Investigation of the Affective Dimension of Dyspnea

描述（由申请人提供）：呼吸困难（呼吸短促）是心血管和肺部疾病的主要症状。这是非常痛苦和虚弱的。在因严重疾病住院的病人中，呼吸困难和疼痛一样常见，在门诊病人中也很普遍。尽管其普遍存在并伴有痛苦，但令人惊讶的是，人们对呼吸困难的神经生理学和感知知之甚少，特别是与疼痛相比。我们的目标是通过测试呼吸困难的感知包括可以分别区分和调节的感觉和情感维度，并且必须共同测量以充分表征症状的假设来提高对感知机制的基本理解。现有的一般呼吸困难措施不能解决呼吸困难的多个维度的概念。有一种有用且被广泛接受的疼痛模型是一种多维体验。有证据表明，该模型的某些方面适用于呼吸困难，例如，将感觉维度表征为由定性可区分的感觉组成。一个多阶段的情感维度模型，包括立即不愉快的阶段（现在感觉有多“糟糕”）和随后的情绪/评价反应（多么“可怕”或“沮丧”），从未对呼吸困难进行过测试。我们将在3项研究中检验这一概念模型是否适用于呼吸困难，这些研究在一系列环境和条件下具有一致的目标、假设和测量：1)在健康受试者和患者中由受控实验室方法引起的呼吸困难；2)急诊科不同诊断患者当前呼吸困难情况；3) COPD患者接受治疗性运动后呼吸困难的变化。我们跨学科团队的成员在理解和测量呼吸困难的感觉成分以及确定神经机制方面做出了重大贡献。我们的研究结果使我们将这一建议集中在情感维度的概念澄清上。我们将研究即时不愉快和情绪反应的情感阶段与感觉维度（强度和质量）之间的关系。我们的目标是阐明在各种临床和实验室环境中重要的呼吸困难的各个方面。我们相信，一个更好的呼吸困难维度的概念模型将导致改进测量方法，选择更相关的实验室模型，更好地评估临床试验中的干预措施，以及更好地在实验室工作和临床研究之间进行转换。

DESCRIPTION (provided by applicant): Dyspnea (shortness of breath) is a leading symptom of both cardiovascular and pulmonary disease. It is severely distressing and debilitating. Dyspnea is as common as pain in patients hospitalized for serious disease and is also very prevalent in outpatients. Despite its prevalence and associated suffering, there is surprisingly little known about neurophysiology and perception of dyspnea, especially when compared to pain. Our goal is to improve basic understanding of perceptual mechanisms by test the hypothesis that the perception of dyspnea comprises sensory and affective dimensions that can be discriminated and modulated separately and that must be measured jointly to adequately characterize the symptom. Existing general dyspnea measures do not address the concept of multiple dimensions of dyspnea. There is a useful and widely accepted model of pain as a multidimensional experience. Evidence shows that some aspects of that model apply to dyspnea, e.g., characterization of the sensory dimension as consisting of qualitatively distinguishable sensations. A multi-stage affective dimension model comprising stages of immediate unpleasantness (how 'bad' it feels now) and consequent emotional/evaluative responses (how 'scary' or 'depressing1 it is) has never been tested for dyspnea. We will test whether this conceptual model applies to dyspnea in 3 studies designed to have congruent aims, hypotheses, and measurements across a spectrum of settings and conditions: 1) dyspnea induced by controlled laboratory methods in both healthy subjects and patients; 2) current dyspnea in patients of differing diagnoses in the emergency department; and 3) changes in dyspnea in COPD patients undergoing a therapeutic exercise program. Members of our interdisciplinary team have made substantial contributions to the understanding and measurement of sensory components of dyspnea and determination of neural mechanisms. Our findings have led us to focus this proposal on conceptual clarification of the affective dimension. We will examine the relationships between the affective stages of immediate unpleasantness and emotional response and the sensory dimension (intensity and quality). Our goal is to clarify the aspects of dyspnea that are important in various clinical and laboratory settings. We believe a better conceptual model of the dimensions of dyspnea will lead to improved methods of measurement, selection of more relevant laboratory models, better assessment of interventions in clinical trials, and better translation between laboratory work and clinical studies.