Skip to main content
SpringerLink
Log in

Ventilatory Control and Dyspnea

  • Chapter
Chronic Obstructive Pulmonary Disease

Abstract

The progress of ideas in respiratory physiology has often been accelerated by the need for practical solutions. Thus the clinical problems of gas mask design in World War I led Haldane and co-workers to further study the stimulant effects of respiratory gases whilst the hypoxia of high altitude experienced by World War II fighter pilots generated new research about the chemical regulation of human breathing. The subsequent rise in the incidence of and mortality from chronic obstructive pulmonary disease gave a new clinical dimension to these problems. The dangers of high concentrations of oxygen during acute exacerbations of COPD were soon recognized [1] and led Campbell to apply new technologies to first identify the physiologic problem (hypercapnia), then hypothesize a mechanism for its production (reduced hypercapnic ventilatory drive) and finally suggest a practical solution (low flow oxgyen treatment by Venturi mask) [2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Donald, K.W. (1949) Neurological effects of oxygen. Lancet, ii, 1056–7.

    Article  Google Scholar 

  2. Campbell, E.J.M. (1967) The management of acute respiratory failure in chronic bronchitis and emphysema. Am. Rev. Respir. Dis., 96, 626–39.

    PubMed  CAS  Google Scholar 

  3. Howell, J.B.L. and Campbell, E.J.M. (1966) Breathlessness. Blackwell Scientific, Oxford.

    Google Scholar 

  4. Jones, N.L. and Killian, K.J. (1992) Breathlessness: The Campbell Symposium. Boehringer Ingelheim (Canada), Hamilton.

    Google Scholar 

  5. von Euler, C. (1986) Brain stem mechanisms for generation and control of breathing pattern, in Handbook of Physiology (eds N.S. Cherniack and J.G. Widdicombe) Vol. 2, Part II, Section 3, Control of breathing. Am. Physiol. Soc. Bethesda, pp. 1–67.

    Google Scholar 

  6. Long, S. and Duffin, J. (1986) The neuronal determinants of respiratory rhythm. Prog. Neurobiol., 27, 101–82.

    Article  PubMed  CAS  Google Scholar 

  7. Mead, J. (1960) Control of respiratory frequency. J. Appl. Physiol., 15, 325–36.

    Google Scholar 

  8. Otis, A.B. (1954) The work of breathing. Physiol. Rev., 34, 449–58.

    PubMed  CAS  Google Scholar 

  9. Clark, F.J. and von Euler, C. (1972) On the regulation of depth and rate of breathing. J. Physiol. (Lond.), 222, 267–95.

    CAS  Google Scholar 

  10. Berger, A.J., Mitchell, R.A. and Severinghaus, J.W. (1977) Regulation of respiration. N. Engl. J. Med., 297, 92–7.

    Article  PubMed  CAS  Google Scholar 

  11. Derenne, J-Ph., Couture, J., Iscoe, S. et al. (1976) Regulation of breathing in anaesthetized human subjects. J. Appl. Physiol., 40, 804–14.

    Google Scholar 

  12. Shea, S.A., Horner, R.L., Beuchetrit, G. and Guz, A. (1990) The persistence of a respiratory ‘personality’ into Stage IV sleep in man. Respir. Physiol., 80, 33–44.

    Article  PubMed  CAS  Google Scholar 

  13. Issa, F.G. and Remmers, J.E. (1992) Identification of a subsurface area in the ventral medulla sensitive to local changes in PCO2. J. Appl. Physiol., 72, 439–46.

    PubMed  CAS  Google Scholar 

  14. Richter, D.W. (1982) Generation and maintenance of the respiratory rhythm. J. Exp. Biol., 100, 93–107.

    PubMed  CAS  Google Scholar 

  15. Anderson, P. and Sears, T.A. (1964) The role of inhibition in the phasing of spontaneous thalamo-cortical discharge. J. Physiol. (Lond.), 173, 459–80.

    Google Scholar 

  16. Rabette, P.S., Costelve, K.L. and Stocks, J. (1991) Persistence of the Hering-Breur reflex beyond the neonatal period. J. Appl. Physiol., 71, 474–80.

    Google Scholar 

  17. Chan, C.S., Grunstein, R.R., Bye, P.T.P., et al. (1989) Obstructive sleep apnea with severe chronic airflow limitation: comparisons of hypercapnic and eucapnic patients. Am. Rev. Respir. Dis., 140, 1274–8.

    Article  PubMed  CAS  Google Scholar 

  18. Chan, C.S., Bye, P.T.P., Woolcock, A.J. and Sullivan, C.E. (1990) Eucapnia and hypercapnia in patients with chronic airflow limitation. Am. Rev. Respir. Dis., 141, 861–5.

    Article  PubMed  CAS  Google Scholar 

  19. Jalleh, R., Fitzpatrick, M.F., Jan, M.A. et al. (1993) Alcohol and cor pulmonale in chronic bronchitis and emphysema. Br. Med. J., 306, 374.

    Article  CAS  Google Scholar 

  20. Martin, J.G. and De Troyer, A. (1985) The thorax and control of functional residual capacity, in The Thorax (eds. C. Roussos and P.T. Macklem), Marcel Dekker, New York, pp. 899–922.

