Download PDF
Semin Speech Lang 2011; 32(1): 005-020
DOI: 10.1055/s-0031-1271971
© Thieme Medical Publishers

Nature and Evaluation of Dyspnea in Speaking and Swallowing

Jeannette D. Hoit1 , Robert W. Lansing2 , Kristen Dean3 , Molly Yarkosky4 , Amy Lederle5
  • 1Departments of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona
  • 2Department of Psychology, University of Arizona, Tucson, Arizona
  • 3Department of University of California San Diego Medical Center, Tri-City Medical Center, San Diego, California
  • 4Department of HealthSouth Rehabilitation Institute of Tucson
  • 5Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona
Further Information

Publication History

Publication Date:
13 April 2011 (online)

    Permissions and Reprints

ABSTRACT

Dyspnea (breathing discomfort) is a serious and pervasive problem that can have a profound impact on quality of life. It can manifest in different qualities (air hunger, physical exertion, chest/lung tightness, and mental concentration, among others) and intensities (barely noticeable to intolerable) and can influence a person's emotional state (causing anxiety, fear, and frustration, among others). Dyspnea can make it difficult to perform daily activities, including speaking and swallowing. In fact, dyspnea can cause people to change the way they speak and swallow in their attempts to relieve their breathing discomfort; in extreme cases, it can even cause people to avoid speaking and eating/drinking. This article provides an overview of dyspnea in general, describes the effects of dyspnea on speaking and swallowing, includes data from two survey studies of speaking-related dyspnea and swallowing-related dyspnea, and outlines suggested protocols for evaluating dyspnea during speaking and swallowing.

