Geriatria

REVIEW

Is there any treatment other than drugs to alleviate dyspnea in COPD patients?
Nicolino Ambrosino 1 Guido Vagheggini 2
Pulmonary Unit. Cardio-Thoracic Department, University Hospital, Pisa, Italy; 2Internal Medicine Unit. S.M. Maddalena General Hospital, Volterra, Italy
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Abstract: Patients with chronic obstructive pulmonary disease (COPD) are often limited in their activities bybreathlessness. In these patients, exercise training may result in significant improvements in dyspnea, exercise tolerance, and health related quality of life (HRQoL). Further possibilities are to reduce ventilatory demand by decreasing the central respiratory drive or to lessen the perceived breathing effort by increasing respiratory muscle strength through specific respiratory muscle training.Upper limb training may also improve exercise capacity and symptoms in these patients through the modulation of dynamic hyperinflation. Ventilatory assistance during exercise reduces dyspnea and work of breathing and enhances exercise tolerance, although further studies should be required to define their applicability in the routine pulmonary rehabilitation programs. Lung volume resection surgeryand lung transplantation in selected patients may control symptoms and improve HRQoL. Keywords: chronic obstructive pulmonary disease, dyspnea, nonpharmacologic treatment, pulmonary rehabilitation.

Introduction
Dyspnea is the most common symptom of patients suffering from chronic obstructive pulmonary disease (COPD). It progresses with the natural history of disease. Increased breathlessnessleads patients with severe COPD to inactivity and related peripheral muscle deconditioning, resulting in a vicious cycle leading to further inactivity, social isolation, fear of dyspnoea, and depression. With increasing severity of disease, drugs may not be enough to alleviate dyspnea. In this review article we summarize the recent literature concerning the nonpharmacological treatment of dyspnea inpatients with COPD. A search of MEDLINE research since 1966 including the terms, “Dyspnea/diet therapy” [MeSH] OR “ Dyspnea/rehabilitation” [MeSH] OR “ Dyspnea/therapy” [MeSH] NOT “ Dyspnea/drug therapy” [MeSH], shows 1157 articles. We focused only on the most significant original papers, reviews, and book chapters (in our view) and related references since 2000.

What does dyspnea mean?
It is“a term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social, and environmental factors, and may induce secondary physiological and behavioral responses” (ATS 1999).

Correspondence: Nicolino Ambrosino U.O.Pneumologia, Dipartimento Cardio-Toracico, Azienda OspedalieroUniversitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy Tel +39 05 099 6786 Fax +39 05 099 6779 Email n.ambrosino@ao-pisa.toscana.it

Respiratory sensation
Like pain, the subjective perception of dyspnea is an unpleasant physiologic sensation; it is a signal to the conscious brain that there is a somehow disturbed physiologicstate. There are many similarities between dyspnea and pain, namely subjective

International Journal of COPD 2006:1(4) 355–361 © 2006 Dove Medical Press. All rights reserved

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Ambrosino and Vagheggini

characteristics, afferent pathways and cortical areas involved (Mahler 2005). A common neural network underlying the perception of both sensations has been suggested (von Leupoldt andDahme 2005). Chemo- and airways receptors, lung parenchyma, and respiratory muscle receptors provide sensory feedback via vagal, phrenic, and intercostals nerves to the spinal cord, medulla, and higher centers of the central nervous system (ATS 1999). According to the neuromechanical dissociation theory a patient suffers from dyspnea when there is a disparity between the central reflexic drive to...