    Google Scholar 

  21. Ingram, R.H. and Schilder, D.P. (1967) Effect of pursed lips expiration on the pulmonary pressure-flow relationship in obstructive lung disease. Am. Rev. Respir. Dis., 96, 381–7.

    PubMed  Google Scholar 

  22. Biscoe, T.J. and Purves, M.J. (1967) Factors affecting the cat carotid chemoreceptor and cervical sympathetic activity with special reference to passive hind limb movements. J. Physiol. (Lond.), 190, 425–41.

    CAS  Google Scholar 

  23. Biscoe, T.J., Bradley, G.W. and Purves, M.J. (1970) The relation between carotid body chemoreceptor discharge carotid sinus pressure and carotid body venous flow. J. Physiol. (Lond.), 208, 99–120.

    CAS  Google Scholar 

  24. Calverley, P.M.A., Howatson, R., Flenley, D.C. and Lamb, D. (1992) Clinicopathological correlations in cor pulmonate. Thorax, 47, 494–8.

    Article  PubMed  CAS  Google Scholar 

  25. Pallot, D.J. (1987) The mammalian carotid body. Adv. Anat. Embryol. Cell, Biol., 102, 1–90.

    Article  CAS  Google Scholar 

  26. Dejours, P. (1963) Control of respiration by arterial chemoreceptors. Ann. N.Y. Acad. Sci., 109, 682–95.

    Article  PubMed  CAS  Google Scholar 

  27. Pappenheimer, J.R., Fencl, V., Hersey, S.R. and Held, D. (1965) Role of cerebral fluids in control of respiration as studied in un-anesthetized goats. Am. J. Physiol., 208, 436–50.

    PubMed  CAS  Google Scholar 

  28. Bledsoe, S.W. and Hornbein, T.F. (1981) Central chemoreceptors and the regulation of their chemical environment, in Regulation of Breathing (ed. T.F. Hornbein), Marcel Dekker, New York, pp. 347–406.

    Google Scholar 

  29. Davidson, T.L., Sullivan, M.P., Swanson, K.E. and Adams, J.M. (1992) Cl-replacement alters the ventilatory response to central chemoreceptor stimulation. J. Appl. Physiol., 74, 280–5.

    Google Scholar 

  30. Bruce, E.N. and Cherniack, N.S. (1987) Central chemoreceptors. J. Appl. Physiol., 62, 389–402.

    PubMed  CAS  Google Scholar 

  31. Shannon, R. (1986) Reflexes from respiratory muscles and costovertebral joints, in Handbook of Physiology, (eds. N.S. Cherniack and J.G. Widdicombe), Vol. 2, Part II, Section 3, Control of Breathing, Am. Physiol. Soc., Bethesda, pp. 431–448.

    Google Scholar 

  32. Easton, P.A., Slykerman, L.J. and Anthonisen, N.R. (1986) Ventilatory response to sustained hypoxia in normal adults. J. Appl. Physiol., 61, 906–11.

    PubMed  CAS  Google Scholar 

  33. Parsons, S.T., Griffiths, T.L., Christie, J.M.L. and Holgate, S.T. (1991) Effect of theophylline and dipyridamole on the respiratory response to isocapnic hypoxia in normal human subjects. Clin. Sci., 80, 107–12.

    PubMed  CAS  Google Scholar 

  34. Easton, P.A., Slykerman, L.J. and Anthonisen, N.R. (1988) Ventilatory response to sustained hypoxia after pretreatment with aminophylline. J. Appl. Physiol., 64, 1445–50.

    PubMed  CAS  Google Scholar 

  35. Rudolf, M., Banks, R.A. and Semple, S.J.G. (1977) Hypercapnia during oxygen therapy in acute exacerbations of chronic respiratory failure. Lancet, 2, 483–6.

    Article  PubMed  CAS  Google Scholar 

  36. Prechter, G.C., Nelson, S.R. and Hubmayr, R.D. (1990) The ventilatory recruitment threshold for carbon dioxide. Am. Rev. Respir. Dis., 141, 758–64.

    Article  PubMed  CAS  Google Scholar 

  37. Parisi, R.A., Edelman, N.H. and Santiago, T.V. (1992) Central respiratory carbon dioxide chemosensitivity does not decrease during sleep. Am. Rev. Respir. Dis., 145, 832–6.

    Article  PubMed  CAS  Google Scholar 

  38. Wasserman, D.H. and Whipp, B.J. (1983) Coupling of ventilation to pulmonary gas exchange during non steady-state work in men. J. Appl. Physiol., 54, 587–93.

    PubMed  CAS  Google Scholar 

  39. Wasserman, K.B., Whipp, B.J. and Casaburi, R. (1986) Respiratory control during exercise, in Handbook of Physiology, (eds. N.S. Cherniack and J.G. Widdicombe), Vol. 2, Part II, Section 3, Am. Physiol. Soc. Bethesda, pp. 595–619.

    Google Scholar 

  40. Band, D.M., Wolff, C.B., Ward, J. et al. (1980) Respiratory oscillations in arterial carbon dioxide tensions as a control signal in exercise. Nature, 283, 84–5.

    Article  PubMed  CAS  Google Scholar 

  41. Wasserman, K., Whipp, B.J., Kogal, S.N. and Cleary, M.G. (1975) Effect of carotid body resection on ventilatory and acid-base control during exercise. J. Appl. Physiol., 39, 354–8.

