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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">In previous studies we identified a subgroup of patients whose perception of breathlessness was exaggerated during acute bronchoconstriction and who were termed &#8220;over perceivers&#8221; or &#8220;hyperperceivers&#46;&#8221; In this study we aimed to determine whether such over perception is sporadic or stable over time&#46; We also examined whether there is an association between over perception of dyspnea and hyperventilation syndrome&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">The subjects were 22 stable asthmatics &#40;11 men&#44; 11 women&#41; who had been over perceivers of dyspnea in a study 9 years earlier&#46; After a medical history was taken&#44; a patient performed forced spirometry and a severity classification was made according to the criteria of the Global Initiative for Asthma &#40;GINA&#41;&#46; A bronchial histamine challenge was then administered to measure dose-related perception of dyspnea on a Borg scale&#44; according to a procedure that was similar to the one used 9 years earlier by the same investigator&#46; The patients were also asked for a subjective assessment of the severity of their asthma &#40;scale&#44; 0&#8211;10&#41; and to respond to items on the Nijmegen hyperventilation questionnaire and the trait form of the State-Trait Anxiety Inventory&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The overall perception of severity of disease&#44; level of anxiety&#44; and perception of dyspnea at rest were lower after 9 years &#40;<span class="elsevierStyleItalic">P</span> &#60;&#46;001&#41;&#46; No change was observed in bronchial hyperresponsiveness &#40;dose of inhaled histamine required to provoke a 20&#37; decline in forced expiratory volume in the first second &#91;FEV<span class="elsevierStyleInf">1</span>&#93;-PD<span class="elsevierStyleInf">20</span>&#41; or objective parameters of severity &#40;FEV<span class="elsevierStyleInf">1</span> and GINA classification&#41;&#46; Fourteen asthmatics &#40;64&#37;&#41; were still over perceivers and the other patients had changed&#58; 6 were normal perceivers and 2 were &#8220;poor perceivers&#46;&#8221; Only subjective perception of disease severity improved for the patients who were still over perceivers&#59; the other patients&#44; on the other hand&#44; showed improvements in subjective assessments&#44; objective ones &#40;except PD<span class="elsevierStyleInf">20</span>&#41;&#44; and anxiety&#46; Finally&#44; those who remained over perceivers had higher scores for anxiety &#40;24 vs 15&#59; <span class="elsevierStyleItalic">P</span> &#60;&#46;05&#41; and hyperventilation &#40;18 vs 13&#59; <span class="elsevierStyleItalic">P</span>&#61; not significant&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Most over perceivers of dyspnea remain so over the years and this trait is related to anxiety&#46; We have been unable to demonstrate an association with hyperventilation syndrome&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">En investigaciones previas para estudiar la percepci&#243;n de disnea de los asm&#225;ticos durante la bronco-constricci&#243;n aguda&#44; encontramos un subgrupo de pacientes que presentaban una percepci&#243;n exagerada &#40;hiperpercepto-res&#41;&#46; En el presente trabajo hemos querido comprobar si esta alteraci&#243;n perceptiva es un fen&#243;meno espor&#225;dico o mantenido en el tiempo&#46; Asimismo nos planteamos conocer si existe una asociaci&#243;n entre la hiperpercepci&#243;n de la disnea y el s&#237;ndrome de hiperventilaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; en el estudio a 22 asm&#225;ticos estables que en un estudio realizado 9 a&#241;os antes se hab&#237;an mostrado hiperperceptores de disnea &#40;11 varones y 11 mujeres&#41;&#46; Tras una espirometr&#237;a forzada y una entrevista cl&#237;nica&#44; se les clasific&#243; en su categor&#237;a de gravedad de asma -GINA &#40;Global Initiative for Asthma&#41;-&#46; A continuaci&#243;n se les someti&#243; a una prueba de provocaci&#243;n bronquial con histamina para medir la disnea percibida con cada dosis en una escala de Borg &#40;procedimiento similar al empleado 9 a&#241;os antes por el mismo investigador&#41;&#46; Adem&#225;s se les pidi&#243; una valoraci&#243;n subjetiva de la gravedad de su asma &#40;escala de 0&#8211;10&#41; y que relle-naran el cuestionario Nijmegen de hiperventilaci&#243;n y el STAI-R &#40;State-Trait Anxiety Inventory&#41; de ansiedad&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Globalmente&#44; transcurridos 9 a&#241;os&#44; se han reducido &#40;p &#60; 0&#44;001&#41; la percepci&#243;n de gravedad del asma&#44; la ansiedad y la disnea basal&#46; No se observaron cambios en el grado de hiperrespuesta bronquial &#40;PD<span class="elsevierStyleInf">20</span>&#58; concentraci&#243;n de histamina capaz de provocar un descenso del volumen espi-ratorio forzado en el primer segundo del 20&#37;&#41; ni en par&#225;-metros objetivos de gravedad &#40;volumen espiratorio forzado en el primer segundo y GINA&#41;&#46; Catorce asm&#225;ticos segu&#237;an siendo hiperperceptores &#40;64&#37;&#41; y en el resto hab&#237;a cambia-do la percepci&#243;n de la disnea&#58; 6 normoperceptores y 2 hipo-perceptores&#46; En el grupo que segu&#237;a siendo hiperperceptor s&#243;lo mejor&#243; significativamente la percepci&#243;n subjetiva de gravedad&#59; en cambio&#44; en el grupo restante mejoraron la en-fermedad subjetiva y objetivamente &#40;excepto la PD<span class="elsevierStyleInf">20</span>&#41; y la ansiedad&#46; Por &#250;ltimo&#44; los que continuaban siendo hiperperceptores puntuaron m&#225;s alto en los cuestionarios de ansiedad &#40;24 frente a 15&#59; p &#60; 0&#44;05&#41; e hiperventilaci&#243;n &#40;18 fren-te a 13&#59; p &#61; no significativa&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de hiperperceptores de disnea se mantienen as&#237; con el paso de los a&#241;os&#44; lo cual est&#225; relacio-nado con la ansiedad &#40;no hemos podido demostrar su asociaci&#243;n con el s&#237;ndrome de hiperventilaci&#243;n&#41;&#46;</p>"
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Vol. 42. Issue 3.
Pages 120-124 (March 2006)
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Vol. 42. Issue 3.
Pages 120-124 (March 2006)
Original Articles
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Evolution Over Time in Over Perceivers of Dyspnea in Asthma
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E. Martínez-Moragóna,
Corresponding author
emm01v@saludalia.com

