Одышка: механизмы, оценка, лечение. Консенсус

1. Howell J.B.L., Campbell E.J.M., eds. Breathlessness. Blackwell Scientific Publications, London. 1966.

2. Altose M., Cherniack N., Flshman A.P. Respiratory sensations and dyspnea. J. Appl. Physiol. 1985; 58: 1051–1054.

3. Simon P.M., Schwartzstein R.M., Weiss J.W. et al. Distinguishable types of dyspnea in patients with shortness of breath. Am. Rev. Respir. Dis. 1990; 142: 1009–1014.

4. Elliott M.W., Adams L., Cockcroft A. et al. The language of breathlessness: use of verbal descriptors by patients with cardiopulmonary disease. Am. Rev. Respir. Dis. 1991; 144: 826–832.

5. Schwartzstein R.M., Cristiano L.M. Qualities of respiratory sensation. In: Adams L., Guz A., eds. Lung biology in health and disease, Vol. 90: Respiratory Sensation. Marcel Dekker, New York. 1996. 125–154.

6. Schwartzslein R.M. The language of dyspnea. In: Mahler D.A., ed. Lung Biology in Health and Disease, Vol. Ill: Dyspnea. Marcel Dekker, New York. 1998. 35–62.

7. Mahler D.A., Harvcr A., Lentine T. et al. Descriptors of breathlessness in cardiorespiratory diseases. Am. J. Respir. Crit. Care Med. 1996; 154: 1357–1363.

8. Manning H.L., Schwartzstein R.M. Pathophysiology of dyspnea. N. Engl. J. Med. 1995; 333: 1547–1553.

9. Killian K.J., Summers E., Jones N.L., Campbell E.J.M. Dyspnea and leg effort during incremental cycle ergometry. Am. Rev. Respir. Dis. 1992; 145: 1339–1345.

10. Killian K.J., Leblanc P., Martin D.H. et al. Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. Am. Rev. Respir. Dis. 1992.; 146: 935–940.

11. Corfield D.R., Fink G.R., Ramsay S.С. et al. Evidence for limbic system activation during CO2 stimulated breathing In man. J. Physiol. (Zond.) 1995. 488: 77–84.

12. Mulnier H.E., Adams L., Murphy K. et al. Areas of cerebral cortex activated by dyspnoea. Neuroimage 1998. 7: 5430.

13. Guz A. Brain, breathing and breathlessness. Respir. Physiol. 1997. 109: 197–204.

14. Kikuchi Y., Okabe S., Tamura G. et al. Chemosensitivity and perception of dyspnea in patients with a history of near fatal asthma. N. Engl. J. Med. 1994; 330: 1329–1334.

15. Gorman J.M., Fyer M.R., Goetz R. et al. Ventilatory physiology of patients with panic disorder. Arch. Gen. Psychiatry 1988; 45: 31–39.

16. Fishman A.P. NIH workshop summary: pulmonary rehabilitation research. Am. J. Respir. Crit. Care Med. 1994. 149: 825–833.

17. Adams L., Guz A. Lung biology in health and disease, Vol. 90: Respiratory sensation. Marcel Dekker, New York. 1996.

18. Mahler D.A. Lung biology in health and disease, Vol. III; Dyspnea. Marcel Dekker, New York. 1998.

19. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1995; 152: S77–S120.

20. Higgins M. Epidemiology of obstructive pulmonary disease. In: Cassaburi R., Petty T.L., eds. Principles and practice of pulmonary rehabilitation. W.B. Saunders, Philadelphia. 1993.

21. Celli B.R. Pulmonary rehabilitation in patients with COPD. Am. J. Respir. Crit. Care Med. 1995; 152: 861–864.

22. Wright G.W., Branscomb B.V. Origin of the sensations of dyspnea. Trans. Am. Clin. Climatol. Assoc. 1966: 116–125.

23. Wasserman K., Cassaburi R. Dyspnea; physiological and pathophysiological mechanisms. Ann. Rev. Med. 1988; 39: 503–515.

24. Simon P.M., Schwartzstein R.M., Weiss J.W. et al. Distinguishable sensations of breathlessness in normal volunteers. Am. Rev. Respir. Dis. 1989; 140: 1021–027.

25. Nattie E.E. Central chemoreceptors. In: Dempsey J.A., Pack A.L., eds. Regulation of breathing, 2 nd ed. Marcel Dekker, New York. 1995; 473–510.

26. Fitzgerald R.S., Lahiri S. Reflex response to chemoreccptor stimulation. In: Cherniack N.S., Widdicombe J.G., eds. Handbook of Physiology, Section 3: The Respiratory system, Vol. 2. Control of Breathing. American physiological Society, Bethesda. 1986. 313–362.

27. Widdicombe J.G. Pulmonary and respiratory tract receptors. J. Exp. Biol. 1982; 100: 41–57.

28. Bolsher D.C, Lindsey B.G., Shannon R. Medullary inspiratory activity; influence of intercostal tendon organs and muscle spindle endings. J. Appl. Physiol. 1987; 62: 1046–1056.

29. Bolsher D.С, Lindsey В.G., Shannon R. Respiratory pattern changes produced by intercostal muscle/rib vibration. Appl. Physiol. 1988; 84: 1487–1491.

30. Younes M. Mechanisms of respiratory load compensation. In: Dempsey J.A., Pack A.L., eds. Regulation of breathing, 2 nd ed. Marcel Dekker, New York. 1995. 867–922.

31. McClosky D.I. Kinesthetic sensibility. Physiol. Rev. 1978; 58: 763–820.

32. Killian K.J., Gandevia S.C., Summer E., Campbell E.J.M. Effect of increased lung volume on perception of breathless ness, effort and tension. J. Appl. Physiol. 1984; 57: 686–691.