    PubMed  CAS  Google Scholar 

  42. Phillipson, E.A., Duffin, J. and Cooper, J.D. (1981) Critical dependence of respiratory rhythmicity on metabolic CO2 load. J. Appl. Physiol., 50, 45–54.

    PubMed  CAS  Google Scholar 

  43. De Backer, W.A., Heyrman, R.M., Wittesaele, W.M. et al. (1987) Ventilation and breathing patterns during hemodialysis-induced carbon dioxide unloading. Am. Rev. Respir. Dis., 136, 406–10.

    Article  PubMed  Google Scholar 

  44. Paintal, A.S. (1973) Vagal sensory receptors and their reflex effects. Physiol. Rev., 53, 159–227.

    PubMed  CAS  Google Scholar 

  45. Coleridge, H.M. and Coleridge, J.C.G. (1986) Reflexes evoked from tracheobronchial tree and lungs, in Handbook of Physiology, (eds. N.S. Cherniack and J.G. Widdicombe), Vol. 2, Part II, Section 3, Control of Breathing. Am. Physiol. Soc., Bethesda, pp. 395–430.

    Google Scholar 

  46. Homma, I., Obata, T., Sibuya, M. and Uchida, M. (1984) Gate mechanisms in breathlessness caused by chest wall vibration in humans. J. Appl. Physiol., 56, 8–11.

    PubMed  CAS  Google Scholar 

  47. Burgess, K.R. and Whitelaw, W.A. (1984) Reducing ventilatory response to carbon dioxide by breathing cold air. Am. Rev. Respir. Dis., 129, 687–90.

    PubMed  CAS  Google Scholar 

  48. Spence, D.P.S., Graham, D.R., Ahmed, J. et al. (1993) Does cold air affect exercise capacity and dyspnea in stable chronic obstructive pulmonary disease? Chest, 103, 693–6.

    Article  PubMed  CAS  Google Scholar 

  49. Gautier, H., Bonora, M. and Gaudy, J.H. (1981) Breuer-Hering inflation reflex and breathing in anesthetized humans and cats. J. Appl. Physiol., 51, 1162–8.

    PubMed  CAS  Google Scholar 

  50. Zin, W.A., Behrakis, P.K., Luijoudijk, S.C.M. et al. (1986) Immediate response to resistive loading in anaesthetised humans. J. Appl. Physiol., 60, 506–12.

    PubMed  CAS  Google Scholar 

  51. Sanders, M.H., Owens, G.R., Sciurba, F.C. et al. (1989) Ventilation and breathing pattern during progressive hypercapnia and hypoxia after human heart-lung transplantation. Am. Rev. Respir. Dis., 140, 38–40.

    Article  PubMed  CAS  Google Scholar 

  52. Kagawa, F.T., Duncan, S.R. and Theodore, J. (1991) Inspiratory timing of heart-lung transplant recipients during progressive hypercapnia. J. Appl. Physiol., 71, 945–50.

    PubMed  CAS  Google Scholar 

  53. Tapper, D.P., Duncan, S.R., Kraft, S. et al. (1992) Detection of inspiratory resistive loads by heart-lung transplant recipients. Am. Rev. Respir. Dis., 145, 458–60.

    Article  PubMed  CAS  Google Scholar 

  54. Frost, A.E., Zamel, N., McClean, P. et al. (1992) Hypercapnic ventilatory response in recipients of double-lung transplants. Am. Rev. Respir. Dis., 146, 1610–2.

    Article  PubMed  CAS  Google Scholar 

  55. Hugelin, A. (1982) Suprapontine control of respiratory movement, in (eds. J.L. Feldman and A.J. Berger), Proceedings of International Symposium: Central Neural Production of Periodic Respiratory Movements. Lake Bluff, Illinois, pp. 60–63.

    Google Scholar 

  56. Newsom-Davis, J. and Stagg, D. (1975) Interrelationships of the volume and time components of individual breaths in normal man. J. Physiol. (Lond.), 245, 481–98.

    Google Scholar 

  57. Wheatley, J.R., Amis, T.C., and Engel, L.A. (1991) Oronasal partioning of ventilation during exercise in humans. J. Appl. Physiol., 71, 546–51.

    PubMed  CAS  Google Scholar 

  58. Mador, M.J. and Tobin, M.J. (1991) Effect of alterations in mental activity on the breathing pattern in healthy subjects. Am. Rev. Respir. Dis., 144, 481–7.

    Article  PubMed  CAS  Google Scholar 

  59. Severinghaus, J.W. and Mitchell, R.A. (1962) Ondine’s curse — failure of respiratory centre automaticity while awake. Clin. Res., 10, 122.

    Google Scholar 

  60. Rigg, J.R.A., Inman, E.M., Saunders, N.A. et al. (1977) Interaction of mental factors with hypercapnic ventilatory drive in man. Clin. Sei., 52, 264–75.

    Google Scholar 

  61. Grodins, F.S. (1950) Analysis of factors concerned in regulation of breathing in exercise. Physiol. Rev., 30, 220–39.

    PubMed  CAS  Google Scholar 

  62. Catterall, J.R., Calverley, P.M.A. and MacNee, W. et al. (1985) Mechanisms of transient nocturnal hypoxaemia in hypoxic chronic bronchitis and emphysema. J. Appl. Physiol., 59, 1698–703.

