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Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions

Authors Hanania NA, O'Donnell DE

Received 19 September 2018

Accepted for publication 1 April 2019

Published 24 May 2019 Volume 2019:14 Pages 1127—1138

DOI https://doi.org/10.2147/COPD.S188141

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell


Nicola A Hanania,1 Denis E O’Donnell2

1Department of Medicine, Section of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX, USA; 2Division of Respirology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

Abstract: Dyspnea is a distressing, debilitating, and near-ubiquitous symptom affecting patients with COPD. In addition to the functional consequences of dyspnea, which include activity limitation and reduced exercise tolerance, it is important to consider its psychological impact on patients with COPD, such as onset of depression or anxiety. Moreover, the anticipation of dyspnea itself can have a significant effect on patients’ emotions and behavior, with patients frequently self-limiting physical activity to avoid what has become the hallmark symptom of COPD. Dyspnea is, therefore, a key target for COPD treatments. Pharmacologic treatments can optimize respiratory mechanics, provide symptom relief, and reduce patients’ increased inspiratory neural drive to breathe. However, it is important to acknowledge the value of non-pharmacologic interventions, such as pulmonary rehabilitation and patient self-management education, which have proven to be invaluable tools for targeting the affective components of dyspnea. Furthermore, it is important to encourage maintenance of physical activity to optimize long-term patient outcomes. Here, we review the physiological and psychological consequences of activity-related dyspnea in COPD, assess the efficacy of modern management strategies in improving this common respiratory symptom, and discuss key unmet clinical and research needs that warrant further immediate attention.

Keywords: dyspnea, chronic obstructive pulmonary disease, psychology, physiology, management


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