KEYWORDS

Breathing discomfort - air hunger - exertional dyspnea - respiratory disease

REFERENCES

  • 1 Hammond E C. Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women.  Am J Public Health Nations Health. 1964;  54 11-23
    PubMedGoogle Scholar
  • 2 Kroenke K, Arrington M E, Mangelsdorff A D. The prevalence of symptoms in medical outpatients and the adequacy of therapy.  Arch Intern Med. 1990;  150 (8) 1685-1689
    CrossrefPubMedGoogle Scholar
  • 3 Desbiens N A, Mueller-Rizner N, Connors Jr AF, Wenger N S, Lynn J. SUPPORT Investigators . Study to Understand Prognoses and Preferences for Outcome and Risks of Treatment. The symptom burden of seriously ill hospitalized patients.  J Pain Symptom Manage. 1999;  17 (4) 248-255
    CrossrefPubMedGoogle Scholar
  • 4 Banzett R B, Lansing R W, Brown R et al. “Air hunger” from increased PCO2 persists after complete neuromuscular block in humans.  Respir Physiol. 1990;  81 (1) 1-17
    CrossrefPubMedGoogle Scholar
  • 5 Hill L, Flack M. The effect of excess of carbon dioxide and of want of oxygen upon the respiration and the circulation.  J Physiol. 1908;  37 (2) 77-111
    PubMedGoogle Scholar
  • 6 Smoller J W, Pollack M H, Otto M W, Rosenbaum J F, Kradin R L. Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations.  Am J Respir Crit Care Med. 1996;  154 (1) 6-17
    PubMedGoogle Scholar
  • 7 American Thoracic Society . Dyspnea. Mechanisms, assessment, and management: a consensus statement.  Am J Respir Crit Care Med. 1999;  159 (1) 321-340
    PubMedGoogle Scholar
  • 8 Banzett R B, Moosavi S. Dyspnea and pain: similarities and contrasts between two very unpleasant sensations.  Am Pain Soc Bull. 2001;  11 (1) 6-8
    PubMedGoogle Scholar
  • 9 Banzett R B, Mulnier H E, Murphy K, Rosen S D, Wise R J, Adams L. Breathlessness in humans activates insular cortex.  Neuroreport. 2000;  11 (10) 2117-2120
    CrossrefPubMedGoogle Scholar
  • 10 Evans K C, Banzett R B, Adams L, McKay L, Frackowiak R S, Corfield D R. BOLD fMRI identifies limbic, paralimbic, and cerebellar activation during air hunger.  J Neurophysiol. 2002;  88 (3) 1500-1511
    PubMedGoogle Scholar
  • 11 Peiffer C, Poline J B, Thivard L, Aubier M, Samson Y. Neural substrates for the perception of acutely induced dyspnea.  Am J Respir Crit Care Med. 2001;  163 (4) 951-957
    PubMedGoogle Scholar
  • 12 Banzett R B, Gracely R H, Lansing R W. When it's hard to breathe, maybe pain doesn't matter. Focus on “Dyspnea as a noxious sensation: inspiratory threshold loading may trigger diffuse noxious inhibitory controls in humans”.  J Neurophysiol. 2007;  97 (2) 959-960
    PubMedGoogle Scholar
  • 13 Nishino T, Shimoyama N, Ide T, Isono S. Experimental pain augments experimental dyspnea, but not vice versa in human volunteers.  Anesthesiology. 1999;  91 (6) 1633-1638
    CrossrefPubMedGoogle Scholar
  • 14 Melzack R, Torgerson W S. On the language of pain.  Anesthesiology. 1971;  34 (1) 50-59
    CrossrefPubMedGoogle Scholar
  • 15 Elliott M W, Adams L, Cockcroft A, MacRae K D, Murphy K, Guz A. The language of breathlessness. Use of verbal descriptors by patients with cardiopulmonary disease.  Am Rev Respir Dis. 1991;  144 (4) 826-832
    CrossrefPubMedGoogle Scholar
  • 16 O'Driscoll M, Corner J, Bailey C. The experience of breathlessness in lung cancer.  Eur J Cancer Care (Engl). 1999;  8 (1) 37-43
    CrossrefPubMedGoogle Scholar
  • 17 Lansing R W, Gracely R H, Banzett R B. The multiple dimensions of dyspnea: review and hypotheses.  Respir Physiol Neurobiol. 2009;  167 (1) 53-60
    CrossrefPubMedGoogle Scholar
  • 18 Schwartzstein R M, Christiano L M. Qualities of respiratory sensation. In:, Adams L, Guz A, eds. Respiratory Sensation. New York, NY: Marcel Dekker; 1996: 125-154
    Google Scholar
  • 19 Lansing R W, Im B S, Thwing J I, Legedza A T, Banzett R B. The perception of respiratory work and effort can be independent of the perception of air hunger.  Am J Respir Crit Care Med. 2000;  162 (5) 1690-1696
    CrossrefPubMedGoogle Scholar
  • 20 Moy M L, Woodrow J W, Sparrow D, Israel E, Schwartzstein R M. Quality of dyspnea in bronchoconstriction differs from external resistive loads.  Am J Respir Crit Care Med. 2000;  162 (2 Pt 1) 451-455