33. Chen Z., Eldridge F.L., Wagner P.G. Respiratory associated rhythmic firing of midbrain neurones in cats: relation to level of respiratory drive. J. Physiol. (Zond.) 1991; 437: 305–325.

34. Chen Z., Eldridge F.L., Wagner P.G. Respiratory associated thalamic activity is related to level of respiratory drive. Respir. Physiol. 1992; 90: 99–113.

35. Campbell E.J.M, Gandevia S.С., Killian K.J et al. Changes in the perception of inspiratory resistive loads during partial curarization. J. Physiol. (Zond.) 1990; 309: 93–100.

36. Supinski G.S., Clary S.J., Bark H. et al. Effect of inspiratory muscle fatigue on perception of effort during loaded breathing. J. Appl. Physiol. 1987; 62: 300–307.

37. El&Manshawi A., Killian K.J., Summers E. et al. Breath lessness during exercise with and without resistive loading. J. Appl. Physiol. 1986; 61: 896–905.

38. Gandevia S.C, Macefield G. Projection of low threshold affercnts from human intercostal muscles to the cerebral cortex. Respir. Physiol. 1989; 77: 203–214.

39. Homma I., Kanamaru A., Sibuya M. Proprioceptive chest wall afferents and the effect on respiratory sensation. In: С. von Euler, M. Katz Salamon, eds. Respiratory Psychophysiology. Stockton Press, New York. 1988. 161–166.

40. Campell E.J.M., Howell J.B.L. The sensation of breathlessness. Br. Med. Bull. 1963; 19: 36–40.

41. Homma I., Obata T., Sibuya M. et al. Gate mechanism in breathlessness caused by chest wall vibration in humans. J. Appl. Physiol. 1984; 56: 8–11.

42. Sibuya M., Yamada M., Kanamaura A. et al. Effect of chest wall vibration on dyspnea in patients with chronic respiratory disease. Am. J. Respir. Crit. Care Med 1994; 149: 1235–1240.

43. Chonan Т., Mulholland M.B., Cherniack N.S. et al. Effects of voluntary constraining of thoracic displacement during hypercapnia. J. Appl. Physiol. 1987; 63: 1822–1828.

44. Schwartzstein R.M., Simon P.M., Weiss J.W. et al. Breathlessness induced by dissociation between ventilation and chemical drive. Aw. Rev. Respir. Dis. 1989; 139: 1231–1237.

45. Altose M.D., Syed I., Shoos L. Effects of chest wall vibration on the intensity of dyspnea during constrained breathing. Proc. Int. Union Physiol. Sci. 1989; 17: 288.

46. Clark F.J., С. von Euler. On the regulation of depth and rate of breathing. J. Physiol. 1972; 222: 267–295.

47. Banzett R.В., Lansing R.W., Brown R. High level quadriplegics perceive lung volume change. J. Appl. Physiol. 1987; 62: 567–573.

48. Manning H.L., Shea S.A., Schwartzstein R.M. et al. Reduced tidal volume increases air 'hunger' at fixed PCO2 in ventilated quadriplegics. Respir. Physiol. 90: 19–30.

49. Guz A., Noble N.I.M., Eisele J.H. et al. Experimental results of vagal blockade in cardiopulmonary disease. In: Porter R., ed. Breathing: Hering Breuer Centenary Symposium. Churchill. London. 1970. 315–329.

50. Noble M.I.M., Eisele J.H., Trenchard D. et al. Effect of selective peripheral nerve blocks on respiratory sensations. In: Porter R., ed. Breathing: I Iering Breyer Symposium. Churchill, London. 1970. 233–246.

51. Davies S.P., McQuaid K.R., Iber С. et al. Extreme dyspnea from unilateral pulmonary venous obstruction: demonstration of a vagal mechanism and relief by right vagotomy. Am. Rev. Respir. Dis. 1987; 136: 184–188.

52. Taguchi O., Kikuchi Y., Hida W. et al. Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea. J. Appl. Physiol. 1991; 71: 2183–2190.

53. Paintal A.S. Sensations from J receptors. NIPS 1995; 10: 238–243.

54. Banzett R.В., Lansing R.W., Reid M.B. et al. Brown R. 'Air hunger' arising from increased PCO2 in mechanically ventilated quadriplegics. Respir. Physiol. 1989; 76: 53–67.

55. Banzett R.В., Lansing R.W., Brown R. 'Air hunger' from increased PCO 2 persists after complete neuromuscular block in humans. Respir. Physiol. 1990; 81: 1–17.

56. Chonan Т., Mulholland M.B., Leitner J. et al. Sensation of dyspnea during hypercapnia, exercise and voluntary hyperventilation. J. Appl. Physiol. 1990; 68: 2100–2106.

57. Lane R., Cockcroft A., Adams L. et al. Arterial saturation and breathlessness in patients with chronic obstructive airways disease. Clin. Sci. 1987; 72: 693–698.

58. Schwartzstein R.M., Manning H.L., Weiss J.W. et al. Dyspnea: a sensory experience. Lung 1990; 168: 185–399.

59. O'Donnell D.E., Webb K.A. Exertionat breathlessness in patients with chronic airflow limitation. Am. Rev. Respir. Dis. 1993; 148: 1351–1357.

60. Manning H.L., Molinary E.J., Leiter J.С. Effect of inspiratory flow rate on respiratory sensation and pattern of breathing. Am. J. Respir. Crit. Care Med 1995; 151: 751–757.

61. Killian K.J., Summers E., Jones N.L. et al. Dyspnea and leg effort during incremental cycle ergometry. Am. Rev. Respir. Dis. 1992; 145: 1339–1345.

62. Burns B.H., Howell J.B.L. Disproportionately severe breathlessness in chronic bronchitis. Q. J. Med. 1969; 38: 277–294.

