Abstract
Purpose
(1) To determine whether healthy humans can distinguish between the intensity and unpleasantness of exertional dyspnoea; (2) to evaluate the reliability of qualitative dyspnoea descriptors during exercise; and (3) to assess the reliability of the Multidimensional Dyspnoea Profile (MDP)
Methods
Forty-four healthy participants (24M:20F, 25 ± 5 years) completed maximal incremental cycling tests on three visits. During visit 1, participants rated the intensity and unpleasantness of dyspnoea simultaneously throughout exercise using the modified 0–10 category-ratio Borg scale. On visits 2 and 3, participants rated either the intensity or unpleasantness of dyspnoea alone at the same measurement times as visit 1. On all visits, participants selected qualitative descriptors throughout all exercise intensities from a list of 4, selected relevant qualitative descriptors from a list of 15 at peak exercise, and completed the MDP.
Results
Participants rated their dyspnoea intensity significantly higher for a given minute ventilation (\(\dot{V}_{E}\)) compared to dyspnoea unpleasantness (dyspnoea-\(\dot{V}_{E}\) slope: 0.08 ± 0.02 vs. 0.07 ± 0.03 Borg 0–10/L min−1, p < 0.001) during visit 1. The onset of intensity ratings occurred at a significantly lower work rate compared to unpleasantness ratings measured on the same exercise test (52 ± 41 vs. 91 ± 53 watts, p < 0.001). Dyspnoea intensity and unpleasantness remained significantly different for a given ventilation even when measured independently on separate exercise tests (p < 0.05). There was good-to-excellent reliability (ICC > 0.60) for the use of qualitative dyspnoea descriptors and the MDP to measure dyspnoea at peak exercise.
Conclusion
Exercise-induced dyspnoea in healthy adults can differ in the sensory and affective dimensions, and can be measured reliably using qualitative descriptors and the MDP.
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Data availability
The datasets generated during the current study are available from the corresponding author on reasonable request.
Code availability
The statistical code used in the study is available from the corresponding author on reasonable request.
Abbreviations
- A:
-
Affective
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- EELV:
-
End-expiratory lung volume
- EILV:
-
End-inspiratory lung volume
- ESM:
-
Electronic supplementary material
- F:
-
Female
- F b :
-
Breathing frequency
- FEV1 :
-
Forced expiratory volume in 1 s
- FVC:
-
Forced vital capacity
- HR:
-
Heart rate
- IC:
-
Inspiratory capacity
- ICC:
-
Intraclass correlation coefficient
- M:
-
Male
- MDP:
-
Multidimensional dyspnoea profile
- RER:
-
Respiratory exchange ratio
- SQ:
-
Sensory quality
- \(\dot{V}{\text{CO}}_{2}\) :
-
Carbon dioxide production
- \(\dot{V}_{E}\) :
-
Minute ventilation
- \(\dot{V}{\text{O}}_{2}\) :
-
Oxygen consumption
- V T :
-
Tidal volume
References
Banzett RB, Pedersen SH, Schwartzstein RM, Lansing RW (2008) The affective dimension of laboratory dyspnea: air hunger is more unpleasant than work/effort. Am J Respir Crit Care Med 177:1384–1390. https://doi.org/10.1164/rccm.200711-1675OC
Banzett RB, O'Donnell CR, Guilfoyle TE, Parshall MB, Schwartzstein RM, Meek PM, Gracely RH, Lansing RW (2015) Multidimensional Dyspnea Profile: an instrument for clinical and laboratory research. Eur Respir J 45:1681–1691. https://doi.org/10.1183/09031936.00038914
Belo LF, Rodrigues A, Vicentin AP, Paes T, de Castro LA, Hernandes NA, Pitta F (2019) A breath of fresh air: validity and reliability of a Portuguese version of the Multidimensional Dyspnea Profile for patients with COPD. PLoS ONE 14:e0215544. https://doi.org/10.1371/journal.pone.0215544
Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381
Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290. https://doi.org/10.1037/1040-3590.6.4.284
Cory JM, Schaeffer MR, Wilkie SS, Ramsook AH, Puyat JH, Arbour B, Basran R, Lam M, Les C, MacDonald B (2015) Sex differences in the intensity and qualitative dimensions of exertional dyspnea in physically active young adults. J Appl Physiol 119:998–1006. https://doi.org/10.1152/japplphysiol.00520.2015
Ekström M, Bornefalk H, Sköld M, Janson C, Blomberg A, Sandberg J, Bornefalk-Hermansson A, Igelström H, Sundh J (2019) Validation of the Swedish Multidimensional Dyspnea Profile (MDP) in outpatients with cardiorespiratory disease. BMJ Open Respir Res 6:e000381. https://doi.org/10.1136/bmjresp-2018-000381