    PubMedGoogle Scholar
  • 21 Simon P M, Schwartzstein R M, Weiss J W et al. Distinguishable sensations of breathlessness induced in normal volunteers.  Am Rev Respir Dis. 1989;  140 (4) 1021-1027
    CrossrefPubMedGoogle Scholar
  • 22 Simon P M, Schwartzstein R M, Weiss J W, Fencl V, Teghtsoonian M, Weinberger S E. Distinguishable types of dyspnea in patients with shortness of breath.  Am Rev Respir Dis. 1990;  142 (5) 1009-1014
    PubMedGoogle Scholar
  • 23 Wright G W, Branscomb B V. The origin of the sensations of dyspnea.  Trans Am Clin Climatol Assoc. 1954;  66 116-125
    PubMedGoogle Scholar
  • 24 Banzett R B, Lansing R W, Reid M B, Adams L, Brown R. “Air hunger” arising from increased PCO2 in mechanically ventilated quadriplegics.  Respir Physiol. 1989;  76 (1) 53-67
    CrossrefPubMedGoogle Scholar
  • 25 Banzett R B, Lansing R W. Respiratory sensations arising from chemoreceptors and pulmonary receptors: air hunger and lung volume. In:, Adams L, Guz A, eds. Respiratory Sensation. New York, NY: Marcel Dekker; 1996: 155-180
    Google Scholar
  • 26 O'Donnell D E, Banzett R B, Carrieri-Kohlman V et al. Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable.  Proc Am Thorac Soc. 2007;  4 (2) 145-168
    CrossrefPubMedGoogle Scholar
  • 27 Harty H R, Mummery C J, Adams L et al. Ventilatory relief of the sensation of the urge to breathe in humans: are pulmonary receptors important?.  J Physiol. 1996;  490 (Pt 3) 805-815
    PubMedGoogle Scholar
  • 28 Manning H L, Shea S A, Schwartzstein R M, Lansing R W, Brown R, Banzett R B. Reduced tidal volume increases “air hunger” at fixed PCO2 in ventilated quadriplegics.  Respir Physiol. 1992;  90 (1) 19-30
    CrossrefPubMedGoogle Scholar
  • 29 Opie L H, Smith A C, Spalding J MK. Conscious appreciation of the effects produced by independent changes of ventilation volume and of end-tidal pCO2 in paralysed patients.  J Physiol. 1959;  149 494-499
    PubMedGoogle Scholar
  • 30 Remmers J E, Brooks III JE, Tenney S M. Effect of controlled ventilation on the tolerable limit of hypercapnia.  Respir Physiol. 1968;  4 (1) 78-90
    CrossrefPubMedGoogle Scholar
  • 31 Vovk A, Binks A P. Raising end-expiratory volume relieves air hunger in mechanically ventilated healthy adults.  J Appl Physiol. 2007;  103 (3) 779-786
    CrossrefPubMedGoogle Scholar
  • 32 Chonan T, Mulholland M B, Leitner J, Altose M D, Cherniack N S. Sensation of dyspnea during hypercapnia, exercise, and voluntary hyperventilation.  J Appl Physiol. 1990;  68 (5) 2100-2106
    PubMedGoogle Scholar
  • 33 Gandevia S C, Killian K J, Campbell E J. The effect of respiratory muscle fatigue on respiratory sensations.  Clin Sci (Lond). 1981;  60 (4) 463-466
    CrossrefPubMedGoogle Scholar
  • 34 Killian K J, Gandevia S C, Summers E, Campbell E J. Effect of increased lung volume on perception of breathlessness, effort, and tension.  J Appl Physiol. 1984;  57 (3) 686-691
    PubMedGoogle Scholar
  • 35 Moosavi S H, Topulos G P, Hafer A et al. Acute partial paralysis alters perceptions of air hunger, work and effort at constant PCO2 and VE .  Respir Physiol. 2000;  122 (1) 45-60
    CrossrefPubMedGoogle Scholar
  • 36 Campbell E JM, Gandevia S C, Killian K J, Mahutte C K, Rigg J R. Changes in the perception of inspiratory resistive loads during partial curarization.  J Physiol. 1980;  309 93-100
    PubMedGoogle Scholar
  • 37 Price D D, Harkins S W. The affective-motivational dimension of pain: a two stage model.  Am Pain Soc J. 1992;  1 229-239
    PubMedGoogle Scholar
  • 38 Banzett R B, Pedersen S H, Schwartzstein R M, Lansing R W. The affective dimension of laboratory dyspnea: air hunger is more unpleasant than work/effort.  Am J Respir Crit Care Med. 2008;  177 (12) 1384-1390
    CrossrefPubMedGoogle Scholar
  • 39 Gift A G. Psychologic and physiologic aspects of acute dyspnea in asthmatics.  Nurs Res. 1991;  40 (4) 196-199
    PubMedGoogle Scholar
  • 40 Janson-Bjerklie S, Ruma S S, Stulbarg M, Carrieri V K. Predictors of dyspnea intensity in asthma.  Nurs Res. 1987;  36 (3) 179-183
    PubMedGoogle Scholar
