Abstract
Patients with chronic dyspnoea may learn to fear situations that cue dyspnoea onset. Such dyspnoea-specific cues may then cause anxiety, and worsen or trigger dyspnoea even before commencement of physical activity. We therefore developed an experimental tool to probe emotional processing of dyspnoea for use with neuroimaging in COPD. The tool consists of a computerised task comprising multiple presentations of dyspnoea-related word cues with subsequent rating of dyspnoea and dyspnoea-anxiety with a visual analogue scale. Following 3 development stages, sensitivity to clinical change was tested in 34 COPD patients undergoing pulmonary rehabilitation. We measured internal consistency, sensitivity to clinical change and convergence with established dyspnoea measures (including Dyspnoea-12). Cronbach’s alpha was 0.90 for dyspnoea and 0.94 for dyspnea-anxiety ratings. Ratings correlated with Dyspnoea-12 (dyspnoea: r=0.51, P=0.002; dyspnea-anxiety: r=0.54, P=0.001). Reductions in dyspnea-anxiety ratings following pulmonary rehabilitation correlated with reductions in Dyspnoea-12 (r=0.51, P=0.002). We conclude that the word-cue task is reliable, and is thus a potentially useful tool for neuroimaging dyspnoea research.
Highlights
The role of cognitive and emotional factors in dyspnoea is supported by a growing body of literature (Hayen et al, 2013), including a consensus statement published by the American College of Chest Physicians (Mahler et al, 2010)
Nine cues were removed for being unclear or not applicable, and 6 cues modified for clarity or relevance
We describe the development of a computerised cue-based task for exploring recall of dyspnoea and dyspnoearelated anxiety in patients with chronic obstructive pulmonary disease (COPD)
Summary
The role of cognitive and emotional factors in dyspnoea is supported by a growing body of literature (Hayen et al, 2013), including a consensus statement published by the American College of Chest Physicians (Mahler et al, 2010). Over time the association between dyspnoea-inducing physical activity and the ringing telephone may induce anxiety even prior to commencement of physical activity Such associations between symptoms and emotions may be studied through presentation of symptom-specific cues. Cues can be images or words related to situations associated with the symptom, and can cause the patient to recall feelings connected with the episodes when the symptom was triggered This approach has been used to elucidate emotional processing and brain mechanisms in a wide range of disorders, including panic disorder (Wittmann et al, 2011), anxiety and phobias (Etkin and Wager, 2007) and pain (Fairhurst et al, 2012; Jackson et al, 2006; Ogino et al, 2007)
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