Background: The severity of a patient’s asthma and the intensity with which he describes his dyspnea do not correlate. Objectives: There is an indirect relationship between airway function in asthma and the intensity of dyspnea; this relationship is found only when the measure of a patient’s general tendency to exaggerate the intensity of any somatic symptom is considered simultaneously. Methods: Lung function, including spirometry (forced expiratory volume in 1 s, FEV1) and plethysmography (airway resistance, Raw), dyspnea (Borg scale score) and the tendency to exaggerate (the somatosensory amplification scale score, SSAS) have been quantified in 42 stable asthmatic patients. Results: There was no correlation between the Borg score and any spirometric or plethysmographic measure in these subjects. By contrast, there was a moderate correlation between the Borg score and the SSAS (r = 0.36, p = 0.03). However, when FEV1 or Raw (abscissa) and Borg scores (ordinate) were converted to residuals, there was a moderate correlation between the residuals and the SSAS score (for FEV1, r = 0.33 and p = 0.05; for Raw, r = –0.36 and p = 0.03). Conclusion: A physician may make a reasonable estimate of an asthmatic patient’s lung function from the intensity of his complaint only if he – the physician – considers the patient’s tendency to symptom amplify as well.

Keywords:
Airway obstruction, Asthma, Dyspnea, Anxiety scale, Symptom amplification
1.
Teeter JG, Bleecker ER: Relationship between airway obstruction and respiratory symptoms in adult asthmatics. Chest 1998;113:272–277.
2.
Osborne ML, Vollmer WM, Pedula KL, Wilkins J, Buist AS, O’Hollaren M: Lack of correlation of symptoms with specialist-assessed long-term asthma severity. Chest 1999;115:85–91.
3.
Boulet L-P, Leblanc P, Turcotte H: Perception scoring of induced bronchoconstriction as an index of awareness of asthma symptoms. Chest 1994;105:1430–1433.
4.
Burdon JGW, Juniper EF, Killian KJ, Hargreave FE, Campbell EJM: The perception of breathlessness in asthma. Am Rev Respir Dis 1982;126:825–828.
5.
Chetta A, Gerra G, Foresi A, Zaimovic A, DelDonno 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.
6.
Lougheed MD, Webb KA, O’Donnell DE: Breathless during induced lung hyperinflation in asthma: the role of the inspiratory threshold load. Am J Respir Crit Care Med 1995;152:911–920.
7.
Gorini M, Iandelli I, Misuri G, Bertoli F, Filippelli M, Mancini M, Duranti R, Gigliotti F, Scano G: Chest wall hyperinflation during acute bronchoconstriction in asthma. Am J Respir Crit Care Med 1999;160:808–816.
8.
Nascimento I, Egidio Nardi A, Valenca AM, Lopes FL, Mezzasalma MA, Nascentes R, Zin WA: Psychiatric disorders in asthmatic patients. Psychiatry Res 2002;110:73–80.
9.
ten Brinke A, Ouwerkerk ME, Zwinderman AH, Spinhoven P, Bel EH: Psychopathology in patients with severe asthma is associated with increased health care utilization. Am J Respir Crit Care Med 2001;163:1093–1096.
10.
Hudgel DW, Cooperson DM, Kinsman RA: Recognition of added resistive loads in asthma. Am Rev Respir Dis 1982;126:121–125.
11.
Isenberg S, Lehrer P, Hochron S: Defensiveness and perception of external inspiratory resistive loads in asthma. J Behav Med 1997;20:461–472.
12.
Rietveld S, Prins PJM, Kolk AMM: The capacity of children with and without asthma to detect external resistive loads on breathing. J Asthma 1996;33:221–230.
13.
Horton DJ, Suda WL, Kinsman RA, Souhrada J, Spector SL: Bronchoconstrictive suggestion in asthma: a role for airways hyperreactivity and emotions. Am Rev Respir Dis 1978;117:1029–1038.
14.
McFadden ER Jr, Luparello T, Lyons HA, Bleecker ER: The mechanism of action of suggestion in the induction of acute asthma attacks. Psychosom Med 1969;31:134–143.
15.
Barsky AJ, Wyshak G, Klerman GL: The somatosensory amplification scale and its relationship to hypochondriasis. J Psych Res 1990;24:323–334.
16.
Bradley TD, Chartrand DA, Fitting JW, Killian KJ, Grassino A: The relation of inspiratory effort sensation to fatiguing patterns of the diaphragm. Am Rev Respir Dis 1986;134:1119–1124.
17.
Demediuk BH, Manning H, Lilly J, Fencl V, Weinberger SE, Weiss JW, Schwartzstein RM: Dissociation between dyspnea and respiratory effort. Am Rev Respir Dis 1992;146:1222–1225.
18.
von Leupoldt A, Ambruzsova R, Nordmeyer S, Jeske N, Dahme B: Sensory and affective aspects of dyspnea contribute differently to the Borg scale’s measurement of dyspnea. Respiration 2006;73:762–768.
19.
Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L: The Hopkins symptom check list (HSCL): a self-report symptom inventory. Behav Sci 1974;19:1–13.
20.
Ciccone DS, Chandler HK, Lavietes MH, Janal M: Influence of somatosensory awareness on accuracy of symptom reporting in patients with asthma. J Nerv Mental Dis 2007;195:119–124.
21.
Lavietes MH, Matta J, Tiersky LA, Natelson BH, Bielory L, Cherniack NS: The perception of dyspnea in patients with mild asthma. Chest 2001;120:409–415.
22.
Banzett RB, Dempsey JA, O’Donnell DE, Wamboldt MZ: Symptom perception and respiratory sensation in asthma. Am J Respir Crit Care Med 2000;162:1178–1182.
23.
McFadden ER Jr, Kiser R, DeGroot WJ: Acute bronchial asthma. Relations between clinical and physiological manifestations. N Engl J Med 1973;288:221–225.
24.
Ringel ER, Loring SH, McFadden ER Jr, Ingram RH Jr: Chest wall configurational changes before and during acute obstructive episodes in asthma. Am Rev Respir Dis 1983;128:607–610.
25.
O’Malley PG, Wong PWK, Kroenke K, Roy MJ, Wong RKH: The value of screening for psychiatric disorders prior to upper endoscopy. J Psychosom Res 1998;44:279–287.
26.
O’Malley PG, Jones DL, Feuerstein IM, Taylor AJ: Lack of correlation between psychological factors and subclinical coronary artery disease. N Engl J Med 2000;343:1298–1304.
27.
Kikuchi Y, Okabe S, Tamura G, Hida W, Homma M, Shirato K, Takishima T: Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. N Engl J Med 1994;330:1329–1334.
28.
Barreiro E, Gea J, Sanjuas C, Marcos R, Broquetas J, Milic-Emili J: Dyspnea at rest and at the end of different exercises in patients with near-fatal asthma. Eur Respir J 2004;24:219–225.
© 2007 S. Karger AG, Basel
2007
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