  • 41 Carrieri-Kohlman V, Donesky-Cuenco D, Park S K, Mackin L, Nguyen H Q, Paul S M. Additional evidence for the affective dimension of dyspnea in patients with COPD.  Res Nurs Health. 2010;  33 (1) 4-19
    PubMedGoogle Scholar
  • 42 von Leupoldt A, Seemann N, Gugleva T, Dahme B. Attentional distraction reduces the affective but not the sensory dimension of perceived dyspnea.  Respir Med. 2007;  101 (4) 839-844
    CrossrefPubMedGoogle Scholar
  • 43 Dorman S, Byrne A, Edwards A. Which measurement scales should we use to measure breathlessness in palliative care? A systematic review.  Palliat Med. 2007;  21 (3) 177-191
    CrossrefPubMedGoogle Scholar
  • 44 Bausewein C, Booth S, Higginson I J. Measurement of dyspnoea in the clinical rather than the research setting.  Curr Opin Support Palliat Care. 2008;  2 (2) 95-99
    CrossrefPubMedGoogle Scholar
  • 45 Gift A G. Validation of a vertical visual analogue scale as a measure of clinical dyspnea.  Rehabil Nurs. 1989;  14 (6) 323-325
    PubMedGoogle Scholar
  • 46 Mador M J, Kufel T J. Reproducibility of visual analog scale measurements of dyspnea in patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1992;  146 (1) 82-87
    PubMedGoogle Scholar
  • 47 Lansing R W, Banzett R B. The use of psychophysical methods in the study of respiratory sensation. In:, Adams L, Guz A, eds. Respiratory Sensation. New York, NY: Marcel Dekker; 1996: 69-100
    Google Scholar
  • 48 Borg G AV. A category scale with ratio properties for intermodal and interindividual comparisons. In:, Geisler H, Petzold P, eds. Psychophysical Judgement and the Process of Perception. Amsterdam, The Netherlands; 1982: 25-34
    Google Scholar
  • 49 Lansing R W, Moosavi S H, Banzett R B. Measurement of dyspnea: word labeled visual analog scale vs. verbal ordinal scale.  Respir Physiol Neurobiol. 2003;  134 (2) 77-83
    CrossrefPubMedGoogle Scholar
  • 50 Jones P W, Baveystock C M, Littlejohns P. Relationships between general health measured with the sickness impact profile and respiratory symptoms, physiological measures, and mood in patients with chronic airflow limitation.  Am Rev Respir Dis. 1989;  140 (6) 1538-1543
    CrossrefPubMedGoogle Scholar
  • 51 Hodgev V, Kostianev S, Marinov B. University of Cincinnati Dyspnea Questionnaire for Evaluation of Dyspnoea during physical and speech activities in patients with chronic obstructive pulmonary disease: a validation analysis.  Clin Physiol Funct Imaging. 2003;  23 (5) 269-274
    CrossrefPubMedGoogle Scholar
  • 52 Guyatt G H, Berman L B, Townsend M, Pugsley S O, Chambers L W. A measure of quality of life for clinical trials in chronic lung disease.  Thorax. 1987;  42 (10) 773-778
    CrossrefPubMedGoogle Scholar
  • 53 Pitta F, Troosters T, Spruit M A, Decramer M, Gosselink R. Activity monitoring for assessment of physical activities in daily life in patients with chronic obstructive pulmonary disease.  Arch Phys Med Rehabil. 2005;  86 (10) 1979-1985
    CrossrefPubMedGoogle Scholar
  • 54 Sanders S H. Automated versus self-monitoring of “up-time” in chronic low-back pain patients: a comparative study.  Pain. 1983;  15 (4) 399-405
    CrossrefPubMedGoogle Scholar
  • 55 Shephard R J. Limits to the measurement of habitual physical activity by questionnaires.  Br J Sports Med. 2003;  37 (3) 197-206 discussion 206
    CrossrefPubMedGoogle Scholar
  • 56 White C S, Humm J H, Armstrong E D, Lundgren N P. Human tolerance to acute exposure to carbon dioxide. Report No. 1: Six per cent carbon dioxide in air and in oxygen.  J Aviat Med. 1952;  23 (5) 439-455
    PubMedGoogle Scholar
  • 57 Otis A B, Clark R G. Ventilatory implications of phonation and phonatory implications for ventilation.  Ann N Y Acad Sci. 1968;  155 122-128
    CrossrefPubMedGoogle Scholar
  • 58 Bunn J C, Mead J. Control of ventilation during speech.  J Appl Physiol. 1971;  31 (6) 870-872
    PubMedGoogle Scholar
  • 59 Phillipson E A, McClean P A, Sullivan C E, Zamel N. Interaction of metabolic and behavioral respiratory control during hypercapnia and speech.  Am Rev Respir Dis. 1978;  117 (5) 903-909
    PubMedGoogle Scholar
