Psychophysiologic aspects of dyspnea in chronic obstructive pulmonary disease: a pilot study

The level of dyspnea reported by the patient with chronic obstructive pulmonary disease is related to both the physiologic and psychologic state of the person at the time. The purpose of this pilot study was to explore, from a psychophysiologic perspective, the differences in anxiety, depression, and somatization during times of high and low levels of dyspnea. Six male subjects with chronic obstructive pulmonary disease, with a mean age of 64 years and a mean forced expiratory volume in 1 second that was 44% of predicted, completed the study. They were assessed for clinical signs and their level of dyspnea indicated on a vertical visual analogue scale, after which they completed the Spielberger State Anxiety Inventory and the Brief Symptom Inventory. Arterial blood was then drawn for blood gas analysis and determination of cortisol level. All measures were repeated twice, once when the subject reported a high level of dyspnea and once when he reported a low level. Analysis of the data by use of t tests for paired groups indicated that during times of high dyspnea levels subjects had greater anxiety, accessory muscle use, cortisol level, and PCO2 level. Subjects receiving oral prednisone had high depression levels that increased during times of severe dyspnea. Somatization, PO2, respiratory rate, depth of respiration, and other clinical signs did not change with dyspnea level. These results indicate that dyspnea is accompanied by both psychologic and physiologic changes that can be targeted to assist in alleviating this distressing symptom.