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Multivariate support for three distinct approaches to the assessment of respiratory sensation in patients with obstructive lung disease
68
Sympostum
on Respiraror)
Psychophysiolog)i
common feature. The tendency to adopt similar ventilatory strategies during automatic and voluntary breathing resembles certain characteristics of automatic behaviours acquired through learning or repetition.
MULTIVARIATE SUPPORT FOR THREE DISTINCT APPROACHES TO THE ASSESSMENT OF RESPIRATORY SENSATION IN PATIENTS WITH OBSTRUCTIVE LUNG DISEASE Andrew HARVER, Donald and Joan F. MCGOVERN Depcrrtment of Ph_vslologv. Dartmouth
A. MAHLER,
J. Andrew
DAUBENSPECK,
Medical School. Hanouer. NH 03756. U.S.A
Recently, we reported that clinical ratings of dyspnea are unrelated to the perceived magnitude of resistive loads in patients with obstructive lung disease. Furthermore, we have observed that Borg ratings of breathlessness during graded exercise are independent of both ratings of dyspnea and perceived magnitude of resistive loads. In this paper, we provide multivariate support for the independence of these approaches in the assessment of respiratory sensation in obstructive lung disease. Respiratory sensations were assessed in 20 patients with mild to moderate obstructive lung disease. Patients participated in each of three scaling tasks: clinical ratings of dyspnea, magnitude scaling of resistive loads added to inspiration, and Borg ratings of shortness of breath during progressive exercise on a cycle ergometer. The clinical ratings of dyspnea were obtained by two independent observers using the baseline dyspnea index, the oxygen cost diagram, and a modified Medical Research Council scale. Psychophysical testing consisted of estimation of the magnitude of breathlessness evoked by Breathlessness during progressive five resistive loads added to inspiration. exercise was determined through the psychophysical power law describing the relationship between Borg ratings and expired minute ventilation at I-min intervals. Factor analysis was employed to determine the arrangement of variables within an orthogonal factor structure. A total of 20 variables were entered into the initial analysis; selected combinations of variables were examined subsequently. The major analysis yielded six orthogonal factors: clinical dyspnea ratings, respiratory performance, lung function, gas exchange, perceived magnitude of resistive loads, and age. Borg ratings of breathlessness during exercise fit with the respiratory performance factor. Subsequent analyses accomplished through removal of specific variables complemented the major analysis; clinical ratings of dyspnea, perceived magnitude of resistive loads, and Borg ratings of breathlessness during exercise were consistently separate
Symposium
on Resprratog~ F~ychaphysloio~
69
factors. These multivariate results provide support for previous observations that clinical, psychophysical and exercise methods for quantifying breathlessness independently assess respiratory sensation in patients with obstructive lung disease.
STRATEGIES MYOGRAPHIC
TO REDUCE THE EFFORT OF BREATHING ELECTROAND INCENTIVE INSPIROMETRY BIOFEEDBACK
Erik PEPER insttiui~ for Holistic Healing Studies, San Francisco State Universit_y, Sun Francisco, CA 94132, U.S.A.
This paper reports on a new methodology, upper thoracic electromyography (EMG), incentive inspirometry (Voldyne) feedback, and desensitization to reduce the muscular efforts of breathing, inhibit paradoxical breathing, enhance diaphragmatic breathing, increase inhalation volume and reduce asthmatic symptoms. The training was offered in groups of 7-10 subjects for lo-15 weekly sessions. Subjects, mean age = 29.7, mean years of asthma = 17.1, with mild to moderately severe asthma were taught effortless diaphragmati~ breathing. Preand post-assessment questionnaires, spirometry and breathing efforts (thoracic EMG per sequential inhaled volume) were recorded. The specific components of the group training program consisted of (1) Didactic and experiential demonstrations of breath patterns. (2) inhibiting scalene/ trapezius EMG activity during inhalation. (3) Increasing inhalation volume with incentive inspirometry (Voldyne) feedback. (4) Home and group practice of diaphragmatic breathing with incentive inspirometry feedback. (5) Inhalation volume-monitored desensitization to imagined and actual environmentai and emotional stressors. (4) Simulated wheezing practice (symptom prescription bracketed by diaphragmatic breathing). (7) Awareness and re-establishment of effortless breathing at the onset of symptoms. In most recent groups, all subjects learned to increase inhalation volume while decreasing EMG efforts by 73.2% over the upper thorax (p = .Ol, one-tailed t-test, pre- and post-study baseline). In addition, mean PVC increased by 9.9%, FEV, by 25.5X, FEV,/FVC by 25.5%. All subjects reported significant improvement in their symptoms (shortness of breath, chest tight-
Sympostum
on Respiraror)
Psychophysiolog)i
common feature. The tendency to adopt similar ventilatory strategies during automatic and voluntary breathing resembles certain characteristics of automatic behaviours acquired through learning or repetition.