63. Sue D.Y., Wasserman K., Moricca R.B. et al. Metabolic acidosis during exercise in patients with chronic obstructive pulmonary disease. Chest 1988; 94: 93–98.

64. Casaburi R., Patessio A., Loli F. et al. Reduction in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am. Rev. Respir. Dis. 143: 9–18.

65. Silvestri G.A., Mahler D. Evaluation of dyspnea in elderly patients. Clinics Chest Med. 1993; 14: 393–404.

66. Killian K.J., Jones S.L. The use of exercise testing and other methods in the investigation of dyspnea. Clinics Chest Mod. 1984; 5: 99–108.

67. Manning H. Effects of chest wall vibration on breathlessness during hypercapnic ventilatory response. J. Appl. Physiol. 1998; 85: 1485–1486.

68. Rochester D. Respiratory muscles and ventilatory failure. Am. J. Med. Sci. 1993; 305: 394–402.

69. Altose M.D. Respiratory muscles and dyspnea. Semin. Respir. Med. 1992; 13: 1–6.

70. Killian K.J., Jones N.L. Respiratory muscles and dyspnea. Clin. Chest Med. 1988; 9: 237–248.

71. Hamilton A.L., Killian K.J., Summers E. et al. Muscle strength, symptom intensity and exercise capacity in patients with cardiorespiratory disorders. Am. J. Respir. Crit. Care Med. 1995; 152: 2021–2031.

72. Belman M.J., Botnick W.С., Shin J.W. Inhaled bronchodilators reduce dynamic hyperinflation during exercise in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1996; 153: 967–975.

73. Altose M.D., Cherniack N.S. Respiratory sensation and respiratory muscle activity. Adv. Physiol. Sci. 1981; 10: 111–119.

74. Burdon J.G.W., Juniper E.F., Killian K.J. et al. Effect of ventilatory drive on the perceived magnitude of added loads to breathing. J. Appl. Physiol. 1982; 53: 901–907.

75. Wilhelmsen L., Hagman M., Werko L. Recurrent pulmonary embolism: incidence, predisposing factors and prognosis. Acta Med. Scand. 1972; 192: 565–575.

76. Thoman R.L., Stoker G.L., Ross J.С. The efficacy of purselips breathing in patients with COPD. Am. Rev. Respir. Dis. 1966; 93: 100–106.

77. O'Donnell D.E., Bain D.J., Webb K.A. Factors contributing to relief of exertional breathlessness during hyperoxia in chronic airflow limitation. Am. J. Respir. Crit. Care Med. 1997; 155: 530–535.

78. Lane R., Cockcroft A., Adams L. et al. Arterial oxygen saturation and breathlessness in patients with chronic obstructive airway disease. Clin. Sci. 1987; 72: 693–698.

79. Chronos N., Adams L., Guz A. Effect of hyperoxia andhypoxia on exercise induced breathlessness in normal subjects. Clin. Sci. 1988; 64: 531–537.

80. Demediuk B.H., Manning H., Lilly J. et al. Dissociation between dyspnea and respiratory effort. Am. Rev. Respir. Dis. 1992; 146: 1222–1225.

81. Moy M.L., Lantin M.L., Harver A. et al. Language of dyspnea in assessment of patients with acute asthma treated with nebulized albuterol. Am. Respir. Crit. Care Med. 1998 (In press).

82. Gift A.G., Plaut S.M., Jacox A. Psychologic and physiologic factors related to dyspnea in subjects with chronic obstructive pulmonary disease. Heart Lung 1986; 15: 595–601.

83. Gift A.G., Cahill С.A. Psychophysiologic aspects of dyspnea in chronic obstructive pulmonary disease: a pilot study. Heart Lung 1990; 19: 252–257.

84. Dudley D.L., Martin С.J., Holmes Т.Н. Dyspnea; psychological and physiologic observations. J. Psychosom. Res. 1968; 12: 205–214.

85. Dales R.E., Spitzer W.O., Schechter M.T. et al. The influence of psychological status on respiratory symptom reporting. Am. Rev. Respir. Dis. 1989; 139: 1459–1463.

86. Rosser R., Guz A. Psychological approaches to breathlessness and its treatment. J. Psychosom. Res. 1981; 25: 439–447.

87. Guenard H., Gallego J., Dromer C. Exercise dyspnoea in patients with respiratory disease. Eur. Respir. Rev. 1995; 5: 6–13.

88. Fletcher С.М. The clinical diagnosis of pulmonary emphysema: an experimental study. Proc. Res. Soc. Med. 1952; 45: 577–584.

89. Schilling R.S.F., Hughes J.P.W., Dingwall&Fordyce I. Disagreement between observers in an epidemiological study of respiratory disease. Br. Med. J. 1955; 1: 65–68.

90. Fletcher С.М., Elmes Р.С, Wood С.Н. The significance of respiratory symptoms and the diagnosis of chromic bronchitis in a working population. Br. Med. J. 1959; 1: 257–266.

91. Nunnally J.С. Psychometric Theory, 2 nd ed. McGrawHill, New York. 1978.

92. McGavin C.R., Artvinli M., Naoe H. Dyspnea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. Br. Med. J. 1978; 2: 241–243.

93. Mahler D., Weinberg D., Wells C. et al. The measurement of dyspnea: contents, inlerobserver agreement and physiologic correlates of two new clinical indexes. Chest 1984; 85: 751–758.

94. Mahler D., Rosiello R., Harver A. et al. Comparison of clinical dyspnea ratings and psychological measurements of respiratory sensation in obstructive pulmonary disease. Am. Rev. Respir. Dis. 1987; 135: 1229–1233.

95. Mahler D., Harver A., Rosiello R. et al. Measurement of respiratory sensation in interstitial lung disease. Chest 1989; 96: 767–771.

