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Dyspnoea is the clinician’s term for breathlessness or ‘shortness of breath’–we all experience some form of dyspnoea (e.g. when engaged in heavy exercise), but we pay little attention to it as it does not bother us much and we can make it go away quickly. The agreed definition of dyspnoea is an unpleasant feeling of breathing discomfort which can comprise several distinct sensations in varying amount. The overall intensity and unpleasantness is influenced by psychological, environmental and social factors. The distinct components may include a sense of ‘air hunger’ (‘unsatisfied inspiration’ or an unpleasant urge to breathe), sense of breathing effort and a sense of chest tightness.
Clinical dyspnoea is the cardinal symptom of cardiopulmonary disease but is also a feature of other conditions, accounting for ≈50% of the symptom burden among hospitalized patients. Half of patients with advanced cancer experience intense dyspnoea and patients with psychiatric morbidity (e.g. panicdisorder) suffer ‘exaggerated’ dyspnoea. The symptom can be unyielding, even when the underlying disease is optimally managed, thus degrading the patient’s quality of life, undermining their will to live and making them frightened to engage in even basic levels of day to day activity. Despite its prevalence andclinical impact, we still do not have effective and safe options to relieve dyspnoea when the underlying disease can’t be cured.
Since the late 1980s, progress has been made in (i) understanding the neuro-physiological mechanisms of dyspnoea, (ii) improving reliability, specificity and sensitivity of dyspnoea measurement tools and (iii) developing and validating experimental models of clinical dyspnoea that can be used to systematically induce specific forms of dyspnoea in healthy volunteers. Given this progress we are better equipped to design hypothesis-driven experiments in healthy volunteers with the aim of identifying new pharmacological targets for relief of intractable dyspnoea, paving the way to translational phase II and III clinical trials.
Dr. Najib Rahman, Director -Oxford Respiratory Trials Unit, Churchill Hospital
Dr. Paul Leeson, Head of the CCRF, Oxford University
Helen Jackson, Nurse Consultant in Heart Failure, John Radcliffe Hospital
Mr. Alex Green, Neurosurgeon, Clinical Neuroscience, John Radcliffe Hospital
Mr. Puneet Plaha, Neurosurgeon, Clinical Neuroscience, John Radcliffe Hospital
Dr. Tim James, Head of Clinical Biochemistry, John Radcliffe Hospital
Dr. Andre Van Wyck, Stroke Neurologist, Royal Berkshire Hospital, Reading
Dr. John Park, Respiratory Medicine, Royal Berkshire Hospital, Reading