Guenette JA, Chin RC, Cory JM, Webb KA, O'Donnell DE (2013) Inspiratory capacity during exercise: measurement, analysis, and interpretation. Pulm Med 2013:956081. https://doi.org/10.1155/2013/956081
Han J, Zhu Y, Li S, Chen X, Put C, de Woestijne V, Van den Bergh O (2005) Respiratory complaints in Chinese: cultural and diagnostic specificities. Chest 127:1942–1951. https://doi.org/10.1378/chest.127.6.1942
Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163. https://doi.org/10.1016/j.jcm.2016.02.012
Kunik ME, Roundy K, Veazey C, Souchek J, Richardson P, Wray NP, Stanley MA (2005) Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest 127:1205–1211. https://doi.org/10.1016/S0012-3692(15)34468-8
Laveneziana P, Webb KA, Ora J, Wadell K, O'Donnell DE (2011) Evolution of dyspnea during exercise in chronic obstructive pulmonary disease: impact of critical volume constraints. Am J Respir Crit Care Med 184:1367–1373. https://doi.org/10.1164/rccm.201106-1128OC
Laveneziana P, Bruni GI, Presi I, Stendardi L, Duranti R, Scano G (2013) Tidal volume inflection and its sensory consequences during exercise in patients with stable asthma. Respir Physiol Neurobiol 185:374–379. https://doi.org/10.1016/j.resp.2012.08.026
Mahler DA, Harver A, Lentine T, Scott JA, Beck K, Schwartzstein RM (1996) Descriptors of breathlessness in cardiorespiratory diseases. Am J Respir Crit Care Med 154:1357–1363. https://doi.org/10.1164/ajrccm.154.5.8912748
McGraw KO, Wong SP (1996) Forming inferences about some intraclass correlation coefficients. Psychol Methods 1:30–46. https://doi.org/10.1037/1082-989X.1.1.30
Meek PM, Banzett R, Parshall MB, Gracely RH, Schwartzstein RM, Lansing R (2012) Reliability and validity of the multidimensional dyspnea profile. Chest 141:1546–1553. https://doi.org/10.1378/chest.11-1087
Mendonca CT, Schaeffer MR, Riley P, Jensen D (2014) Physiological mechanisms of dyspnea during exercise with external thoracic restriction: role of increased neural respiratory drive. J Appl Physiol 116:570–581. https://doi.org/10.1152/japplphysiol.00950.2013
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, Van der Grinten C, Gustafsson P (2005) Standardisation of spirometry. Eur Respir J 26:319–338. https://doi.org/10.1183/09031936.05.00034805
Morélot-Panzini C, Perez T, Sedkaoui K, de Bock E, Aguilaniu B, Devillier P, Pignier C, Arnould B, Bruneteau G, Similowski T (2018) The multidimensional nature of dyspnoea in amyotrophic lateral sclerosis patients with chronic respiratory failure: air hunger, anxiety and fear. Respir Med 145:1–7. https://doi.org/10.1016/j.rmed.2018.10.010
O’Donnell DE, Chau LK, Webb KA (1998) Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. J Appl Physiol 84:2000–2009. https://doi.org/10.1152/jappl.1998.84.6.2000
O'Donnell DE, Bertley JC, Chau LK, Webb KA (1997) Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am J Respir Crit Care Med 155:109–115. https://doi.org/10.1164/ajrccm.155.1.9001298
O'Donnell DE, Hong HH, Webb KA (2000) Respiratory sensation during chest wall restriction and dead space loading in exercising men. J Appl Physiol 88:1859–1869. https://doi.org/10.1152/jappl.2000.88.5.1859
Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC (2012) An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 185:435–452. https://doi.org/10.1164/rccm.201111-2042ST
Price DD (2000) Psychological and neural mechanisms of the affective dimension of pain. Science 288:1769–1772. https://doi.org/10.1126/science.288.5472.1769
Quon BS, Wilkie SS, Ramsook AH, Schaeffer MR, Puyat JH, Wilcox PG, Guenette JA (2016) Qualitative dimensions of exertional dyspnea in adults with cystic fibrosis. J Appl Physiol 121:449–456. https://doi.org/10.1152/japplphysiol.00391.2016
Schaeffer MR, Mendonca CT, Levangie MC, Andersen RE, Taivassalo T, Jensen D (2014) Physiological mechanisms of sex differences in exertional dyspnoea: role of neural respiratory motor drive. Exp Physiol 99:427–441. https://doi.org/10.1113/expphysiol.2013.074880
Schaeffer MR, Guenette JA, Ramsook AH, Molgat-Seon Y, Mitchell RA, Wilkie SS, Dhillon SS, Sheel AW, Ryerson CJ (2019) Qualitative dimensions of exertional dyspnea in fibrotic interstitial lung disease. Respir Physiol Neurobiol 266:1–8. https://doi.org/10.1016/j.resp.2019.04.004
