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Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada K7L 2V7
We compared
qualitative and quantitative aspects of perceived exertional dyspnea in
patients with interstitial lung disease (ILD) and normal subjects and
sought a physiological rationale for their differences. Twelve patients
with ILD [forced vital capacity = 64 ± 4 (SE)
%predicted] and 12 age-matched normal subjects performed
symptom-limited incremental cycle exercise tests with measurements of
dyspnea intensity (Borg scale), ventilation, breathing pattern,
operational lung volumes, and esophageal pressures (Pes). Qualitative
descriptors of dyspnea were selected at exercise cessation. Both groups
described increased "work and/or effort" and
"heaviness" of breathing; only patients with ILD described
"unsatisfied inspiratory effort" (75%), "increased
inspiratory difficulty" (67%), and "rapid breathing" (58%)
(P < 0.05 patients with ILD vs.
normal subjects). Borg-O2 uptake
(
O2) and Borg-ventilation
slopes were significantly greater during exercise in patients with ILD
(P < 0.01). At peak exercise, when
dyspnea intensity and inspiratory effort (Pes-to-maximal inspiratory
pressure ratio) were similar, the distinct qualitative perceptions of
dyspnea in patients with ILD were attributed to differences in dynamic
ventilatory mechancis, i.e., reduced inspiratory capacity, heightened
Pes-to-tidal volume ratio, and tachypnea. Factors contributing to
dyspnea intensity in both groups were also different: the best
correlate of the Borg-O2
slope in patients with ILD was the resting tidal volume-to-inspiratory
capacity ratio (r = 0.58, P < 0.05) and in normal subjects was
the slope of Pes-to-maximal inspiratory pressure ratio over
O2
(r = 0.60, P < 0.05).
respiratory sensation; respiratory mechanics; exercise
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