Dyspnea Sensation and Chemical Control of Breathing in Adult Twins

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Abstract
To examine possible genetic influence on the sensation of dyspnea and on load compensation, we conducted a twin study using healthy adult pairs (10 monozygotes, MZ, and 9 dizygotes, DZ). The ventilatory response to progressive hypercapnia (HCVR) was examined under three different conditions: hyperoxia (PetO2 > 150 mm Hg), hypoxia (PetO2 maintained at 50 to 55 mm Hg), and hyperoxia with an inspiratory flow-resistive load (17 mm H2O/L/s), with simultaneous assessment of the dyspnea sensation by visual analog scale (VAS). Although the Vdz/Vmz ratio (Vmz and Vdz are within-pair variances in MZ and DZ, respectively) for the slope value of the minute ventilation-PetCO2 regression line was not different from 1 in hyperoxia either with or without an inspiratory load, it was significantly larger than 1 in hypoxia (F = 5.17, p < 0.05), suggesting that a genetic influence on HCVR existed only in the presence of hypoxia. During 3% CO2 inhalation, the Vdz/Vmz ratio for the tidal volume (Vt) was larger than 1 in hyperoxic HCVR with loading (F = 7.89, p < 0.01), and that for respiratory frequency (f) was larger than 1 only in hypoxic HCVR (F = 3.59, p < 0.05). At a PetCO2 of 55 mm Hg, the Vt ratio was larger than 1 under all conditions (F = 5.91, p < 0.05; F = 6.99, p < 0.05; F = 3.75, p < 0.05; respectively), and the f ratio was significantly larger than 1 again only in hypoxic HCVR (F = 3.48, p < 0.05). Under all conditions the dyspnea sensation, evaluated as an increase in VAS scores at a given level of minute ventilation or PetCO2, was greatly variable even within MZ pairs. It was the same for load compensation, evaluated as the relative ratio of HCVR with and without loading or as the ratio ΔP0.1/ΔPetCO2. These results suggest a positive genetic control of respiratory chemosensitivity, especially to hypoxia, and a nongenetic control of the dyspnea sensation and of load compensation during hypercapnia in adult humans.