FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 333:1547-1553 December 7, 1995 Number 23 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Patients with cardiopulmonary disease often have respiratory distress, which physicians refer to as dyspnea. Dyspnea is responsible for substantial disability and for millions of patient visits each year. Although dyspnea has been defined in several ways,^1,2,3,4 we define it as "an uncomfortable sensation of breathing." This review will focus on the mechanisms of dyspnea, because a greater understanding of those mechanisms may lead to better therapy for this often troubling symptom.

Problems in the Study of Dyspnea

Dyspnea differs from other sensations in that the neural pathways underlying it are not well understood. For example, free nerve endings transmit pain signals to the central nervous system, . . . [Full Text of this Article]

Mechanisms of Dyspnea

Sense of Respiratory Effort

Chemoreceptors

            Hypercapnia

            Hypoxia

Mechanoreceptors

            Upper-Airway Receptors

            Lung Receptors

            Chest-Wall Receptors

Afferent Mismatch

Dyspnea in Some Common Disorders

Approach to Patients with Dyspnea

Conclusions

Source Information

From the Section of Pulmonary and Critical Care Medicine, Dartmouth–Hitchcock Medical Center, and Dartmouth Medical School, Lebanon, N.H. (H.L.M.); and the Divisions of Emergency Medicine and Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Hospital and Harvard Medical School, Boston (R.M.S.).

Address reprint requests to Dr. Schwartzstein at the Divisions of Emergency Medicine and Pulmonary and Critical Care Medicine, Beth Israel Hospital, 330 Brookline Ave., Boston, MA 02215.

References

This article has been cited by other articles:

• Jensen, D., Webb, K. A., Davies, G. A. L., O'Donnell, D. E. (2008). Mechanical ventilatory constraints during incremental cycle exercise in human pregnancy: implications for respiratory sensation. J. Physiol. 586: 4735-4750 [Abstract] [Full Text]  
• Banzett, R. B., Pedersen, S. H., Schwartzstein, R. M., Lansing, R. W. (2008). The Affective Dimension of Laboratory Dyspnea: Air Hunger Is More Unpleasant than Work/Effort. Am. J. Respir. Crit. Care Med. 177: 1384-1390 [Abstract] [Full Text]  
• Kim, V., Benditt, J. O., Wise, R. A., Sharafkhaneh, A. (2008). Oxygen Therapy in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 5: 513-518 [Abstract] [Full Text]  
• MacNee, W. (2008). Update in Chronic Obstructive Pulmonary Disease 2007. Am. J. Respir. Crit. Care Med. 177: 820-829 [Full Text]  
• Leduc, D., Cappello, M., Gevenois, P. A., De Troyer, A. (2008). Mechanics of the canine diaphragm in ascites: a CT study. J. Appl. Physiol. 104: 423-428 [Abstract] [Full Text]  
• Ottenheijm, C. A. C., Heunks, L. M. A., Dekhuijzen, P. N. R. (2007). Diaphragm Muscle Fiber Dysfunction in Chronic Obstructive Pulmonary Disease: Toward a Pathophysiological Concept. Am. J. Respir. Crit. Care Med. 175: 1233-1240 [Abstract] [Full Text]  
• Leduc, D., De Troyer, A. (2007). Dysfunction of the canine respiratory muscle pump in ascites. J. Appl. Physiol. 102: 650-657 [Abstract] [Full Text]  
• Ramasamy, R., Hildebrandt, T., O'Hea, E., Patel, M., Clemow, L., Freudenberger, R., Skotzko, C. (2006). Psychological and Social Factors That Correlate With Dyspnea in Heart Failure. Psychosomatics 47: 430-434 [Abstract] [Full Text]  
• Mahler, D. A. (2006). Mechanisms and Measurement of Dyspnea in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 3: 234-238 [Abstract] [Full Text]  
• Laveneziana, P., Lotti, P., Coli, C., Binazzi, B., Chiti, L., Stendardi, L., Duranti, R., Scano, G. (2006). Mechanisms of dyspnoea and its language in patients with asthma.. Eur Respir J 27: 742-747 [Abstract] [Full Text]  
• Wang, C. S., FitzGerald, J. M., Schulzer, M., Mak, E., Ayas, N. T. (2005). Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?. JAMA 294: 1944-1956 [Abstract] [Full Text]  
• Eckert, D. J., Catcheside, P. G., McDonald, R., Adams, A. M., Webster, K. E., Hlavac, M. C., McEvoy, R. D. (2005). Sustained Hypoxia Depresses Sensory Processing of Respiratory Resistive Loads. Am. J. Respir. Crit. Care Med. 172: 1047-1054 [Abstract] [Full Text]  
• von Leupoldt, A., Dahme, B. (2005). Cortical Substrates for the Perception of Dyspnea. Chest 128: 345-354 [Abstract] [Full Text]  
• Burki, N. K., Dale, W. J., Lee, L.-Y. (2005). Intravenous adenosine and dyspnea in humans. J. Appl. Physiol. 98: 180-185 [Abstract] [Full Text]  
• Man, W D C, Mustfa, N, Nikoletou, D, Kaul, S, Hart, N, Rafferty, G F, Donaldson, N, Polkey, M I, Moxham, J (2004). Effect of salmeterol on respiratory muscle activity during exercise in poorly reversible COPD. Thorax 59: 471-476 [Abstract] [Full Text]  
• Gehlbach, B. K., Geppert, E. (2004). The Pulmonary Manifestations of Left Heart Failure. Chest 125: 669-682 [Abstract] [Full Text]  
• Rao, A B, Gray, D (2003). Breathlessness in hospitalised adult patients. Postgrad. Med. J. 79: 681-685 [Abstract] [Full Text]  
• Bezzi, M., Donzel-Raynaud, C., Straus, C., Tantucci, C., Zelter, M., Derenne, J-P., Similowski, T. (2003). Unaltered respiratory-related evoked potentials after acute diaphragm dysfunction in humans. Eur Respir J 22: 625-630 [Abstract] [Full Text]  
• Vazquez, J., Lydic, R., Baghdoyan, H. A. (2002). The Nitric Oxide Synthase Inhibitor NG-Nitro-L-Arginine Increases Basal Forebrain Acetylcholine Release during Sleep and Wakefulness. J. Neurosci. 22: 5597-5605 [Abstract] [Full Text]  
• Perkin, R M, Resnik, D B (2002). The agony of agonal respiration: is the last gasp necessary?. J. Med. Ethics 28: 164-169 [Abstract] [Full Text]  
• Yan, A. T., Bradley, T. D., Liu, P. P. (2001). The Role of Continuous Positive Airway Pressure in the Treatment of Congestive Heart Failure. Chest 120: 1675-1685 [Abstract] [Full Text]  
• Ottanelli, R., Rosi, E., Romagnoli, I., Grazzini, M., Stendardi, L., Duranti, R., Scano, G. (2001). Do Inhaled Corticosteroids Affect Perception of Dyspnea During Bronchoconstriction in Asthma?. Chest 120: 770-777 [Abstract] [Full Text]  
• PEIFFER, C., POLINE, J.-B., THIVARD, L., AUBIER, M., SAMSON, Y. (2001). Neural Substrates for the Perception of Acutely Induced Dyspnea. Am. J. Respir. Crit. Care Med. 163: 951-957 [Abstract] [Full Text]  
• Harver, A., Mahler, D. A., Schwartzstein, R. M., Baird, J. C. (2000). Descriptors of Breathlessness in Healthy Individuals : Distinct and Separable Constructs. Chest 118: 679-690 [Abstract] [Full Text]  
• Jones, N. L., Killian, K. J. (2000). Exercise Limitation in Health and Disease. NEJM 343: 632-641 [Full Text]  
• MOY, M. L., WOODROW WEISS, J., SPARROW, D., ISRAEL, E., SCHWARTZSTEIN, R. M. (2000). Quality of Dyspnea in Bronchoconstriction Differs from External Resistive Loads. Am. J. Respir. Crit. Care Med. 162: 451-455 [Abstract] [Full Text]  
• NISHINO, T., IDE, T., SUDO, T., SATO, J. (2000). Inhaled Furosemide Greatly Alleviates the Sensation of Experimentally Induced Dyspnea. Am. J. Respir. Crit. Care Med. 161: 1963-1967 [Abstract] [Full Text]  
• YAN, S. (1999). Sensation of Inspiratory Difficulty during Inspiratory Threshold and Hyperinflationary Loadings . Effect of Inspiratory Muscle Strength. Am. J. Respir. Crit. Care Med. 160: 1544-1549 [Abstract] [Full Text]  
• Harty, H. R., Corfield, D. R., Schwartzstein, R. M., Adams, L. (1999). External thoracic restriction, respiratory sensation, and ventilation during exercise in men. J. Appl. Physiol. 86: 1142-1150 [Abstract] [Full Text]  
• Meek, P. (1999). Dyspnea . Mechanisms, Assessment, and Management: A Consensus Statement. Am. J. Respir. Crit. Care Med. 159: 321-340 [Full Text]  
• MOY, M. L., LANTIN, M. L., HARVER, A., SCHWARTZSTEIN, R. M. (1998). Language of Dyspnea in Assessment of Patients with Acute Asthma Treated with Nebulized Albuterol. Am. J. Respir. Crit. Care Med. 158: 749-753 [Abstract] [Full Text]  
• NISHINO, T., TAGAITO, Y., SAKURAI, Y. (1997). Nasal Inhalation of l-menthol Reduces Respiratory Discomfort Associated with Loaded Breathing. Am. J. Respir. Crit. Care Med. 156: 309-313 [Abstract] [Full Text]