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Neural respiratory drive and breathlessness in COPD
Caroline J Jolley1, Yuanming M Luo2, Joerg Steier3
1King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK. caroline.jolley@kcl.ac.uk.
The European Respiratory Journal
|October 18, 2014
Summary
Neural respiratory drive, measured by diaphragm electromyogram (EMGdi%max), closely relates to breathlessness in chronic obstructive pulmonary disease (COPD). Awareness of neural drive, not neuroventilatory uncoupling, primarily explains breathlessness intensity during exercise in COPD patients.
Area of Science:
- Respiratory Physiology
- Pulmonary Medicine
- Biomarkers
Background:
- Chronic obstructive pulmonary disease (COPD) is characterized by exertional dyspnea.
- The precise physiological underpinnings of breathlessness in COPD remain incompletely understood.
- Neural respiratory drive is a potential contributor to the sensation of breathlessness.
Purpose of the Study:
- To test the hypothesis that neural respiratory drive, quantified by EMGdi%max, correlates with breathlessness intensity in COPD patients.
- To investigate the contribution of neuroventilatory uncoupling to breathlessness compared to neural drive awareness.
- To explore the potential of EMGdi%max as a biomarker for breathlessness in COPD.
Main Methods:
- 12 COPD patients underwent incremental cycle and treadmill exercise.
- Diaphragm electromyogram (EMGdi) and ventilation were continuously measured.
- EMGdi was expressed as a percentage of maximum (EMGdi%max) and relative to tidal volume to assess neuroventilatory uncoupling.
Main Results:
- EMGdi%max showed a strong correlation with Borg breathlessness scores during both cycling (r=0.98) and treadmill exercise (r=0.94).
- Neuroventilatory uncoupling also correlated with breathlessness, but the relationship was comparable to EMGdi%max.
- The link between breathlessness and ventilation weakened when tidal volume expansion was limited.
Conclusions:
- Exertional breathlessness intensity in COPD is strongly associated with EMGdi%max.
- Awareness of neural respiratory drive levels appears to be the primary driver of breathlessness in COPD, more so than neuroventilatory uncoupling.
- EMGdi%max shows promise as a physiological biomarker for quantifying breathlessness in COPD.
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