Weatherald Jason, Lougheed M Diane, Taillé Camille, Garcia Gilles
Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
Service de Pneumologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.
Eur Respir Rev. 2017 Jun 14;26(144). doi: 10.1183/16000617.0015-2017. Print 2017 Jun 30.
Asthma is a heterogeneous condition, with dyspnoea during exercise affecting individuals to a variable degree. This narrative review explores the mechanisms and measurement of exertional dyspnoea in asthma and summarises the available evidence for the efficacy of various interventions on exertional dyspnoea. Studies on the mechanisms of dyspnoea in asthma have largely utilised direct bronchoprovocation challenges, rather than exercise, which may invoke different physiological mechanisms. Thus, the description of dyspnoea during methacholine challenge can differ from what is experienced during daily activities, including exercise. Dyspnoea perception during exercise is influenced by many interacting variables, such as asthma severity and phenotype, bronchoconstriction, dynamic hyperinflation, respiratory drive and psychological factors. In addition to the intensity of dyspnoea, the qualitative description of dyspnoea may give important clues as to the underlying mechanism and may be an important endpoint for future interventional studies. There is currently little evidence demonstrating whether pharmacological or non-pharmacological interventions specifically improve exertional dyspnoea, which is an important area for future research.
哮喘是一种异质性疾病，运动时的呼吸困难对个体的影响程度各不相同。本叙述性综述探讨了哮喘中运动性呼吸困难的机制和测量方法，并总结了各种干预措施对运动性呼吸困难疗效的现有证据。关于哮喘中呼吸困难机制的研究主要采用直接支气管激发试验，而非运动试验，因为运动可能引发不同的生理机制。因此，乙酰甲胆碱激发试验期间的呼吸困难描述可能与日常活动（包括运动）中所经历的不同。运动期间的呼吸困难感知受许多相互作用的变量影响，如哮喘严重程度和表型、支气管收缩、动态肺过度充气、呼吸驱动和心理因素。除了呼吸困难的强度外，呼吸困难的定性描述可能为潜在机制提供重要线索，并且可能是未来干预研究的重要终点。目前几乎没有证据表明药物或非药物干预是否能特异性改善运动性呼吸困难，这是未来研究的一个重要领域。
