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Perception of dyspnea during acetylcholine-induced bronchoconstriction in asthmatic children

Chikako Motomura1, Hiroshi Odajima, Junichiro Tezuka

  • 1Department of Pediatrics, Fukuoka National Hospital, Fukuoka, Japan. cmotomura@mfukuoka2.hosp.go.jp

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|February 24, 2009
PubMed

Insights

Asthmatic children with severe bronchial hyperresponsiveness (BHR) have a reduced perception of airway obstruction severity. This insensitivity to dyspnea may lead to undertreatment of asthma in these patients.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Allergy

Background:

  • Dyspnea perception and bronchial hyperresponsiveness (BHR) in pediatric asthma are not well-studied.
  • Understanding this relationship is crucial for effective asthma management in children.

Purpose of the Study:

  • To investigate the association between severe BHR and poor perception of airway obstruction severity in asthmatic children.
  • To test if children with severe BHR are less sensitive to the sensation of breathing difficulty.

Main Methods:

  • 101 asthmatic children underwent acetylcholine chloride (Ach) challenge to assess BHR (PC20 - provocative concentration causing 20% decrease in FEV1).
  • Dyspnea perception was measured using a modified Borg scale, defining the dyspnea threshold and perception scores (PS20, PS(BD)).

Main Results:

  • Children with severe BHR showed significantly lower dyspnea perception scores (PS20, PS(BD)) compared to those with mild BHR.
  • A greater decrease in forced expiratory volume in 1 second (FEV1) was needed to elicit a dyspnea sensation in the severe BHR group.
  • Perception scores and FEV1 changes correlated significantly with BHR severity (PC20).

Conclusions:

  • Asthmatic children with severe BHR exhibit a delayed or blunted perception of dyspnea, occurring after mild bronchoconstriction.
  • This relative insensitivity to dyspnea may contribute to the undertreatment of asthma in this vulnerable pediatric population.
Abstract

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