Correspondence: Dra. E. Martínez-Moragón. Avda. Pérez Galdós, 12-10. 46007 Valencia. España
, M. Perpiñáb, A. Bellochc, B. Serraa, A. Llorisb, V. Maciánb
a Servicio de Neumología, Hospital de Sagunto, Sagunto, Valencia, Spain
b Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
c Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Valencia, Spain
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Objective

In previous studies we identified a subgroup of patients whose perception of breathlessness was exaggerated during acute bronchoconstriction and who were termed “over perceivers” or “hyperperceivers.” In this study we aimed to determine whether such over perception is sporadic or stable over time. We also examined whether there is an association between over perception of dyspnea and hyperventilation syndrome.

Patients and methods

The subjects were 22 stable asthmatics (11 men, 11 women) who had been over perceivers of dyspnea in a study 9 years earlier. After a medical history was taken, a patient performed forced spirometry and a severity classification was made according to the criteria of the Global Initiative for Asthma (GINA). A bronchial histamine challenge was then administered to measure dose-related perception of dyspnea on a Borg scale, according to a procedure that was similar to the one used 9 years earlier by the same investigator. The patients were also asked for a subjective assessment of the severity of their asthma (scale, 0–10) and to respond to items on the Nijmegen hyperventilation questionnaire and the trait form of the State-Trait Anxiety Inventory.