96. Mahler D., Matthay R., Snyder P. et al. Sustained release theophylline reduces dyspnea in nonreversible obstructive airway disease. Am. Rev. Respir. Dis. 1985; 131: 22–25.

97. Archibald С.J., Guidotti T.L. Degree of objectively measured impairment and perceived shortness of breath with activities of daily living in patients with chronic obstructive pulmonary disease. Can. J. Rehab. 1987; 1: 45–54.

98. Eakin E.G., Sassi&Dambron D.E., Ries A.L. et al. Reliability and validity of dyspnea measures in patients with obstructive lung disease. Int. J. Behav. Med. 1995; 2: 118–134.

99. Eakin E.G., Prewitt L.M., Ries A.L. et al. Validation of the UCSD shortness of breath questionnaire. J. Cardiopulm. Rehab. 1994; 14: 322.

100. Means J.H. Dyspnea, Medicine 1924; 3: 309–416.

101. Meakins J.M. The cause and treatment of dyspnea in cardiovascular disease. Br. Med. J. 1923; 1: 1043–1055.

102. Borg G. Perceived exertion as an indicator of somatic stress. Scand. J. Rehab. Med. 1970; 2: 92–98.

103. Borg G. Simple rating methods for estimation of perceived exertion. Wenner Gren Center International Symposium Scries 1976; 28: 39–47.

104. Borg G. Psychophysical bases of perceived exertion. Med. Sci. Sports Exerc. 1982; 14: 377–381.

105. Borg G. Perceived exertion: a note on 'history' and methods. Med. Sci. Sports 1973; 5: 90–93.

106. LeBlanc P., Bowie D.M., Summers E. et al. Breathlessness and exercise in patients with cardiorespiratory disease. Am. Rev. Respir. Dis. 1986; 133: 21–25.

107. Silverman M., Barry J., Hellerstein H. et al. Variability of the perceived sense of breathing during exercise in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1988; 137: 206–209.

108. Muza S.R., Silverman M.T., Gilmore G.C. et al. Comparison of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1990; 141: 909–913.

109. Skinner J., Hutsler R., Bergsteinnova V. et al. The validity and reliability of a rating scale of perceived exertion, Med. Sci. Sports 1973; 5: 94–96.

110. Wilson R.C, Jones P.W. Differentiation between the intensity of breathlessness and the distress it evokes in normal subjects during exercise. Clin. Sci. 1991; 80: 65–70.

111. Gift A.G. Validation of a vertical visual analogue scale as a measure of clinical dyspnea. Rehab. Nurs. 1989; 14: 313–325.

112. Janson&Bjerklie S., Carrieri V.K., Hudcs M. The sensations of pulmonary dyspnea. Nurs. Res. 1986; 35: 154–159.

113. Janson&Bjerklie S., Ruma S.S., Stulbarg M. et al. Predictors of dyspnea intensity in asthma. Nurs. Res. 1987; 36: 179–183.

114. Rubinfeld A.F., Pain M.C.F. Perception of asthma. Lancer 1976; 1: 882–884.

115. Comroe J.H., Jr. Dyspnea. Mod. Con. of Cardiovascular Dis. 1956; 25: 347–349.

116. Guyatt G.H., Berman L.B., Townsend M. et al. A measure of quality of life for clinical trials in chronic lung disease. Thorax 1987; 42: 773–778.

117. Jones P.W., Quirk F.H., Baveystock C.M. et al. A self complete measure of health status for chronic airflow limitation. Am. Rev. Respir. Dis. 1992; 145: 1321–1327.

118. Lareau S., Carrieri&Kohlman V., Janson&Bjerklie S. et al. Development and testing of the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ). Heart Lung 1994; 23: 242–250.

119. Weaver T.E., Narsavage G.L. Physiological and psychological variables related to functional status in COPD. Nurs. Res. 1992; 41: 286–291.

120. Narsavage G.L., Weaver Т.Е. Hardiness and coping as predictors of outcomes in chronic obstructive pulmonary disease. Nurs. Res. 1994; 43: 90–94.

121. Carrieri V.K., Janson&Bjerklie S. Strategies patients use to manage the sensation of dyspnea. W. J. Nurs. Res. 1986; 8: 284–305.

122. Kohlman&Carrieri V., Janson&Bjerklie S. Coping and selfcare strategies. In: Mahler D.A., ed. Dyspnea. Futura Publishing Co., Mount Kisco, NY. 1990; 201–230.

123. Jones N.L., Jones G., Edwards R.H.T. Exercise tolerance in chronic airway obstruction. Am. Rev. Respir. Dis. 1971; 103: 477–491.

124. Marcus J.H., McLean R.L., Duffell G.M. et al. Exercise performance in relation to the pathophysiologic type of chronic obstructive pulmonary disease. Am. J. Med. 1970; 49: 14–22.

125. Kaltreider N.L., McCann W.S. Respiratory response during exercise in pulmonary fibrosis and emphysema. J. Clin. Invest. 1937; 16: 23–40.

126. Leblanc P., Bowie D.M., Summers E. et al. Breathlessness and exercise in patients with cardio respiratory disease. J. Appl. Physiol. 1986; 133: 21–25.

127. O'Donnell D.E., Webb K.A. Brealhlessness in patients with severe chronic airflow limitation: physiologic correlates. Chest 1992; 102: 824–831.

128. Jones N.L., Jones G., Edwards R.H.T. Exercise tolerance in chronic airway obstruction. Clin. Sci. 1966; 31: 39–50.

129. Bauerle O., Younes M. Role of ventilatory response to exercise in determining exercise capacity in COPD. J. Appl. Physiol. 1995; 79: 1870–1877.

