title: Dyspnea related to reversibly-binding P2Y12 inhibitors: A review of the pathophysiology, clinical presentation and diagnostics.
abstract: Dyspnea is a common symptom physiologically associated with strenuous exercise and pathologically reflecting well-known diseases and conditions that are predominantly pulmonary, cardiovascular, and weight-related in origin. Dyspnea improves with appropriate measures that enhance physical performance and treatment of the underlying diseases. Dyspnea is less commonly triggered by other causes such as the environment (e.g., ozone), drugs, and others, some of which do not seem to affect bronchopulmonary function as evidenced by normal results of comprehensive pulmonary function testing. In cardiovascular medicine, dyspnea has recently attracted attention because it has been reported that this symptom occurs more frequently with the administration of the new oral reversibly-binding platelet P2Y12 receptor inhibitors ticagrelor [1-6], cangrelor [7-10], and elinogrel [11]. This paper succinctly addresses the current understanding of the pathophysiology, clinical presentation, and diagnostics of dyspnea, associated either with bronchopulmonary function impairment, as triggered mainly by pulmonary and cardiovascular diseases, or without bronchopulmonary function impairment, as induced by endogenous or external compounds such as drugs in order to provide a context for understanding, recognizing and managing P2Y12 inhibitor-induced dyspnea.
authors.affiliation: Clinical Research Institute, Center for Cardiovascular Diseases, Academic Teaching Institution of the Goethe-University Frankfurt/Main, Rotenburg an der Fulda, Germany. Electronic address: mu.hkz.rotenburg@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Unverdorben
authors.affiliation: Department of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Department of Experimental and Clinical Medicine, Respiratory Medicine, University of Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pistolesi
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
mesh_terms: D004417:Dyspnea / Q000139:chemically induced / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology*; D006801:Humans; D011485:Protein Binding / Q000502:physiology; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects* / Q000378:metabolism* / Q000627:therapeutic use; D058925:Receptors, Purinergic P2Y12 / Q000378:metabolism*
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12
keywords: Discontinuation of medication; Oral anti-platelet agents; P2Y(12) inhibitors; Pathophysiology; Pulmonary function; c-Fibers