Document Detail

Do obstructive and restrictive lung diseases share common underlying mechanisms of breathlessness?
MedLine Citation:
PMID:  20303724     Owner:  NLM     Status:  MEDLINE    
This review tries to answer two main questions: (i) What are the neurophysiological underpinnings of the most commonly selected cluster descriptors which define the qualitative dimension of dyspnea in patients? (ii) How do mechanical constraints affect dyspnea? (iii) Do obstructive and restrictive lung diseases share some common underlying mechanisms? Qualitative dimensions of dyspnea, which allude to increased respiratory work/effort breathing, reflect a harmonious coupling between increased respiratory motor output and lung volume displacement in healthy subjects. Descriptors that allude to unsatisfied inspiration are the dominant qualitative descriptors in patients with a variety of respiratory diseases. It is possible that sensory feedback from a multitude of mechanoreceptors throughout the respiratory system (in the muscle, chest wall, airways and lung parenchyma) collectively convey information to the consciousness that volume/flow or chest wall displacement is inadequate for the prevailing respiratory drive. The data would lend support to the idea that: (i) an altered afferent proprioceptive peripheral feedback signals that ventilatory response is inadequate to the prevailing motor drive, reflecting neuromechanical uncoupling (NMU), (ii) mechanical constraints on volume expansion (dynamic restriction) play a pivotal role in dyspnea causation in patients with a variety of either obstructive or restrictive respiratory disorders, and (iii) all of the physiological adaptations that optimize neuromechanical coupling in obstructive and restrictive disorders are seriously disrupted so that an NMU underpins cluster descriptors of dyspnea which are similar in obstructed and in restricted patients.
Giorgio Scano; Giulia Innocenti-Bruni; Loredana Stendardi
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-03-19
Journal Detail:
Title:  Respiratory medicine     Volume:  104     ISSN:  1532-3064     ISO Abbreviation:  Respir Med     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-08-05     Completed Date:  2010-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  925-33     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Ltd. All rights reserved.
Department of Internal Medicine, Section of Clinical Immunology and Respiratory Medicine, University of Florence, Italy.
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MeSH Terms
Dyspnea / physiopathology*
Feedback, Sensory / physiology*
Heart Failure / physiopathology*
Lung Diseases / physiopathology*
Neural Pathways / physiopathology*
Pulmonary Disease, Chronic Obstructive
Respiratory Mechanics / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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