130. Maltais F., LeBlanc P., Simard С. et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1996; 154: 442–447.

131. Casaburi R., Patessio A., loli F. et al. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am. Rev. Respir. Dis. 1991; 143: 9–18.

132. Reardon J., Awad E., Normandin E. et al. Effects of a comprehensive outpatient pulmonary rehabilitation on dyspnea. Chest 1994; 105: 1046–1052.

133. O'Donnell D.E., McGuire M., Samis L. et al. The impact of exercise reconditioning on breathlessness in severe chronic airflow limitation. Am. J. Respir. Crit. Care Med 1995; 152: 2005–2013.

134. Swinburn С.R., Wakefield J.M., Jones P.W. Relationship between ventilation and breathlessness during exercise in chronic obstructive airway disease is not altered by prevention of hypoxemia. Clin. Sci. 1984; 67: 146–149.

135. Harris&Eze A.O., Guruswamy S., Clemens E. et al. Oxygen improves maximal exercise performance of patients with interstitial lung disease breathing air and oxygen. Am. Rev. Respir. Dis. 1982; 126: 1105–1012.

136. Stein D.A., Bradley B.L., Miller W. Mechanisms of oxygen effects on exercise in patients with chronic obstructive pulmonary disease. Chest 1982; 81: 6–10.

137. Bradley B.L., Garner A.E., Billiu D. et al. Oxygen assisted exercise in chronic obstructive lung disease: the effect on exercise capacity and arterial blood gas tensions. Am. Rev. Respir. Dis. 1978; 118: 239–243.

138. Bye P.T.P., Esau S.A., Levy R.O. et al. Ventilatory muscle function during exercise in air and oxygen in patients with chronic air flow limitation. Am. Rev. Respir. Dis. 1985; 132: 236–240.

139. Dean N.C, Brown J.K., Himeiman R.B. et al. Oxygen may improve dyspnea and endurance in patients with chronic obstructive pulmonary disease and only mild hypoxemia. Am. Rev. Respir. Dis. 1992; 148: 941–945.

140. Lane R., Crockcroft A., Adams L. et al. Arterial oxygen saturation and breathlessness in patients with chronic obstructive airway disease, Clin. Sci. 1987; 76: 693–698.

141. Ward S.A., Whipp B.J. Effects of peripheral and central chemoreflcx activation on the isopneic rating of breathing in exercise in humans. J. Physiol. 1989; 411: 27–43.

142. Woodcock A.A., Gross E.R., Geddes D.M. Oxygen relieves breathlessness in 'pink puffers.' Lancet 1981; 1: 907–909.

143. Swinburn С.R., Mould H., Stone T.N. et al. Symptomatic benefit of supplemental oxygen in hypoxemic patients with chronic lung disease. Am. Rev. Respir. Dis. 1991; 143: 913–918.

144. Schwartzstein R.M., Lahive K., Pope A. et al. Cold facial stimulation reduces breathlessness induced in normal subjects. Am. Rev. Respir. Dis. 1987; 136: 58–61.

145. Liss H.P., Grant B.J.B. The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1988; 137: 126–133.

146. Booth S., Kelly M.J., Cox N.O. et al. Does oxygen help dyspnea in patients with cancer? Am. J. Respir. Crit. Care Med 1996; 153: 1515–1518.

147. Couser J.I., Make B.J. Transtracheal oxygen decreases inspired minute ventilation. Am. Rev. Respir. Dis. 1989; 139: 627–631.

148. Dewan N.A., Bell С.W. Effect of low flow and high flow oxygen delivery on exercise tolerance and sensation of dyspnea: a study comparing transtracheal catheter and nasal prongs. Chest 1994; 105: 1061–1065.

149. Light R.W., Muro J.R., Sato R.I. et al. Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1989; 139: 126–133.

150. Bellofiore S., DiMaria G.U., Priviteria S., et al. Endogenous opioids modulate the increase in ventilatory output and dyspnea during severe acute bronchoconstriction. Am. Rev. Respir. Dis. 1990; 142: 812–816.

151. Johnson M.A., Woodcock A.A., Geddes D.M. Dihydrocodeine for breathlessness in pink puffers. Br. Med. J. 1983; 286: 675–677.

152. Woodcock A. A., Gross E.R., Geddes D.M. Drug treatment of breathlessness: contrasting effects of diazepam and promethezine in pink puffers. Br. Med. J. 1981; 283: 343–346.

153. Rice K.L., Kroncnberg R.S., Hidemark L.L. et al. Effects of chronic administration of codeine and promethazine on breathlessness and exercise tolerance in patients with chronic airflow limitation. Br. J. Dis. Chest. 1987; 81: 287–292.

154. Leung R., Hill P., Burdon J. Effect of inhaled morphine on the development of breathlessness during exercise in patients with chronic lung disease. Thorax 1996; 51: 596–600.

155. Man G.C.W., Hsu K., Sproule B.J. Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest 1986; 90: 832–836.

156. Mitchell H. P., Murphy K., Minty K. et al. Diazepam in the treatment of dyspnoea in the 'pink puffer' syndrome. Q. J. Med. 1980; 49: 9–20.

157. Singh N.P., Despars J.A., Fischer C.E. et al. Effect of buspirone on exertional dyspnea in chronic airflow obstruction. Chest 1990; 98: 325.

158. Widdicombc J.G. Nervous receptors in the respiratory tract and lung. In: Hornbein T. D., ed. Lung Biology in Health and Disease, Vol. 1: Regulation of Breathing, 17 th ed. Marcel Dekker, New York. 1981. 429–472.

159. Kimoff R.J., Cheong T.T., Cosio M.G. et al. Pulmonary denervation: effects on dyspnea and ventilatory pattern during exercise. Am. Rev. Respir. Dis. 1990; 142: 1034–1040.