  • 60 Doust J H, Patrick J M. The limitation of exercise ventilation during speech.  Respir Physiol. 1981;  46 (2) 137-147
    CrossrefPubMedGoogle Scholar
  • 61 Bailey E F, Hoit J D. Speaking and breathing in high respiratory drive.  J Speech Lang Hear Res. 2002;  45 (1) 89-99
    CrossrefPubMedGoogle Scholar
  • 62 Hoit J D, Lansing R W, Perona K E. Speaking-related dyspnea in healthy adults.  J Speech Lang Hear Res. 2007;  50 (2) 361-374
    CrossrefPubMedGoogle Scholar
  • 63 Loudon R G, Lee L, Holcomb B J. Volumes and breathing patterns during speech in healthy and asthmatic subjects.  J Speech Hear Res. 1988;  31 (2) 219-227
    PubMedGoogle Scholar
  • 64 Lee L, Friesen M, Lambert I R, Loudon R G. Evaluation of dyspnea during physical and speech activities in patients with pulmonary diseases.  Chest. 1998;  113 (3) 625-632
    CrossrefPubMedGoogle Scholar
  • 65 Martin B J, Logemann J A, Shaker R, Dodds W J. Coordination between respiration and swallowing: respiratory phase relationships and temporal integration.  J Appl Physiol. 1994;  76 (2) 714-723
    PubMedGoogle Scholar
  • 66 Nishino T, Yonezawa T, Honda Y. Effects of swallowing on the pattern of continuous respiration in human adults.  Am Rev Respir Dis. 1985;  132 (6) 1219-1222
    PubMedGoogle Scholar
  • 67 Selley W G, Flack F C, Ellis R E, Brooks W A. Respiratory patterns associated with swallowing: Part 1. The normal adult pattern and changes with age.  Age Ageing. 1989;  18 (3) 168-172
    CrossrefPubMedGoogle Scholar
  • 68 Smith J, Wolkove N, Colacone A, Kreisman H. Coordination of eating, drinking and breathing in adults.  Chest. 1989;  96 (3) 578-582
    CrossrefPubMedGoogle Scholar
  • 69 Perlman A L, Ettema S L, Barkmeier J. Respiratory and acoustic signals associated with bolus passage during swallowing.  Dysphagia. 2000;  15 (2) 89-94
    PubMedGoogle Scholar
  • 70 Preiksaitis H G, Mills C A. Coordination of breathing and swallowing: effects of bolus consistency and presentation in normal adults.  J Appl Physiol. 1996;  81 (4) 1707-1714
    PubMedGoogle Scholar
  • 71 Klahn M S, Perlman A L. Temporal and durational patterns associating respiration and swallowing.  Dysphagia. 1999;  14 (3) 131-138
    CrossrefPubMedGoogle Scholar
  • 72 Palmer J B, Hiiemae K M. Eating and breathing: interactions between respiration and feeding on solid food.  Dysphagia. 2003;  18 (3) 169-178
    CrossrefPubMedGoogle Scholar
  • 73 Martin-Harris B, Brodsky M B, Price C C, Michel Y, Walters B. Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows.  J Appl Physiol. 2003;  94 (5) 1735-1743
    CrossrefPubMedGoogle Scholar
  • 74 Martin-Harris B, Brodsky M B, Michel Y, Ford C L, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan.  Arch Otolaryngol Head Neck Surg. 2005;  131 (9) 762-770
    CrossrefPubMedGoogle Scholar
  • 75 Leslie P, Drinnan M J, Ford G A, Wilson J A. Swallow respiratory patterns and aging: presbyphagia or dysphagia?.  J Gerontol A Biol Sci Med Sci. 2005;  60 (3) 391-395
    CrossrefPubMedGoogle Scholar
  • 76 Dozier T S, Brodsky M B, Michel Y, Walters Jr BC, Martin-Harris B. Coordination of swallowing and respiration in normal sequential cup swallows.  Laryngoscope. 2006;  116 (8) 1489-1493
    CrossrefPubMedGoogle Scholar
  • 77 Lederle A, Hoit J D, Barkmeier-Kraemer J M. Effects of sequential drinking tasks on breathing and dyspnea. Paper presented at: American Speech-Language-Hearing Association Convention; November, 2009; New Orleans, LA
    Google Scholar
  • 78 Gross R D, Atwood Jr CW, Ross S B, Olszewski J W, Eichhorn K A. The coordination of breathing and swallowing in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2009;  179 (7) 559-565
    CrossrefPubMedGoogle Scholar
  • 79 Good-Fratturelli M D, Curlee R F, Holle J L. Prevalence and nature of dysphagia in VA patients with COPD referred for videofluoroscopic swallow examination.  J Commun Disord. 2000;  33 (2) 93-110
    CrossrefPubMedGoogle Scholar

Jeannette D HoitPh.D. CCC-SLP 

Professor, Department of Speech, Language, and Hearing Sciences, University of Arizona

P.O. Box 210071, Tucson, Arizona 85721

Email: hoit@email.arizona.edu

      >