Simon PM, Schwartzstein RM, Weiss JW, Lahive K (1989) Distinguishable sensations of breathlessness induced in normal volunteers. Am Rev Respir Dis 140:1021–1027. https://doi.org/10.1164/ajrccm/140.4.1021
Streiner DL, Norman GR, Cairney J (2015) Reliability. Health measurement scales: a practical guide to their development and use, 5th edn. Oxford University Press, Oxford, pp 167–196
Tan WC, Bourbeau J, Hernandez P, Chapman K, Cowie R, FitzGerald MJ, Aaron S, Marciniuk DD, Maltais F, O’Donnell DE (2011) Canadian prediction equations of spirometric lung function for Caucasian adults 20 to 90 years of age: results from the Canadian Obstructive Lung Disease (COLD) study and the Lung Health Canadian Environment (LHCE) study. Can Respir J 18:321–326. https://doi.org/10.1155/2011/540396
Turcotte H, Langdeau J, Thibault G, Boulet L (2003) Prevalence of respiratory symptoms in an athlete population. Respir Med 97:955–963. https://doi.org/10.1016/S0954-6111(03)00123-9
von Leupoldt A, Dahme B (2005a) Cortical substrates for the perception of dyspnea. Chest 128:345–354. https://doi.org/10.1378/chest.128.1.345
von Leupoldt A, Dahme B (2005b) Differentiation between the sensory and affective dimension of dyspnea during resistive load breathing in normal subjects. Chest 128:3345–3349. https://doi.org/10.1378/chest.128.5.3345
von Leupoldt A, Ambruzsova R, Nordmeyer S, Jeske N, Dahme B (2006a) Sensory and affective aspects of dyspnea contribute differentially to the Borg scale’s measurement of dyspnea. Respiration 73:762–768. https://doi.org/10.1159/000095910
von Leupoldt A, Petersen S, Scheuchl S, Fullekrug K, Gerwin C, Reer R, Ziegler M, Braumann KM, Dahme B (2006b) Reliability of verbal descriptors of dyspnea and their relationship with perceived intensity and unpleasantness. G Ital Med Lav Ergon 28:83–88
Wan L, Van Diest I, De Peuter S, Bogaerts K, Van den Bergh O (2009) Repeated breathlessness experiences induced by hypercapnia. Chest 135:455–461. https://doi.org/10.1378/chest.08-1226
Wilson RC, Jones PW (1991) Differentiation between the intensity of breathlessness and the distress it evokes in normal subjects during exercise. Clin Sci 80:65–70. https://doi.org/10.1042/cs0800065
Acknowledgements
We would like to thank Satvir Dhillon, Andrew Ramsook, Nafeez Syed, Cassandra Legault, Erin Little, Serena Midttun, Sydney Schnell, and Chelsey de la Rey for their assistance during data collection. We also thank all the participants for their time and willingness to volunteer for this study.
Funding
This work was funded by a Discovery Grant from the Natural Sciences and Engineering Research Council of Canada (NSERC). JZ was supported by an NSERC Undergraduate Student Research Award. MRS was supported by a postdoctoral fellowship from the Michael Smith Foundation for Health Research (MSFHR). JP was supported by a Scholar Award from the MSFHR. RAM was supported by an NSERC Postgraduate Doctoral Scholarship and a 4-year doctoral fellowship from The University of British Columbia. JAG was supported by a Canadian Institutes of Health Research Clinical Rehabilitation New Investigator Award and a Scholar Award from the MSFHR.
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MRS and JAG conceived and designed the research. JZ, MRS, RAM, KGB, and ONH conducted the experiments. JZ and MRS analyzed the data. JHP wrote the statistical code. All authors contributed to drafting and critically revising the manuscript. All authors read and approved the manuscript.
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No conflict of interest, financial or otherwise, are declared by the authors. The findings of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.
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All experimental protocols were approved by the University of British Columbia and Providence Health Care Research Institute Ethics Board. The study was performed in accordance with all the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.
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Zhang, J., Schaeffer, M.R., Mitchell, R.A. et al. A multidimensional assessment of dyspnoea in healthy adults during exercise. Eur J Appl Physiol 120, 2533–2545 (2020). https://doi.org/10.1007/s00421-020-04479-2
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DOI: https://doi.org/10.1007/s00421-020-04479-2