160. Winning A.J., Hamilton R.D., Guz A. Ventilation and breathlessness on maximal exercise in patients with interstitial lung disease after local anesthetic aerosol inhalation, din. Sci. 1988; 74: 275–281.

161. Winning A.J., Hamilton R.D., Shea S.A. et al. The effect of airway anesthesia on the control of breathing and the sensation of breathlessness in man. Clin. Sci. 1985; 68: 215–225.

162. Tallaride G., Baldoni F. Cardio respiratory reflex from muscles during dynamic and static exercise in the dog. Appl. Physiol. 1985; 58: 844–850.

163. Clark A.L., Piepoli M., Coats A.J. Skeletal muscle and the control of ventilation on exercise: evidence for metabolic receptors. Eur. J. Clin. Invest. 1995; 25: 299–305.

164. Clark A., Volterrani M., Swan J.W. et al. Leg blood flow, metabolism and exercise capacity in chronic stable heart failure. Int. J. Cardiol. 1996; 55: 127–135.

165. Manning H.L., Basner R.С., Ringler J. et al. Effect of chest wall vibration on breathlessness in normal subjects. J. Appl. Physiol. 1991; 71: 175–181.

166. Cristiano L.M., Schwartzstein R. Effect of chest wall vibration on dyspnea during hypercapnia and exercise in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1997; 155: 1552–1559.

167. Burns S.M. Understanding, applying and evaluating pressure modes of ventilation. AACN Clinical Issues 1996; 7: 495–506.

168. MacIntyre N.R. Respiratory function during pressure support ventilation. Chest 1986; 89: 677–683.

169. MacIntyre N.R. Effects of initial flow rates and breath termination criteria on pressure support ventilation. Chest 1991; 99: 134–138.

170. Knebel A.R., Janson&Bjerklie S.L., Malley J.D. et al. Comparison of breathing comfort during weaning with two ventilatory modes. Am. J. Respir. Crit. Care Med. 1994; 14: 14–18.

171. Kollef M.H., Johnson R.С. Transtracheal gas administration and the perception of dyspnea. Respir. Care 1990; 35: 791–799.

172. Stark R.D., O'Neill P.A., Russell N.J.W. et al. Effects of small particle aerosols of local anaesthetic on dyspnoea in patients with respiratory disease. Clin. Sci. 1985; 69: 29–36.

173. Massod A.R., Reed J.W., Thomas S.H. Lack of effect of inhaled morphine on exercise induced breathlessness in chronic obstructive pulmonary disease. Thorax 1995; 50: 629–634.

174. Farncombe M., Chater S., Gillin A. Clinical application of nebulized opioids for treatment of dyspnea in patients with malignant disease. Supp. Care Cancer 1994; 2: 184–187.

175. Farncombe M., Chater S., Gillin A. The use of nebulized opioids for breathlessness: a chart review. Palliat. Med. 1994; 8: 306–312.

176. Howe J.L. Nebulized morphine for hospice patients. Am. J. Hops. Pallat. Care 1995; 12: 6.

177. Farncombe M., Charter S. Case studies outlining use of nebulized morphine for patients with end stage chronic lung and cardiac disease. J. Pain Symptom Management 1993; 8: 221–225.

178. Pang W.S. Dyspnea in advanced malignacies: a palliative approach. Ann. Acad. Med. 1994; 23: 183–185.

179. Simon P.M., Basner R.С., Weinberger S.E. et al. Oral mucosal stimulation modulates intensity of breathlessness induced in normal subjects. Am. Rev. Respir. Dis. 1991; 144: 419–422.

180. O'Donnell D.E., Bertley J.C., Chau L.L. et al. Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am. J. Respir. Crit. Care Med. 1997; 155: 109–115.

181. Fitzgerald M.X., Keelan P.I., Cugell D.W. Long term results of surgery for bullous emphysema. J. Thorac. Cardiovasc. Surg. 1974; 08: 566–587.

182. Jones N.L., Rebuck A.S. Tidal volume during exercise in patients with diffuse fibrosing alveolitis. Bull. Eur. Physiopathol. Respir. 1979; 15: 321–327.

183. Casaburi R., Porzasz J., Buens M.R. et al. Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1997; 155: 1541–1551.

184. Campbell E.J.M., Friend J. Action of breathing exercises in pulmonary emphysema. Lancet 1955. 325–329.

185. Willeput R., Vaclaionelez J.P., Lendier D. et al. Thoracoabdominal motion during chest physiotherapy in patients affected by chronic obstructive lung disease. Respiration 1983; 44: 204–214.

186. O'Donnell D.E., Webb K.A., Bertley J. et al. Mechanisms of relief of exertional brcalhlessness following unilateral bullectomy and lung volume reduction surgery in emphysema. Chest 1996; 10: 18–27.

187. Martinez F.J., Montes de Oca M., Whyte R.I. et al. Lung volume reduction improves dyspnea, dynamic hyperinflation and respiratory muscle function. Am. J. Respir. Crit. Care Med. 1997; 155: 1984–1990.

188. Sciurba F., Rogers R., Keenan R. et al. Improvement in pulmonary function and elastic recoil after lung reduction surgery for diffuse emphysema. J. Thorac. Cardiovasc. Surg. 1996; 111: 317–322.

189. Gelb A., Zamel N., McKenna R. et al. Mechanism of shortterm improvement in lung function after emphysema resection. Am. J. Respir. Crii. Care Med. 1996; 154: 945–951.

190. Lougheed M.D., Webb K.A., O'Donnell D.E. Breathlessness during induced lung hyperinflation in asthma: the role of the in spiratory threshold load. Am. J. Respir. Crit. Care Med. 1995; 152: 911–920.

191. Petrof B.J., Legare M., Goldberg P. et al. Continuous positive airway pressure reduces the work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive lung disease. Am. Rev. Respir. Dis. 1990; 141: 281–289.

