Background: Perception of dyspnea is poorly related to bronchoconstriction and may be influenced by distinct psychophysiologic stimuli. Objective: This study compared the perceived psychophysiologic changes during histamine- and methacholine-induced bronchoconstriction using verbal as well as nonverbal assessment techniques. Methods: Perception of dyspnea was studied during induced bronchoconstriction in 40 atopic subjects randomly ascribed to either histamine (n = 20) or methacholine (n = 20) bronchial challenge. A 100% increase in specific airway resistance (sRaw) indicated airway hyperresponsiveness (AHR). Dyspnea was verbally assessed by the Borg Scale (BS) and the Asthma Symptom Checklist (ASL). A hand dynamometer (HD) served for nonverbal assessment. Both challenge groups did not differ significantly with respect to age, anthropometric data, smoking and lung function before challenge. Results: AHR did not differ between groups but groups differed significantly with respect to the number of symptoms and to symptom intensity reported after challenge. Subjects who underwent the histamine challenge scored significantly higher on both measures derived from the ASL. BS ratings and HD scores correlated significantly but were not significantly related to the degree of AHR. Accurate and poor perceivers could be discriminated by analysis of the relationship between BS and sRaw. Conclusions: These findings suggest that perception of induced dyspnea differs between histamine and methacholine when assessed by a symptom report.

Keywords:
Bronchial challenge, Dyspnea, Perception
1.
Rubinfeld AR, Pain MCF: Perception of asthma. Lancet 1976;i:882–884.
2.
Boudreau D, Styhler A, Gray-Donald K, Martin JG: A comparison of breathlessness during spontaneous asthma and histamine-induced bronchoconstriction. Clin Invest Med 1995;18:25–32.
3.
Burdon JGW, Juniper EF, Killian KJ, Hargreave FE, Campbell EJM: The perception of breathlessness in asthma. Am Rev Respir Dis 1982;126:825–828.
4.
Brand PLP, Rijcken B, Schouten JP, Koeter GH, Weiss ST, Postma DS: Perception of airway obstruction in a random population sample. Relationship to airway hyperresponsiveness in the absence of respiratory symptoms. Am Rev Respir Dis 1992;146:396–401.
5.
Boulet LP, Leblanc P, Turcotte H: Perception scoring of induced bronchoconstriction as an index of awareness of asthma symptoms. Chest 1994;105:1430–1433.
6.
Barnes PJ: Poorly perceived asthma. Thorax 1992;47:408–409.
7.
Sterk PJ (ed): Airway responsiveness. Standardized challenge testing with pharmacological physical and sensitizing stimuli in adults. Eur Respir J 1993;6(suppl 16):53–83.
8.
Ryan G, Dolovich B, Roberts RS, Fritz PA, Juniper EF, Hargreave FE, Newhouse MT: Standardization of inhalation provocation tests: Two techniques of aerosol generation and inhalation compared. Am Rev Respir Dis 1981;123:195–199.
9.
Borg G: Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982;14:377–381.
10.
Mahler DA, Rosiello RA, Harver A, Lentine T, McGovern JF, Daubenspeck JA: Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airway disease. Am Rev Respir Dis 1987;135:1229–1233.
11.
Kinsman RA, Luparello T, O’Banison K, Spector S: Multidimensional analysis of the subjective symptomatology of asthma. Psychosom Med 1973;35:250–267.
12.
Schmidt KH, Metzler P: Wortschatztest (WST). Weinheim, Beltz Test, 1992.
13.
Nelson HE, O’Conell A: Dementia: The estimation of pre-morbid intelligence levels using a new adult reading test. Cortex 1978;14:234–244.
14.
Turcotte H, Corbeil F, Boulet LP: Perception of breathlessness during bronchoconstriction induced by antigen, exercise, and histamine challenges. Thorax 1990;45:914–918.
15.
Marks GB, Yates DH, Sist M, Ceyhan B, De Campos M, Scott DM, Barnes PJ: Respiratory sensation during bronchial challenge testing with methacholine, sodium metabisulphite and adenosine monophosphate. Thorax 1996;51:793–798.
16.
Roisman GB, Peiffer C, Lacronique JG, Le Cae A, Dusser DJ: Perception of bronchial obstruction in asthmatic patients. J Clin Invest 1995;96:12–21.
17.
Pellegrino R, Violante B, Crimi E, Brusasco V: Effects of aerosol methacholine and histamine on airways and lung parenchyma in healthy humans. J Appl Physiol 1993;74:2681–2686.
18.
Sterk PJ, Timmers MC, Dijkman JH: Maximal airway narrowing in humans in vivo. Histamine compared with methacholine. Am Rev Respir Dis 1986;134:714–718.
19.
Patessio A, Rampulla C, Fracchia C, Ioli F, Majani U, DeMarchi A, Donner CF: Relationship between the perception of breathlessness and inspiratory resistive loading: Report on a clinical trial. Eur Respir J 1989;2(suppl 7):587s–591s.
20.
Turcotte H, Tahan M, Leblanc P, Boulet L-P: Perception of acute or progressive resistive loads in normal and asthmatic subjects. Respiration 1993;60:203–211.
21.
Lougheed MD, Lam M, Forkert L, Webb KA, O’Donnell DE: Breathlessness during acute bronchoconstriction in asthma. Pathophysiologic mechanisms. Am Rev Respir Dis 1993;148:1452–1459.
22.
Luparello TJ, Leist N, Lourie CH, Sweet P: The interaction of psychologic stimuli and pharmacologic agents on airway reactivity in asthmatic subjects. Psychosom Med 1970;32:509–513.
23.
Conolly MJ, Crowley JJ, Charan NB, Nielson CP, Vestal RE: Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax 1992;47:410–413.
24.
Turner MO, Noertjojo K, Vedal S, Bai T, Crump S, Fitzgerald JM: Risk factors for near-fatal asthma. Am J Respir Crit Care Med 1998;157:1804–1809.
25.
Chetta A, Gerra G, Foresi A, Zaimovic A, Del Donno M, Chittolini B, Malorgio R, Castagnaro A, Olivieri D: Personality profiles and breathlessness perception in outpatients with different gradings of asthma. Am J Respir Crit Care Med 1998;157:116–122.
26.
Boulet LP, Turcotte H, Cartier A, Milot J, Malo JL, Laviolette M: Influence of beclomethasone and salmeterol on the perception of methacholine-induced bronchoconstriction. Chest 1998;114:373–379.
27.
Cross modality matching; in Baird JC, Noma E (eds): Fundamentals of Scaling and Psychophysics. Chichester, Wiley, 1976, pp 73–74.
28.
Nouwen A, Freeston MH, Cournoyer I, Deschesnes F, Boulet LP: Perceived symptoms and discomfort during induced bronchospasm: The role of temporal adaptation and anxiety. Behav Res Ther 1994;32:623–628.
29.
Stevens S: The direct estimation of sensory magnitudes – Loudness. Am J Psychol 1956;69:1–25.
30.
Qaunjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC: Lung volumes and forced expiratory flows. Report Working Party Standardization of Lung Function Tests. European Community for Steel and Coal. Eur Respir J 1993;6(suppl 16):5–40.
1999
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