    PubMed  CAS  Google Scholar 

  63. Priban, I.P. and Fincham, W.F. (1965) Self-adaptive control and the respiratory system. Nature, 208, 339–43.

    Article  PubMed  CAS  Google Scholar 

  64. Poon, C.S. (1987) Ventilatory control in hypercapnia and exercise: optimization hypothesis. J. Appl. Physiol., 62, 2447–59.

    PubMed  CAS  Google Scholar 

  65. Poon, C.S. (1989) Effects of inspiratory resistive load on respiratory control in hypercapnia and exercise. J. Appl. Physiol., 66, 2391–9.

    PubMed  CAS  Google Scholar 

  66. Poon, C.S., Lin, S-L. and Knudson, O.B. (1992) Optimization character of inspiratory neural drive. J. Appl. Physiol., 72, 2005–17.

    PubMed  CAS  Google Scholar 

  67. Johnson, B.D., Saupe K.W. and Dempsey J.A. (1992) Mechanical constraints on exercise hyperpnea in endurance atheletes. J. Appl. Physiol., 73, 874–86.

    PubMed  CAS  Google Scholar 

  68. Mead, J. (1979) Responses to loaded breathing. Bull. Physiopathol. Respir., 15 (Suppl.), 61–71.

    Google Scholar 

  69. Farkas, G.A., and Roussos, C. (1983) Diaphragm in emphysematous hamsters: Sarcomere adaptability. J. Appl. Physiol., 54, 1635–40.

    PubMed  CAS  Google Scholar 

  70. Whitelaw, W.A., Derenne, J-P. and Milic-Emili, J. (1975) Occlusion pressure as a measure of respiratory center output in conscious man. Respir. Physiol., 23, 181–99.

    Article  PubMed  CAS  Google Scholar 

  71. Murciano, D., Aubier, M., Bussi, S. et al. (1982) Comparison of esophageal, tracheal and mouth occlusion pressure in patients with chronic obstructive pulmonary disease during respiratory failure. Am. Rev. Respir. Dis., 126, 37–41.

    Google Scholar 

  72. Grassino, A.E., Derenne, J-P., Almirall, J. et al. (1981) Configuration of the chest wall and occlusion pressures in awake humans. J. Appl. Physiol., 50, 134–42.

    PubMed  CAS  Google Scholar 

  73. Whitelaw, W.A., and Derenne, J-P. (1993) Airway occlusion pressure. J. Appl. Physiol., 74, 1475–83.

    PubMed  CAS  Google Scholar 

  74. Elliot, M.W., Mulvey, D.A., Green, M. and Moxham, J. (1993) An evaluation of P0.1 measured in mouth and oesophagus, during carbon dioxide rebreathing in COPD. Eur. Respir. J., 6, 1055–9.

    Google Scholar 

  75. Donald, K.W. and Christie, R.V. (1949) The respiratory response to carbon dioxide and anoxia in emphysema. Clin. Sci., 8, 33–44.

    PubMed  CAS  Google Scholar 

  76. Park, S.S. (1965) Factors responsible for carbon dioxide retention in chronic obstructive lung disease. Am. Rev. Respir. Dis., 92, 245–54.

    PubMed  CAS  Google Scholar 

  77. Lane, D.J., and Howell, J.B.L. (1970) Relationship between sensitivity to carbon dioxide and clinical features in chronic airways obstruction. Thorax, 25, 150–8.

    Article  PubMed  CAS  Google Scholar 

  78. Flenley, D.C. and Millar, J.S. (1967) Ventilatory response to oxygen and carbon dioxide in chronic respiratory failure. Clin. Sci., 33, 319–34.

    PubMed  CAS  Google Scholar 

  79. Flenley, D.C. and Millar, J.S. (1968) The effects of carbon dioxide inhalation on the inspiratory work of breathing in chronic ventilatory failure. Clin. Sci., 34, 385–95.

    PubMed  CAS  Google Scholar 

  80. Flenley, D.C., Franklin, D.H. and Millar, J.S. (1970) The hypoxic drive to breathing in chronic bronchitis and emphysema. Clin. Sci., 38, 503–18.

    PubMed  CAS  Google Scholar 

  81. Altose, M.D., McCauley, W.C., Kelsen, S.G. and Cherniack, N.S. (1977) Effects of hypercapnia and flow resistive loading on respiratory activity in chronic airways obstruction. J. Clin. Invest., 59, 500–7.

    Article  PubMed  CAS  Google Scholar 

  82. Gelb, A.F., Klein, E., Schiffman, P. et al. (1977) Ventilatory response and drive in acute and chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 116, 9–16.

    PubMed  CAS  Google Scholar 

  83. Bradley, C.A., Fleetham, J.A., and Anthonisen, N.R. (1979) Ventilatory control in patients with hypoxemia due to obstructive lung disease. Am. Rev. Respir. Dis., 120, 21–30.

    PubMed  CAS  Google Scholar 

  84. Fleetham, J.A., Bradley, C.A., Kryger, M.H. and Anthonisen, N.R. (1980) The effect of low flow oxygen therapy on the chemical control of ventilation in patients with hypoxemia COPD. Am. Rev. Respir. Dis., 122, 833–40.

