title: Perception of dyspnea during acetylcholine-induced bronchoconstriction in asthmatic children.
abstract: BACKGROUND
  Few studies have examined the relationship between dyspnea perception and bronchial hyperresponsiveness (BHR) in asthmatic children.
  
  
  OBJECTIVE
  To test the hypothesis that severe BHR is associated with poor perception of the severity of airway obstruction.
  
  
  METHODS
  One hundred one asthmatic children (mean [SD] age, 11.1 [2.3] years) were evaluated using acetylcholine chloride (Ach) challenge. The BHR was assessed as the provocative concentration of Ach causing a 20% decrease in forced expiratory volume in 1 second (FEV1) (PC20). Perception of dyspnea was scored using a modified Borg scale after each dose of Ach and bronchodilator. The dyspnea threshold was defined as the point at which the Borg scale score became higher than 0. We evaluated the dyspnea perception score at a 20% decrease in FEV1 relative to baseline (PS20) and after bronchodilator administration (PS(BD)).
  
  
  RESULTS
  The mean (SD) PS20 and PS(BD) were significantly lower in the severe vs the mild BHR group (PS20: 2.1 [1.9] vs 4.2 [2.4], P < .001; PS(BD): 0.5 [1.0] vs 1.0 [1.3], P = .048). The mean (SD) % decrease in FEV1 at the dyspnea threshold was significantly greater in the severe vs the mild BHR group (14.1% [11%] vs 5.4% [11%], P < .001). The PS20 was correlated positively with the PC20 (r2 = 0.25, P < .001), and the decrease in FEV1 at the dyspnea threshold was correlated negatively with the PC20 (r2 = 0.18, P < .001).
  
  
  CONCLUSIONS
  Moderate to severe asthmatic children with severe BHR perceive dyspnea only after the stage of mild bronchoconstriction has passed. This relative insensitivity to dyspnea in asthmatic children with severe BHR may lead to undertreatment of asthma.
authors.affiliation: Department of Pediatrics, Fukuoka National Hospital, Fukuoka, Japan. cmotomura@mfukuoka2.hosp.go.jp
authors.forename: Chikako
authors.initials: C
authors.lastname: Motomura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Odajima
authors.forename: Junichiro
authors.initials: J
authors.lastname: Tezuka
authors.forename: Junko
authors.initials: J
authors.lastname: Harada
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
authors.forename: Sankei
authors.initials: S
authors.lastname: Nishima
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D000293:Adolescent; D001249:Asthma / Q000139:chemically induced / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D001985:Bronchial Provocation Tests; D016084:Bronchoconstriction / Q000187:drug effects / Q000502:physiology*; D002648:Child; D018678:Cholinergic Agents / Q000494:pharmacology; D004417:Dyspnea / Q000139:chemically induced / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index
chemical_list: D018678:Cholinergic Agents; D000109:Acetylcholine