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2012 ; 185
(4
): 435-52
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An official American Thoracic Society statement: update on the mechanisms,
assessment, and management of dyspnea
#MMPMID22336677
Parshall MB
; Schwartzstein RM
; Adams L
; Banzett RB
; Manning HL
; Bourbeau J
; Calverley PM
; Gift AG
; Harver A
; Lareau SC
; Mahler DA
; Meek PM
; O'Donnell DE
Am J Respir Crit Care Med
2012[Feb]; 185
(4
): 435-52
PMID22336677
show ga
BACKGROUND: Dyspnea is a common, distressing symptom of cardiopulmonary and
neuromuscular diseases. Since the ATS published a consensus statement on dyspnea
in 1999, there has been enormous growth in knowledge about the neurophysiology of
dyspnea and increasing interest in dyspnea as a patient-reported outcome.
PURPOSE: The purpose of this document is to update the 1999 ATS Consensus
Statement on dyspnea. METHODS: An interdisciplinary committee of experts
representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory
Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the
overall scope of this update through group consensus. Focused literature reviews
in key topic areas were conducted by committee members with relevant expertise.
The final content of this statement was agreed upon by all members. RESULTS:
Progress has been made in clarifying mechanisms underlying several qualitatively
and mechanistically distinct breathing sensations. Brain imaging studies have
consistently shown dyspnea stimuli to be correlated with activation of
cortico-limbic areas involved with interoception and nociception. Endogenous and
exogenous opioids may modulate perception of dyspnea. Instruments for measuring
dyspnea are often poorly characterized; a framework is proposed for more
consistent identification of measurement domains. CONCLUSIONS: Progress in
treatment of dyspnea has not matched progress in elucidating underlying
mechanisms. There is a critical need for interdisciplinary translational research
to connect dyspnea mechanisms with clinical treatment and to validate dyspnea
measures as patient-reported outcomes for clinical trials.
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