    PubMed  CAS  Google Scholar 

  85. Gribbin, H.R., Gardiner, I.T., Heinz, G.J. et al. (1983) Role of impaired inspiratory muscle function in limiting the ventilatory response to carbon dioxide in chronic airflow obstruction. Clin. Sci., 64, 487–95.

    PubMed  CAS  Google Scholar 

  86. Chonan, T., Hida, W., Kikuchi, Y. et al. (1988) Role of CO2 responsiveness and breathing efficiency in determining exercise capacity of patients with chronic airway obstruction. Am. Rev. Respir. Dis., 138, 1488–93.

    Article  PubMed  CAS  Google Scholar 

  87. Cherniack, R.M. and Snidal, D.P. (1956) The effect of obstruction to breathing on the ventilatory response to CO2. J. Clin. Invest., 35, 1286–90.

    Article  PubMed  CAS  Google Scholar 

  88. Lane, R., Cockcroft, A., Adams, L. and Guz, A. (1987) Arterial oxygen saturation and breathlessness in patients with chronic obstructive airways disease. Clin. Sci., 72, 693–8.

    PubMed  CAS  Google Scholar 

  89. Lourenco, R.V. and Miranda, J.M. (1968) Drive and performance of the ventilatory apparatus in chronic obstructive lung disease. N. Engl J. Med., 279, 53–9.

    Article  PubMed  CAS  Google Scholar 

  90. Gorini, M.D., Spinelli, A., Duranti, R. et al. (1990) Neural respiratory drive and neuromuscular coupling in patients with chronic obstructive pulmonary disease (COPD). Chest, 98, 1179–86.

    Article  PubMed  CAS  Google Scholar 

  91. Lopata, M., Onal, E. and Cromydas, G. (1985) Respiratory load compensation in chronic airway obstruction. J. Appl. Physiol., 59, 1947–54.

    PubMed  CAS  Google Scholar 

  92. Jamal, K., Fleetham, J.A. and Thurlbeck, W.M. (1990) Cor pulmonale: correlation with central airway lesions, peripheral airway lesions, emphysema and control of breathing. Am. Rev. Respir. Dis., 141, 1172–7.

    Article  PubMed  CAS  Google Scholar 

  93. Dempsey, J.A. and Forster, H.V. (1982) Mediation of ventilatory adaptations. Physiol. Rev., 62, 262–346.

    PubMed  CAS  Google Scholar 

  94. Mountain, R., Zwillich, C.W. and Weil, J. (1978) Hypoventilation in obstructive lung disease. The role of familial factors. N. Engl. J. Med., 298, 521–5.

    Article  PubMed  CAS  Google Scholar 

  95. Fleetham, J.A., Arnup, M.E. and Anthonisen, N.R. (1984) Familial aspects of ventilatory control in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 129, 3–7.

    PubMed  CAS  Google Scholar 

  96. Cherniack, N.S. and Altose, M.D. (1981) Respiratory responses to loading, in The Regulation of Breathing (ed. T.K. Hornbein) Part II. Marcel Dekker, New York, pp. 905–64.

    Google Scholar 

  97. Cherniack, N.S. and Milic-Emili, J. (1985) Mechanical aspects of loaded breathing, in Lung Biology in Health and Disease. The Thorax (part B) (eds. C. Roussos and P.T. Macklem) Marcel Dekker, New York, pp. 905–64.

    Google Scholar 

  98. Sorli, J., Grassino, A., Lorange, G. and Milic-Emili, J. (1978) Control of breathing in patients with chronic obstructive lung disease. Clin. Sci. Mol. Med., 54, 295–304.

    PubMed  CAS  Google Scholar 

  99. Skatrud, J.B., Dempsey, J.A., Bhansuli, P. and Irvin, C. (1980) Determinants of chronic carbon dioxide retention and its correction in humans. J. Clin. Invest., 65, 813–21.

    Article  PubMed  CAS  Google Scholar 

  100. Aubier, M., Murciano, D., Fournier, M. et al. (1980) Central respiratory drive in acute respiratory failure of patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 122, 191–9.

    PubMed  CAS  Google Scholar 

  101. Parot, S., Saunier, C., Gautier, H. et al. (1980) Breathing pattern and hypercapnia in patients with obstructive pulmonary disease. Am. Rev. Respir. Dis., 121, 985–91.

    PubMed  CAS  Google Scholar 

  102. Javaheri, S., Blum, J. and Kazemi, H. (1981) Pattern of breathing and carbon dioxide retention in chronic obstructive pulmonary disease. Am. J. Med., 71, 228–34.

    Article  PubMed  CAS  Google Scholar 

  103. Loveridge, B., West, P., Anthonisen, N.R. and Kryger, M.H. (1984) Breathing pattern in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 130, 730–3.

    PubMed  CAS  Google Scholar 

  104. Oliven, A., Kelsen, S.G., Deal, E.C. and Cherniack, N.S. (1983) Mechanisms underlying CO2 retention during flow-resistive loading in patients with chronic obstructive pulmonary disease. J. Clin. Invest., 71, 1442–9.

    Article  PubMed  CAS  Google Scholar 

  105. Murciano, D., Aubier, M., Viau, F. et al. (1982) Effects of airway anesthesia on pattern of breathing and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am. Rev. Respir. Dis., 126, 113–7.