192. O'Donnell D.E., Sanii R., Giesbrecht G. et al. Effect of continuous positive airway pressure on respiratory sensation in patients with chronic obstructive pulmonary disease during submaxi mal exercise. Am. Rev. Respir. Dis. 1988; 138: 1185–1191.

193. O'Donnell D.E., Sanii R., Younes M. Improvement in exercise endurance in patients with chronic airflow limitation using continuous positive airway pressure. Am. Rev. Respir. Dis. 1988; 38: 1510–1514.

194. Petrof B.J., Calderini E., Gottfried S.B. Effect of CPAP on respiratory effort and dyspnea during exercise in severe COPD. J. Appl. Physiol. 1990; 69: 178–188.

195. Burrows В., Niden A.H., Barclay W.R. et al. Chronic obstructive lung disease: relationship to clinical and physiologic findings to the severity of airway obstruction. Am. Rev. Respir. Dis. 1965; 91: 665–678.

196. Fletcher С.М. Discussion. In Bronchitis: An International Symposium. Charles С.Thomas, Assen, Netherlands. 1961. 212.

197. O'Donnell D.E., Webb K.A. Exertional breathlessness in patients with chronic airflow limitation: the role of lung hyperinflation. Am. Rev. Respir. Dis. 1993; 148: 1351–1357.

198. O'Donnell D.E., Bertley J.С., Chau L.L. et al. Qualitative aspects of excrlional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am. J. Respir. Crit. Care Med. 1997; 155: 109–115.

199. Chrystyn H., Mulley B.A., Peake M.D. Dose response relation to oral theophylline in severe chronic obstructive airways disease. Br. Med. J. 1988; 297: 1506–1510.

200. Macklem P.T. Symptoms and signs of respiratory muscle dysfunction. In: Roussos С., ed. Thorax, Part C. 1995; 85: 1751–1761.

201. Braun N.M. Respiratory muscle dysfunction. Heart Lung 1984; 13: 327–332.

202. Campbell E.J., Hughes R.L., Sahagal V. Alterations in intercostal muscle morphology and biochemistry in patients with obstructive lung disease. Am. Rev. Respir. Dis. 1980; 122: 679–686.

203. Roussos C., Macklem P.T. The respiratory muscles. N. Engl. J. Med. 1982; 307: 786 — 797.

204. Arora N.S., Rochester D.F. Effect of body weight and muscularity on human diaphragm muscle mass, thickness, and area. J. Physiol. 1982; 52: 64–70.

205. Thurlbeck W.M. Diaphragm and body weight in emphysema. Thorax 1978; 33: 483–487.

206. Arora N.S., Rochester D.F. Effect of chronic airflow limitation on sternocleidomastoid muscle thickness. Chest 85 (suppl.): 1984. 585–595.

207. Efthimiou J., Fleming J., Gomes С. et al. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1988. 137: 1075–1082.

208. Wilson D.O., Rogers R.M., Wright E.С. et al. Body weight in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1989; 139: 1435–1438.

209. Annemie M.W., Schols J., Soeters P.B. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1995; 152: 1268–1274.

210. Driver A.G., MacAuley M., Smith J.L. Nutritional assess ment of patients with chronic obstructive pulmonary disease and acute respiratory failure. Chest 1982; 82: 568–571.

211. Arora N.S., Rochester D.F. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am. Rev. Respir. Dis. 1982; 126: 5–8.

212. Hunter A., Carey M., Larsh H. The nutritional status of patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1981; 124: 376–381.

213. Goldstein S.A., Thomashow B., Askanazi J. Functional changes during nutritional repletion in patients with lung disease. Clin. Chest Med. 1986; 7: 141–149.

214. Goldstein S.A., Thomashow B.M., Kvetan V. et al. Nitrogen and energy relationships in malnourished patients with emphysema. Am. Rev. Respir. Dis. 1988; 138: 636–644.

215. Whittaker S., Ryan С.F., Buckely P.A. et al. The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic obstructive pulmonary disease patients. Am. Rev. Respir. Dis. 1990; 142: 283–288,

216. Rogers R.M., Donahoe M., Costantino J. Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1992; 146: 1511–1517.

217. Sridhar M.K., Galloway A., Lean M.E.J. et al. An out patient nutritional supplementation programme in COPD patients. Eur. Respir. J. 1994; 7: 720–724,

218. Lewis M.I., Belman M.J., Door&Uyemura L. Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1987; 135: 1062–1068.

219. Otte K.E., Ahlburg P., D'Amore F. et al. Nutritional repletion in malnourished patients with emphysema, journal of Parental Enteral Nutrition 1989; 13: 152–156.

220. Smith L., Cook D., Guyatt G. et al. Respiratory muscle training in chronic airflow limitation; a meta analysis. Am. Rev. Respir. Dis. 1992; 145: 533–539.

221. Harver A., Mahler D.A., Daubenspeck J.A. Targeted inspiratory muscle training improves respiratory muscle function and reduces dyspnea in chronic obstructive pulmonary disease. Ann. Inter. Med. 1989; 111: 117–124.

222. Kim M., Larson J., Covey M. et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease. Nurs. Res. 1993; 42: 356–362.

223. O'Neil S., McCarthy D.S. Postural relief of dyspnea in severe chronic airflow limitation; relationship to respiratory muscle strength. Thorax 1983; 38: 585–600.

224. Barach A.L., Beck G.J. The ventilatory effects of the headdown position in pulmonary emphysema. Am. J. Med. 1954; 16: 55–60.

225. Barach A.L. Chronic obstructive lung disease: postural relief of dyspnea. Arch. Phys. Med. Rehabil. 1974; 55: 494–503.

226. Sharp J.Т., Drutz W.S., Moisan T. et al. Postural relief of dyspnea in severe chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1980; 122: 201–211.