MULTIVARIATE SUPPORT FOR THREE DISTINCT APPROACHES TO THE ASSESSMENT OF RESPIRATORY SENSATION IN PATIENTS WITH OBSTRUCTIVE LUNG DISEASE Andrew HARVER, Donald and Joan F. MCGOVERN Depcrrtment of Ph_vslologv. Dartmouth
A. MAHLER,
J. Andrew
DAUBENSPECK,
Medical School. Hanouer. NH 03756. U.S.A
Recently, we reported that clinical ratings of dyspnea are unrelated to the perceived magnitude of resistive loads in patients with obstructive lung disease. Furthermore, we have observed that Borg ratings of breathlessness during graded exercise are independent of both ratings of dyspnea and perceived magnitude of resistive loads. In this paper, we provide multivariate support for the independence of these approaches in the assessment of respiratory sensation in obstructive lung disease. Respiratory sensations were assessed in 20 patients with mild to moderate obstructive lung disease. Patients participated in each of three scaling tasks: clinical ratings of dyspnea, magnitude scaling of resistive loads added to inspiration, and Borg ratings of shortness of breath during progressive exercise on a cycle ergometer. The clinical ratings of dyspnea were obtained by two independent observers using the baseline dyspnea index, the oxygen cost diagram, and a modified Medical Research Council scale. Psychophysical testing consisted of estimation of the magnitude of breathlessness evoked by Breathlessness during progressive five resistive loads added to inspiration. exercise was determined through the psychophysical power law describing the relationship between Borg ratings and expired minute ventilation at I-min intervals. Factor analysis was employed to determine the arrangement of variables within an orthogonal factor structure. A total of 20 variables were entered into the initial analysis; selected combinations of variables were examined subsequently. The major analysis yielded six orthogonal factors: clinical dyspnea ratings, respiratory performance, lung function, gas exchange, perceived magnitude of resistive loads, and age. Borg ratings of breathlessness during exercise fit with the respiratory performance factor. Subsequent analyses accomplished through removal of specific variables complemented the major analysis; clinical ratings of dyspnea, perceived magnitude of resistive loads, and Borg ratings of breathlessness during exercise were consistently separate
Symposium
on Resprratog~ F~ychaphysloio~
69
factors. These multivariate results provide support for previous observations that clinical, psychophysical and exercise methods for quantifying breathlessness independently assess respiratory sensation in patients with obstructive lung disease.
STRATEGIES MYOGRAPHIC
TO REDUCE THE EFFORT OF BREATHING ELECTROAND INCENTIVE INSPIROMETRY BIOFEEDBACK
Erik PEPER insttiui~ for Holistic Healing Studies, San Francisco State Universit_y, Sun Francisco, CA 94132, U.S.A.
This paper reports on a new methodology, upper thoracic electromyography (EMG), incentive inspirometry (Voldyne) feedback, and desensitization to reduce the muscular efforts of breathing, inhibit paradoxical breathing, enhance diaphragmatic breathing, increase inhalation volume and reduce asthmatic symptoms. The training was offered in groups of 7-10 subjects for lo-15 weekly sessions. Subjects, mean age = 29.7, mean years of asthma = 17.1, with mild to moderately severe asthma were taught effortless diaphragmati~ breathing. Preand post-assessment questionnaires, spirometry and breathing efforts (thoracic EMG per sequential inhaled volume) were recorded. The specific components of the group training program consisted of (1) Didactic and experiential demonstrations of breath patterns. (2) inhibiting scalene/ trapezius EMG activity during inhalation. (3) Increasing inhalation volume with incentive inspirometry (Voldyne) feedback. (4) Home and group practice of diaphragmatic breathing with incentive inspirometry feedback. (5) Inhalation volume-monitored desensitization to imagined and actual environmentai and emotional stressors. (4) Simulated wheezing practice (symptom prescription bracketed by diaphragmatic breathing). (7) Awareness and re-establishment of effortless breathing at the onset of symptoms. In most recent groups, all subjects learned to increase inhalation volume while decreasing EMG efforts by 73.2% over the upper thorax (p = .Ol, one-tailed t-test, pre- and post-study baseline). In addition, mean PVC increased by 9.9%, FEV, by 25.5X, FEV,/FVC by 25.5%. All subjects reported significant improvement in their symptoms (shortness of breath, chest tight-