    PubMed  CAS  Google Scholar 

  106. Scardella, A.T., Parisi, R.A., Phair, D.K. et al. (1986) The role of endogenous opioids in the ventilatory response to acute flow-resistive loads. Am. Rev. Respir. Dis., 133, 26–31.

    PubMed  CAS  Google Scholar 

  107. Weil, J.V., McCullough, R.F., Kline, J.S. and Sodal, I.E. (1975) Diminished ventilatory response to hypoxia and hypercapnia after morphine in normal man. N. Engl J. Med., 292, 1103–6.

    Article  PubMed  CAS  Google Scholar 

  108. Fleetham, J.A., Clarke, H., Dhringa, S. et al. (1980) Endogenous opiates and chemical control of breathing in humans. Am. Rev. Respir. Dis., 121, 1045–9.

    PubMed  CAS  Google Scholar 

  109. Akiyama, Y., Nishimura, M., Suzuki, A. et al. (1990) Naloxone increases ventilatory response to hypercapnic hypoxia in healthy adult humans. Am. Rev. Respir. Dis., 142, 301–5.

    Article  PubMed  CAS  Google Scholar 

  110. Santiago, T.V., Remolina, C., Scoles, V. and Edelman, N.H. (1981) Endorphins and the control of breathing. Ability of naloxone to restore flow-resistive load compensation in chronic obstructive pulmonary disease. N. Engl. J. Med., 304, 1190–5.

    Article  PubMed  CAS  Google Scholar 

  111. Simon, P.M., Pope, A., Lahive, K. et al. (1989) Naloxone does not alter response to hypercapnia or resistive loading in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 139, 134–8 (abstract).

    Article  PubMed  CAS  Google Scholar 

  112. Similowski, T., Yan, S., Gauthier, A.P. et al. (1991) Contractile properties of the human diaphragm during chronic hyperinflation. N. Engl. J. Med., 325, 917–23.

    Article  PubMed  CAS  Google Scholar 

  113. Moxham, J., Edwards, R.H.T., Aubier, M. et al. (1982) Changes in EMG power spectrum (high to low ratio) with force fatigue in humans. J. Appl. Physiol., 53, 1094–9.

    PubMed  CAS  Google Scholar 

  114. Goldstone, J.C., Green, M. and Moxham, J. (1994) Maximum relaxation rate of the diaphragm during weaning from mechanical ventilation. Thorax, 49, 54–60.

    Article  PubMed  CAS  Google Scholar 

  115. Levy, R.D., Esau, S.A., Bye, P.T.P. and Pardy, R.L. (1984) Relaxation rate of mouth pressure with sniffs at rest and with inspiratory muscle fatigue. Am. Rev. Respir. Dis., 130, 38–41.

    PubMed  CAS  Google Scholar 

  116. Oliven, A., Cherniack, N.S., Deal, E.C. and Kelsen, S.G. (1985) The effects of acute bronchoconstriction on respiratory activity in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 131, 236–41.

    PubMed  CAS  Google Scholar 

  117. Bellemare, F. and Grassino, A. (1983) Force reserve of the diaphragm in patients with chronic obstructive pulmonary disease. J. Appl. Physiol., 55, 8–15.

    PubMed  CAS  Google Scholar 

  118. Roussos, C., Fixley, M., Gross, D. and Macklem, P.T. (1979) Fatigue of inspiratory muscles and their synergic behaviour. J. Appl. Physiol., 46, 897–904.

    PubMed  CAS  Google Scholar 

  119. Mador, M.J., and Tobin, M.J. (1992) The effect of inspiratory muscle fatigue on breathing pattern and ventilatory response to CO2. J. Physiol. (Lond.), 455, 17–32.

    CAS  Google Scholar 

  120. Cohen, C.A., Zagelbaum, G., Gross, D. et al. (1982) Clinical manifestations of respiratory muscle fatigue. Am. J. Med., 73, 308–16.

    Article  PubMed  CAS  Google Scholar 

  121. Tobin, M.J., Perez, W., Guenther, S.M. et al. (1987) Does ribcage abdominal paradox signify respiratory muscle fatigue? J. Appl. Physiol., 63, 851–60.

    PubMed  CAS  Google Scholar 

  122. Shapiro, S.H., Ernst, P., Gray-Donald, K. et al. (1992) Effect of negative pressure ventilation in severe pulmonary disease. Lancet, 340, 1425–9.

    Article  PubMed  CAS  Google Scholar 

  123. Haluszka, J., Chartrand, D.A., Grassino, A. and Milic-Emili, J. (1990) Intrinsic PEEP and arterial PCO2 in stable patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 141, 1194–7.

    Article  PubMed  CAS  Google Scholar 

  124. Begin, P. and Grassino, A.E. (1991) Inspiratory muscle dysfunction and chronic hypercapnia in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 143, 905–12.

    Article  PubMed  CAS  Google Scholar 

  125. Molho, M., Shulimzon, T., Benzaray, S. and Katz, I. (1993) Importance of inspiratory load in the assessment of severity of airways obstruction and its correlation with CO2 retention in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 147, 45–9.

    Article  PubMed  CAS  Google Scholar 

  126. Riley, R.L. (1954) The work of breathing and its relation to respiratory acidosis. Ann. Intern. Med., 41, 172–6.

    Article  Google Scholar 

  127. Katz-Salamon, M. (1988) Respiratory psychophysics: a methodological overview, in Respiratory Psychophysiology (eds. von Euler, C. and M. Katz-Salamon), Stockton Press, New York, pp. 65–78.

