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Vol. 40. Issue 4.
Pages 149-154 (April 2004)
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Vol. 40. Issue 4.
Pages 149-154 (April 2004)
Original Articles
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How Can We Assess the Perception of Induced Dyspnea in Chronic Obstructive Pulmonary Disease?
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M.E. Martínez Francésa,*, M. Prpiñá Torderaa, A. Belloch Fusterb, E.M. Martínez Moragónc, A. de Diego Damiáaa
a Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
b Departamento de Personalidad, Universidad de Valencia, Valencia, Spain
c Servicio de Medicina Interna, Hospital Comarcal de Sagunto, Sagunto, Valencia, Spain
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Objective

TO evaluate various methods for studying the perception of dyspnea in chronic obstructive pulmonary disease (COPD) using a new parameter, the change in Borg scale rating, and others already in use: the linear regression slope and the application of Stevens' law to the response-perception curve-ie change in forced expiratory volume in 1 second (ΔFEV1)-change in dyspnea (Adyspnea).

Patients and method

A bronchial challenge test was performed on 70 patients with stable COPD and no contraindications for performing the test (European Respiratory Society criteria), during which dyspnea was measured (Borg scale) after each nebulization. Perception was analyzed using: a) the linear regression slope of ΔFEV1 plotted against (Adyspnea); b) the exponent n of Stevens' law (ψ=kΨn, in which ψ is Δdyspnea and Ψis AFEV1, with perception being poor when n<1 and good when n>1), and c) change in Borg: difference between dyspnea when FEV1 has fallen 20% and dyspnea after saline inhalation. Subjects were classified according to the slope and change in Borg as hypoperceivers, normal perceivers, or hyperperceivers. These 2 methods of classification were compared using the κ statistic.

Results

According to the exponent n, all patients were hypoperceivers (n<1). According to the slope, there were 33 hypoperceivers, 28 normal perceivers, and 9 hyperperceivers. The change in Borg classified 37 subjects as hypoperceivers, 23 as normal perceivers, and 10 as hyperperceivers. All except 5 subjects were classified in the same way by the slope and the change in Borg (κ=0.88). In most of the 5 cases of discrepancy, the slope classified subjects as better perceivers.

Conclusions

The n exponent is not valid for evaluating the perception of dyspnea induced by a bronchial challenge test in COPD. Change in Borg is at least as useful as the slope for evaluating perception of dyspnea. The percentage of patients with this disease who are hyperperceivers is high.

Key words:
Perception
Dyspnea
Chronic obstructive pulmonary disease
Bronchial challenge test
Objetivo

Valorar varios métodos para el estudio de la percepción de la disnea en la enfermedad pulmonar obstructiva crónica (EPOC) usando un nuevo parámetro, el cambio en Borg (CB), y otros ya utilizados: la pendiente de la regresión lineal y la aplicación de la ley de Stevens a la curva respuesta-percepción -cambios en el volumen espiratorio forzado en el primer segundo (ΔFEV1)-cambio en la disnea (Δdisnea).

Pacientes y métodos

Se realizó un test de broncoprovocación a 70 pacientes con EPOC estable, sin contraindi-caciones para dicha prueba (criterios de la European Respiratory Society), durante el que se midió la disnea (escala de Borg) después de cada nebulización. La percepción se analizó mediante: a) la pendiente de la regresión lineal entre ΔFEV1 y Adisnea; b) el exponente n de la ley de Stevens (ψ = kΨn, donde ψ es Δdisnea y ψ es ΔFEV1; cuan-do n < 1, la percepción es mala, y cuando n > 1, buena), y c) el CB: diferencia entre la disnea cuando el FEV1 ha caí-do un 20% y la disnea tras inhalación de salino. Se clasificó a los sujetos según la pendiente y el CB en hipoperceptores (HPO), normoperceptores (NP) e hiperperceptores (HPR). Se compararon ambas clasificaciones mediante el estadístico kappa.

Resultados

Según el exponente n todos los pacientes fueron HPO (n < 1). Según la pendiente hubo 33 HPO, 28 NP y 9 HPR. El CB clasificó como HPO a 37 sujetos, como NP a 23 y como HPR a 10. La pendiente y el CB clasificaron igual a to-dos, excepto a 5 sujetos (kappa = 0,88). En la mayoría de casos discordantes, la pendiente clasificó a los sujetos como mejor perceptores.

Conclusions

El coeficiente n no es válido para estudiar la percepción de la disnea inducida mediante test de bronco-provocación en la EPOC. El CB es, al menos, tan útil como la pendiente para estos estudios. La proporción de HPO entre los pacientes con dicha enfermedad es elevada.

Palabras clave:
Percepción. Disnea
Enfermedad pulmonar obs-tructiva crónica
Prueba de provocación bronquila
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This study was partially subsidized by a grant from Red Respira RTIC 03/11 ISCIII

Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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