Perception of airflow obstruction and associated breathlessness in normal and asthmatic subjects: correlation with anxiety and bronchodilator needs.

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Abstract
BACKGROUND--Perception of bronchoconstriction varies between individuals and its determinants remain to be identified. The perception of airflow obstruction and breathlessness during induced bronchoconstriction was studied, and the effects of anxiety, repetition of the stimulus, and bronchodilator needs on these measurements were examined in normal and asthmatic subjects. METHODS--Fifteen normal (control) and 25 asthmatic subjects had two consecutive methacholine inhalation tests to induce a 20-50% fall in FEV1. Evaluation of the perceived magnitude of airflow obstruction, breathlessness, level of anxiety generated, and bronchodilator needs was obtained before each FEV1 measurement on a modified Borg scale from 0 to 10. RESULTS--Mean (SE) maximal fall in FEV1 in asthmatic and control subjects was of similar magnitude: test 1, 37.6 (1.4)% and 38.7 (3.1)%, and test 2, 36.0 (1.6)% and 27.7 (2.4)% respectively. There was a large interindividual variation in perception of airflow obstruction and breathlessness but, although they were well correlated in asthmatic subjects, they were perceived differently by the control subjects. Perception of airflow obstruction was greater in asthmatic subjects. The level of anxiety and the bronchodilator use were low and did not influence perception. CONCLUSIONS--During induced bronchoconstriction, the overall perception of airflow obstruction and breathlessness were similar among asthmatic subjects but controls showed a higher perception of airflow obstruction for any given level of breathlessness. Asthmatic subjects perceived airflow obstruction and breathlessness to a greater degree than did controls but anxiety and bronchodilator need were not correlated with respiratory sensation. The variability of bronchodilator use for similar degrees of bronchoconstriction suggests that it may be misleading to assess the severity of asthma control using only this indirect measure.