    Google Scholar 

  128. Stubbing, D.G., Ramsdale, E.H., Killian, K.J. and Campbell, E.J.M. (1983) Psychophysics of inspiratory muscle force. J. Appl. Physiol., 54, 1216–21.

    PubMed  CAS  Google Scholar 

  129. Mahutte, C.K., Campbell, E.J.M. and Killian, K.J. (1983) Theory of resistive load detection. Respir. Physiol., 51, 131–9.

    Article  PubMed  CAS  Google Scholar 

  130. Simon, P.M., Schwartzstein, R.M., Weiss, J.W. et al. (1989) Distinguishable sensations of breathlessness induced in normal volunteers. Am. Rev. Respir. Dis., 140, 1021–9.

    Article  PubMed  CAS  Google Scholar 

  131. Elliot, M.W., Adams, L., Cockcroft, A. et al. (1991) The language of breathlessness: use of verbal descriptions by patients with cardiopulmonary disease. Am. Rev. Respir. Dis., 144, 826–32.

    Article  Google Scholar 

  132. Campbell, E.J.M., Freedman, S., Smith, P.S. and Taylor, M.E. (1961) The ability to detect added elastic loads to breathing. Clin. Sci., 20, 222–31.

    Google Scholar 

  133. McCloskey, D.I., Ebeling, P. and Goodwin, G.M. (1974) Estimation of weights and tensions and apparent involvement of a sense of effort. Exp. Neurol., 42, 220–32.

    Article  PubMed  CAS  Google Scholar 

  134. Borg, G. (1982) Psychophysical basis of perceived exertion. Med. Sci. Sports Exer., 14, 377–81.

    CAS  Google Scholar 

  135. Clague, J.E., Carter, J., Pearson, M.G. and Calverley, P.M.A. (1990) Relationship between inspiratory drive and perceived inspiratory effort in normal man. Clin. Sci., 78, 493–6.

    PubMed  CAS  Google Scholar 

  136. Muza, S.R., Silverman, M.T., Gilmore, C.G. et al. (1990) Comparisons of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 141, 909–13.

    Article  PubMed  CAS  Google Scholar 

  137. Wilson, R.C. and Jones, P.W. (1989) A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin. Sci., 76, 277–82.

    PubMed  CAS  Google Scholar 

  138. Mador, M.J. and Kufel, T.J. (1992) Reproducibility of visual analog scale measurements of dyspnea in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 146, 82–7.

    Article  PubMed  CAS  Google Scholar 

  139. Hay, J.G., Stone, P., Carter, J. et al. (1992) Bronchodilator reversibility, exercise performance and breathlessness in stable chronic obstructive pulmonary disease. Eur. Respir. J., 5, 659–64.

    PubMed  CAS  Google Scholar 

  140. Larson, J.L., Kim, M.J., Sharp, J.T. et al. (1988) Inspiratory muscle training with a pressure threshold device in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 138, 689–96.

    Article  PubMed  CAS  Google Scholar 

  141. MRC Committee on Research into Chronic Bronchitis (1966) Instructions for use of the questionnaire on respiratory symptoms. W.J. Holman, Devon.

    Google Scholar 

  142. Mahler, D.A., Weinberg, D.H., Wells, C.K., and Feinstein, A.R. (1984) The measurement of dyspnea: contents, interobserver agreement and physiologic correlates of two new clinical indices. Chest, 85, 751–8.

    Article  PubMed  CAS  Google Scholar 

  143. Mahler, D.A., and Harver, A. (1992) A factor analysis of dyspnea ratings, respiratory muscle strength and lung function in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 145, 467–70.

    Article  PubMed  CAS  Google Scholar 

  144. Cournand, A. and Richards, D.W. (1941) Pulmonary insufficiency. Am. Rev. Tubercl., 44, 26–41.

    CAS  Google Scholar 

  145. McIlroy, M.B., and Christie, R.V. (1954) The work of breathing in emphysema. Clin. Sci., 13, 147–54.

    PubMed  CAS  Google Scholar 

  146. Fowler, W.S. (1954) Breaking point of breath-holding. J. Appl. Physiol., 6, 539–45 (abstract).

    PubMed  CAS  Google Scholar 

  147. Campbell, E.J.M., Godfrey, S., Clark, T.J.H. et al. (1969) The effect of muscular paralysis induced by tubocurarine on the duration and sensation of breath holding during hypercapnia. Clin. Sci., 36, 323–8.

    PubMed  CAS  Google Scholar 

  148. Banzett, R.B., Lansing, R.W., Brown, R. et al. (1990) ‘Air hunger’ from increased PCO2 persists after complete neuromuscular block in humans. Respir. Physiol., 81, 1–18.

    Article  PubMed  CAS  Google Scholar 

  149. Freedman, S. and Campbell, E.J.M. (1970) The ability of normal subjects to tolerate added inspiratory loads. Respir. Physiol., 10, 213–35.

