Department of Pneumology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2011 Oct;124(20):3220-6.
The current theory of dyspnea perception presumes a multidimensional conception of dyspnea. However, its validity in patients with cardiopulmonary dyspnea has not been investigated.
A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort, affective aspects, and behavioral items was administered to 396 patients with asthma, chronic obstructive pulmonary disease (COPD), diffuse parenchymal lung disease, pulmonary vascular disease, chronic heart failure, and medically unexplained dyspnea. Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis. The separation of patient groups was achieved by a variance analysis on symptom factors.
Seven factors appeared to measure three dimensions of dyspnea: sensory (difficulty breathing and phase of respiration, depth and frequency of breathing, urge to breathe, wheeze), affective (chest tightness, anxiety), and behavioral (refraining from physical activity) dimensions. Difficulty breathing and phase of respiration occurred more often in COPD, followed by asthma (R(2) = 0.12). Urge to breathe was unique for patients with medically unexplained dyspnea (R(2) = 0.12). Wheeze occurred most frequently in asthma, followed by COPD and heart failure (R(2) = 0.17). Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R(2) = 0.04). Anxiety characterized medically unexplained dyspnea (R(2) = 0.08). Refraining from physical activity appeared more often in heart failure, pulmonary vascular disease, and COPD (R(2) = 0.15).
Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups. These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.
目前的呼吸困难感知理论假定呼吸困难是一个多维的概念。然而，它在心肺呼吸困难患者中的有效性尚未得到研究。
一项呼吸症状清单纳入了患者自主报告的呼吸不适感觉描述、情感方面和行为项目，共纳入 396 例哮喘、慢性阻塞性肺疾病（COPD）、弥漫性实质肺疾病、肺血管疾病、慢性心力衰竭和无法解释的呼吸困难患者。通过主成分分析得出测量呼吸困难不同定性成分的症状因子。通过对症状因子的方差分析来分离患者组。
似乎有七个因素可以测量呼吸困难的三个维度：感觉（呼吸困难和呼吸阶段、呼吸深度和频率、呼吸急促、喘息）、情感（胸闷、焦虑）和行为（避免体力活动）维度。呼吸困难和呼吸阶段在 COPD 中更为常见，其次是哮喘（R²=0.12）。呼吸急促是无法解释的呼吸困难患者所特有的（R²=0.12）。喘息在哮喘中最为常见，其次是 COPD 和心力衰竭（R²=0.17）。胸闷与无法解释的呼吸困难和哮喘特异性相关（R²=0.04）。焦虑是无法解释的呼吸困难的特征（R²=0.08）。避免体力活动在心力衰竭、肺血管疾病和 COPD 中更为常见（R²=0.15）。
心肺疾病中出现了三个维度和七个定性成分的呼吸困难，每个维度下的成分可以分离出不同的患者群体。这些发现可能为心肺呼吸困难的多维度提供了验证。