227. Gigliotti F., Scano G., Goti P. et al. Four week negative pressure ventilation improves respiratory function in severe hypercapnic COPD patients. Chest 1994; 105: 87–94.

228. Celli В., Rassulo В., Corral R. Ventilatory muscle dysfunction in patients with bilateral idiopathic diaphragmatic paralysis: reversal by intermittent external negative pressure ventilation. Am. Rev. Respir. Dis. 1987; 136: 1276–1278.

229. Shapiro S.H., Macklem P.T., Gray&Donald K. et al. A randomized clinical trial of negative pressure ventilation in severe chronic obstructive pulmonary disease: design and methods. J. Clin. Epidemiol. 1991; 44: 483–496.

230. Renston J.P., Supinski G.S., DiMarco A.F. Respiratory muscle rest using nasal BiPAP ventilation in patients with stable severe COPD. Chest 1994; 105: 1053–1060.

231. Maltais F., Reissmann H., Gottfried S.B. Pressure support reduces inspiratory effort and dyspnea during exercise in chronic air now obstruction. Am. J. Respir. Crit. Care Med. 1995; 151: 1027–1033.

232. Dolmage T.E., Goldstein R.S. Proportional assist ventilation and exercise tolerance in subjects with COPD. Chest 1997; 111: 948–954.

233. Petrof B.J., Calderini E., Gottfried S.B. Effect of CPAP on respiratory effort and dyspnea during exercise in severe COPD. J. Appl. Physiol. 1990; 69: 178–188.

234. Dejkuijzen P.N.R., Decramer M. Steroid induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur. Respir. J. 1992; 5: 997–1003.

235. Khalеeli A.A., Edwards R.H.T., Gohil K. et al. Corticosteroid myopathy: a clinical and pathological study. Clin. Endocrinol. 1983; 18: 155–166.

236. Bowyer S.L., LaMothe M. P., Hollister J.R. Steroid myopathy: incidence and detection in a population with asthma. J. Allergy Clin. Immunol. 1985; 76: 234–242.

237. Janssens S., Decramer M. Corticosteroid induced myopathy and the respiratory muscles, report of two cases. Chest 1989; 95: 1160–1162.

238. Odedra B.R., Bates P.С., Milward D.J. Time course of the effect of catabolic doses of corticosteroid on protein turnover in rat skeletal muscle and liver. Biochem. J. 1983; 214: 617–627.

239. Ferguson G.Т., Irvin С.G., Cherniak R.M. Effect of corticosteroids on diaphragm function and biochemistry in the rabbit. Aw. Rev. Respir. Dis. 1990; 141: 156–163.

240. Wang Y., Zintel T., Vasquez A. et al. Corlicosteroid therapy and respiratory muscle function in humans. Am. Rev. Respir. Dis. 1991; 144: 108–112.

241. Picado C., Fiz J.A., Montserrat J.M. et al. Respiratory and skeletal muscle function in steroid dependent bronchial asthma. Am. Rev. Respir. Dis. 1990; 141: 14–20.

242. Perez Т., Becquart L.A., Stach B. et al. Inspiratory muscle strength and endurance in steroid dependent asthma. Am. Rev. Respir. Dis. 1996; 153: 610–615.

243. Decramer M., Lacquet L.M., Fagard R. et al. Corticosteroids contribute to muscle weakness in chronic airflow obstruction. Am. Rev. Respir. Dis. 1994; 150: 11–16.

244. Kohlman&Carrieri V., Gromely J. Coping strategies. In: Mahler D.A., ed. Dyspnea. Marcel Dekker, New York. 1998. 287–320.

245. Smoller J.W., Pollack M.H., Otto M.W. et al. State of the art: panic anxiety, dyspnea and respiratory disease. Am. J. Respir. Crit. Care Med. 1996; 154: 6–17.

246. Devine E.С. Meta analysis of the effects of psychoeducational care in adults with asthma. Res. Nurs. Health 1996; 19: 367–376.

247. Sassi&Dabron D.E., Eakin E.G., Ries A. et al. Treatment of COPD in dyspnea: a controlled clinical trial of dyspnea management strategies. Chest 1995; 107: 724–729.

248. Thornby M.A., Haas F., Axen K. Effect of distractive auditory stimuli on exercise tolerance in patients with COPD. Chest 1995; 107: 1213–1217.

249. Renfroe K.L. Effect of progressive relaxation on dyspnea and state anxiety in patients with chronic obstructive pulmonary disease. Heart Lung 1988; 17: 408–413.

250. Gift A.G., Moore T., Soeken K. Relaxation to reduce dyspnea and anxiety in COPD patients. Nurs. Res. 1992; 41: 242–246.

251. Turk D.C, Rudy Т.Е. Neglected topics in the treatment of chronic pain patients: relapse, non compliance, and adherence enhancement. Pain 1991; 44: 5–28.

252. Cramphian Asthma Study of Integrate Care (GRASSIC). Effectiveness of routine self monitoring of peak flow in patients with asthma. Br. Med. J. 1994; 308: 564–567.

253. Carrieri&Kohlman V., Douglas M.K., Gromley J.M. et al. Desensitization and guided mastery: treatment approach es for the management of dyspnea. Heart Lung 1993; 22: 226–234.

254. Haas F., Salazar&Schicchi J., Axen K. Desensitization to dyspnea in chronic obstructive pulmonary disease. In: Casaburi R., Petty T., eds. Principles and Practice of Pulmonary Rehabilitation. W.B. Saunders, Philadephia 1993. 241–251.

255. Schwartzstein R., Thiebault G.E. Shortness of breath. In: Braunwald E., Goldman L., eds. Primary Care Cardiology. W.B.Saunders, Philadelphia. (In press).