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. 2020 Feb 12;55(2):1802108.
doi: 10.1183/13993003.02108-2018. Print 2020 Feb.

Intensity and quality of exertional dyspnoea in patients with stable pulmonary hypertension

Athénaïs Boucly  1   2   3 , Capucine Morélot-Panzini  4   5 , Gilles Garcia  1   3   6 , Jason Weatherald  7   8 , Xavier Jaïs  1   2   3 , Laurent Savale  1   2   3 , David Montani  1   2   3 , Marc Humbert  1   2   3 , Thomas Similowski  4   5 , Olivier Sitbon  1   2   3   9 , Pierantonio Laveneziana  10   11   9
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Free article

Intensity and quality of exertional dyspnoea in patients with stable pulmonary hypertension

Athénaïs Boucly et al. Eur Respir J. .
Free article

Abstract

Dynamic hyperinflation is observed during exercise in 60% of patients with clinically stable pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), intensifying exertional dyspnoea. The impact of dynamic changes in respiratory mechanics during exercise on qualitative dimensions of dyspnoea in these patients has not been evaluated.26 patients (PAH n=17; CTEPH n=9) performed an incremental symptom-limited cycle exercise test. Minute ventilation (V'E), breathing pattern, operating lung volumes and dyspnoea intensity were assessed throughout exercise. Dyspnoea quality was serially assessed during exercise using a three-item questionnaire (dyspnoea descriptors). The inflection point of tidal volume (V T) relative to V'E was determined for each incremental test. Changes in inspiratory capacity during exercise defined two groups of patients: hyperinflators (65%) and non-hyperinflators (35%). Multidimensional characterisation of dyspnoea was performed after exercise using the Multidimensional Dyspnea Profile.In hyperinflators, inspiratory capacity decreased progressively throughout exercise by 0.36 L, while remaining stable in non-hyperinflators. The "work/effort" descriptor was most frequently selected throughout exercise in both types of patients (65% of all responses). At the V T/V'E inflection, work/effort plateaued while "unsatisfied inspiration" descriptors became selected predominantly only in hyperinflators (77% of all responses). In the affective domain, the emotion most frequently associated with dyspnoea was anxiety.In pulmonary hypertension patients who develop hyperinflation during exercise, dyspnoea descriptors referring to unsatisfied inspiration become predominant following the V T/V'E inflection. As these descriptors are generally associated with more negative emotional experiences, delaying or preventing the V T/V'E inflection may have important implications for symptom management in patients with pulmonary hypertension.

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Conflict of interest statement

Conflict of interest: A. Boucly reports personal fees and non-financial support from Actelion Pharmaceuticals and Merck, non-financial support from Bayer HealthCare and GlaxoSmithKline, outside the submitted work. Conflict of interest: C. Morélot-Panzini reports personal fees from AstraZeneca, Chiesi, Boehringer Ingelheim, Novartis, Philips, ADEP and SOS Oxygene, outside the submitted work. Conflict of interest: G. Garcia has nothing to disclose. Conflict of interest: J. Weatherald has nothing to disclose. Conflict of interest: X. Jaïs reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, Bayer HealthCare, GlaxoSmithKline and MSD, outside the submitted work. Conflict of interest: L. Savale reports grants and personal fees from Actelion Pharmaceuticals and Bayer HealthCare, personal fees from GlaxoSmithKline and Merck, outside the submitted work. Conflict of interest: D. Montani reports grants and personal fees from Actelion Pharmaceuticals and Bayer HealthCare, personal fees from GlaxoSmithKline, Novartis, Pfizer and BMS, outside the submitted work. Conflict of interest: M. Humbert has relationships with drug companies including Actelion, Bayer, GSK, Merck and United Therapeutics; in addition to being investigator in trials involving these companies, relationships include consultancy services and membership of scientific advisory boards. Conflict of interest: T. Similowski reports personal fees from AstraZeneca, Boehringer Ingelheim France, GSK, Lungpacer Inc., TEVA, Chiesi and Invacare, personal fees and non-financial support from Novartis, outside the submitted work. Conflict of interest: O. Sitbon reports grants, personal fees and non-financial support from Actelion Pharmaceuticals and GlaxoSmithKline, personal fees from Acceleron Pharmaceuticals, Arena Pharmaceuticals and Gossamer Bio, grants and personal fees from Bayer HealthCare and Merck, outside the submitted work. Conflict of interest: P. Laveneziana reports personal fees from Novartis France and Boehringer France, outside the submitted work.

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