Physiologic changes and clinical correlates of advanced dyspnea.
OBJECTIVE
To discuss the pathophysiology of dyspnea as it relates to patients suffering with chronic respiratory illness or end-stage disease.


RESULTS
There are several publications highlighting important new concepts in this field including a new multidimensional model of dyspnea, similar to that developed for pain, that sheds new insight into the pathophysiology. Research in pulmonary rehabilitation, exercise testing and distractive auditory stimulation has also contributed to our understanding. Finally, there are new data on the emotional response of laboratory-induced dyspnea.


CONCLUSIONS
Dyspnea is a complex symptom widely prevalent in advanced disease that involves multiple causes and pathophysiologies. The sensation of dyspnea is subjective and often evokes discomfort, fear, and anxiety. We recommend that this symptom be evaluated whenever vital signs are taken.
Gilman
Sean A
SA
Division of Pulmonary and Critical Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. sgilman@bidmc.harvard.edu
Banzett
Robert B
RB
D000161:Acoustic Stimulation; D000339:Affect; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D004417:Dyspnea / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control; D006801:Humans; D018908:Muscle Weakness / Q000503:physiopathology; D010166:Palliative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology; D012132:Respiratory Muscles / Q000503:physiopathology; D012720:Severity of Illness Index