An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

Am J Respir Crit Care Med. 2012 Feb 15;185(4):435-52. doi: 10.1164/rccm.201111-2042ST.

Abstract

Background: Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome.

Purpose: The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea.

Methods: An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members.

Results: Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains.

Conclusions: Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.

Publication types

  • Consensus Development Conference
  • Practice Guideline

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Bronchodilator Agents / therapeutic use
  • Dyspnea* / diagnosis
  • Dyspnea* / etiology
  • Dyspnea* / physiopathology
  • Dyspnea* / therapy
  • Exercise Therapy
  • Humans
  • Magnetic Resonance Imaging
  • Oxygen Inhalation Therapy

Substances

  • Adrenal Cortex Hormones
  • Analgesics, Opioid
  • Bronchodilator Agents