Respiratory pressure sensation. Relationship to changes in breathing pattern and PCO2 during acute increase in airway resistance in patients with chronic obstructive pulmonary disease.

Abstract

The intensity of sensations experienced during breathing by patients with chronic obstructive pulmonary disease (COPD) might influence their ventilatory response to altered lung mechanics. In 8 patients with COPD (mean FEV1, 1.6 +/- 0.6 L SD) the acuity with which changes in intrathoracic pressure were perceived was studied by a standard psychophysical technique, magnitude production of inspiratory pressure. Subjects voluntarily produced mouth pressures proportional to numbers randomly presented, and the sensory acuity to changes in pressure was assessed from the slope of log-log plots of numbers versus pressures. These slopes were then related to the ventilatory responses of the patients to external resistive loads of 10 cm H2O/L/s, applied during both inspiration and expiration, and methacholine-induced bronchoconstriction, which doubled baseline specific airway resistance. Both modes of increase in airway resistance caused an increase in end-tidal PCO2 in all patients (range, 0.5 to 11 mmHg). The magnitude of CO2 retention correlated significantly with the change in tidal volume during both external loading and bronchoconstriction (r = -0.77, p less than 0.01); decreases in tidal volume were associated with increases in PCO2. The slope for magnitude production of pressure was inversely related to changes in tidal volume during both modes of increases in airway resistance (r = 0.61, p less than 0.01 for both bronchoconstriction and external resistive loads). Patients with the highest exponents for pressure changes (highest slopes) demonstrated the greatest decreases in tidal volume. Consequently, a direct relationship was found between the magnitude of the exponent and the magnitude of CO2 retention during loaded breathing and bronchoconstriction (r = 0.81, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)