Results

The overall perception of severity of disease, level of anxiety, and perception of dyspnea at rest were lower after 9 years (P <.001). No change was observed in bronchial hyperresponsiveness (dose of inhaled histamine required to provoke a 20% decline in forced expiratory volume in the first second [FEV1]-PD20) or objective parameters of severity (FEV1 and GINA classification). Fourteen asthmatics (64%) were still over perceivers and the other patients had changed: 6 were normal perceivers and 2 were “poor perceivers.” Only subjective perception of disease severity improved for the patients who were still over perceivers; the other patients, on the other hand, showed improvements in subjective assessments, objective ones (except PD20), and anxiety. Finally, those who remained over perceivers had higher scores for anxiety (24 vs 15; P <.05) and hyperventilation (18 vs 13; P= not significant).

Conclusions

Most over perceivers of dyspnea remain so over the years and this trait is related to anxiety. We have been unable to demonstrate an association with hyperventilation syndrome.

Key words:
Dyspnea
Asthma
Perception
Over perception
Hyperventilation
Objetivo

En investigaciones previas para estudiar la percepción de disnea de los asmáticos durante la bronco-constricción aguda, encontramos un subgrupo de pacientes que presentaban una percepción exagerada (hiperpercepto-res). En el presente trabajo hemos querido comprobar si esta alteración perceptiva es un fenómeno esporádico o mantenido en el tiempo. Asimismo nos planteamos conocer si existe una asociación entre la hiperpercepción de la disnea y el síndrome de hiperventilación.

Pacientes y métodos

Se incluyó en el estudio a 22 asmáticos estables que en un estudio realizado 9 años antes se habían mostrado hiperperceptores de disnea (11 varones y 11 mujeres). Tras una espirometría forzada y una entrevista clínica, se les clasificó en su categoría de gravedad de asma -GINA (Global Initiative for Asthma)-. A continuación se les sometió a una prueba de provocación bronquial con histamina para medir la disnea percibida con cada dosis en una escala de Borg (procedimiento similar al empleado 9 años antes por el mismo investigador). Además se les pidió una valoración subjetiva de la gravedad de su asma (escala de 0–10) y que relle-naran el cuestionario Nijmegen de hiperventilación y el STAI-R (State-Trait Anxiety Inventory) de ansiedad.

Resultados

Globalmente, transcurridos 9 años, se han reducido (p < 0,001) la percepción de gravedad del asma, la ansiedad y la disnea basal. No se observaron cambios en el grado de hiperrespuesta bronquial (PD20: concentración de histamina capaz de provocar un descenso del volumen espi-ratorio forzado en el primer segundo del 20%) ni en pará-metros objetivos de gravedad (volumen espiratorio forzado en el primer segundo y GINA). Catorce asmáticos seguían siendo hiperperceptores (64%) y en el resto había cambia-do la percepción de la disnea: 6 normoperceptores y 2 hipo-perceptores. En el grupo que seguía siendo hiperperceptor sólo mejoró significativamente la percepción subjetiva de gravedad; en cambio, en el grupo restante mejoraron la en-fermedad subjetiva y objetivamente (excepto la PD20) y la ansiedad. Por último, los que continuaban siendo hiperperceptores puntuaron más alto en los cuestionarios de ansiedad (24 frente a 15; p < 0,05) e hiperventilación (18 fren-te a 13; p = no significativa).

Conclusiones

La mayoría de hiperperceptores de disnea se mantienen así con el paso de los años, lo cual está relacio-nado con la ansiedad (no hemos podido demostrar su asociación con el síndrome de hiperventilación).

Palabras clave:
Disnea
Asma
Percepción
Hiperpercepción
Hiperventilación
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This study was partially funded by grant RTIC-03/11 from the Red RESPIRA-Instituto de Salud Carlos III.

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