22 stable asthmatics (11 men, 11 women) who had been over perceivers of dyspnea in a study 9 years earlier. After a medical history was taken, a patient performed forced spirometry and a severity classification was made according to the criteria of the Global Initiative for Asthma (GINA). A bronchial histamine challenge was then administered to measure dose-related perception of dyspnea on a Borg scale, according to a procedure that was similar to the one used 9 years earlier by the same investigator. The patients were also asked for a subjective assessment of the severity of their asthma (scale, 0-10) and to respond to items on the Nijmegen hyperventilation questionnaire and the trait form of the State-Trait Anxiety Inventory.
The overall perception of severity of disease, level of anxiety, and perception of dyspnea at rest were lower after 9 years (P<.001). No change was observed in bronchial hyperresponsiveness (dose of inhaled histamine required to provoke a 20% decline in forced expiratory volume in the first second [FEV1]-PD20) or objective parameters of severity (FEV1 and GINA classification). Fourteen asthmatics (64%) were still over perceivers and the other patients had changed: 6 were normal perceivers and 2 were "poor perceivers". Only subjective perception of disease severity improved for the patients who were still over perceivers; the other patients, on the other hand, showed improvements in subjective assessments, objective ones (except PD20), and anxiety. Finally, those who remained over perceivers had higher scores for anxiety (24 vs 15; P<.05) and hyperventilation (18 vs 13; P= not significant).
Most over perceivers of dyspnea remain so over the years and this trait is related to anxiety. We have been unable to demonstrate an association with hyperventilation syndrome.
在之前的研究中，我们确定了一组患者，他们在急性支气管收缩期间对呼吸困难的感知被夸大，这些患者被称为“过度感知者”或“高感知者”。在本研究中，我们旨在确定这种过度感知是偶发的还是随时间稳定的。我们还研究了呼吸困难的过度感知与过度通气综合征之间是否存在关联。
研究对象为22名稳定期哮喘患者（11名男性，11名女性），他们在9年前的一项研究中是呼吸困难的过度感知者。在采集病史后，患者进行了用力肺活量测定，并根据全球哮喘防治创议（GINA）的标准进行严重程度分类。然后按照与9年前同一位研究者使用的程序相似的方法，给予支气管组胺激发试验，以用Borg量表测量与剂量相关的呼吸困难感知。还要求患者对其哮喘严重程度进行主观评估（范围0 - 10），并回答奈梅亨过度通气问卷和状态 - 特质焦虑量表特质形式的项目。
9年后，疾病严重程度的总体感知、焦虑水平和静息时呼吸困难的感知均降低（P <.001）。支气管高反应性（引起第一秒用力呼气量[FEV1]下降20%所需的吸入组胺剂量 - PD20）或严重程度的客观参数（FEV1和GINA分类）未观察到变化。14名哮喘患者（64%）仍是过度感知者，其他患者发生了变化：6名是正常感知者，2名是“低感知者”。对于仍为过度感知者的患者，仅疾病严重程度的主观感知有所改善；另一方面，其他患者在主观评估、客观评估（除PD20外）和焦虑方面均有改善。最后，仍为过度感知者的患者焦虑得分更高（24对15；P <.