    Article  PubMed  CAS  Google Scholar 

  150. Campbell, E.J.M. and Howell, J.B.L. (1963) The sensation of breathlessness. Br. Med. Bull., 19, 36–40.

    PubMed  CAS  Google Scholar 

  151. Eisele, J., Trenchard, D., Burki, N. and Guz, A. (1969) The effect of chest wall block on respiratory sensation and control in man. Clin. Sci., 35, 23–33.

    Google Scholar 

  152. Remmers, J.E. (1970) Inhibition of inspiratory activity by intercostal muscle afferents. Respir. Physiol., 10, 358–83.

    Article  PubMed  CAS  Google Scholar 

  153. Manning, H.L., Basner, R., Ringler, J. et al. (1991) Effect of chest wall vibration on breathlessness in normal subjects. J. Appl. Physiol., 71, 175–81.

    PubMed  CAS  Google Scholar 

  154. Gandevia, S.C. and Macefield, G. (1989) Projection of low threshold afferents from human intercostal muscles to the cerebral cortex. Respir. Physiol., 77, 201–14.

    Article  Google Scholar 

  155. Killian, K.J., Mahutte, C.K., Howell, J.B.L. and Campbell, E.J.M. (1980) Effect of timing, flow, lung volume and threshold pressures on resistive load detection. J. Appl. Physiol., 49, 958–63.

    PubMed  CAS  Google Scholar 

  156. Killian, K.J., Gandevia, S.C., Summers, E. and Campbell, E.J.M. (1984) Effect of increased lung volume on perception of breathlessness, effort and tension. J. Appl. Physiol., 57, 686–91.

    PubMed  CAS  Google Scholar 

  157. Killian, K.J., Bucens, D.D., and Campbell, E.J.M. (1982) The effect of patterns of breathing on the perceived magnitude of added loads to breathing. J. Appl. Physiol., 52, 578–84.

    PubMed  CAS  Google Scholar 

  158. Gandevia, S.C., Killian, K.J., and Campbell, E.J.M. (1981) The effect of respiratory muscle fatigue on respiratory sensations. Clin. Sci., 60, 463–6.

    PubMed  CAS  Google Scholar 

  159. Bradley, T.D., Chartrand, D.A., Fitting, J.W. et al. (1986) The relation of inspiratory effort sensation to fatiguing patterns of the diaphragm. Am. Rev. Respir. Dis., 134, 1119–24.

    PubMed  CAS  Google Scholar 

  160. Clague, J.E., Carter, J., Pearson, M.G. and Calverley, P.M.A. (1993) Physiological determinants of inspiratory effort sensation during CO2 rebreathing in normal subjects. Clin. Sci., 85, 637–42.

    PubMed  CAS  Google Scholar 

  161. Chonan, T., Mulholland, M.B., Cherniack, N.S. and Altose, M.D. (1987) Effect of voluntary constraining of thoracic displacement during hypercapnia. J. Appl. Physiol., 63, 1822–8.

    PubMed  CAS  Google Scholar 

  162. Sharp, J.T., Druz, W.S., Moisan, T. et al. (1980) Postural relief of dyspnea in severe COPD. Am. Rev. Respir. Dis., 122, 201–11.

    PubMed  CAS  Google Scholar 

  163. Celli, B.R., Rassulo, J. and Make, B. (1986) Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction. N. Engl. J. Med., 314, 1485–90.

    Article  PubMed  CAS  Google Scholar 

  164. Ward, M.E., Eidelman, D., Stubbing, D.G. et al. (1988) Respiratory sensation and pattern of respiratory muscle activation during diaphragm fatigue. J. Appl. Physiol., 65, 2181–9.

    PubMed  CAS  Google Scholar 

  165. Leblanc, P., Bowie, D.M., Summers, E. et al. (1986) Breathlessness and exercise in patients with cardiorespiratory disease. Am. Rev. Respir. Dis., 133, 21–5.

    PubMed  CAS  Google Scholar 

  166. Zechman, F.W., Muza, S.R., Davenport, P.W. et al. (1985) Relationship of transdiaphragmatic pressure and latencies for detecting added inspiratory loads. J. Appl. Physiol., 58, 236–43.

    PubMed  CAS  Google Scholar 

  167. Davenport, P.W., Friedman, W.A., Thompson, F.J. and Franzen, O. (1986) Respiratory-related cortical potentials evoked by inspiratory occlusion in humans. J. Appl. Physiol., 60, 1843–8.

    PubMed  CAS  Google Scholar 

  168. Murphy, K., Mier, A., Adams, L., and Guz, A. (1990) Putative cerebral cortical involvement in the ventilatory response to inhaled CO2 in conscious man. J. Physiol. (Land.), 420, 1–18.

    CAS  Google Scholar 

  169. Xu, F., Taylor, R.F., McLarney, T. et al. (1993) Respiratory load compensation. 1 Role of the cerebrum. J. Appl. Physiol., 74, 853–8.

    Article  PubMed  CAS  Google Scholar 

  170. Adams, L., Lane, R., Shea, S.A. et al. (1985) Breathlessness during different forms of ventilatory stimulation: a study of mechanisms in normal subjects and respiratory patients. Clin. Sci., 69, 663–72.

    PubMed  CAS  Google Scholar 

  171. Chonan, T., Mulholland, M.B., Leitner, J. et al. (1990) Sensation of dyspnea during hypercapnia, exercise and voluntary hyperventilation. J. Appl. Physiol., 68, 2100–6.

    Article  PubMed  CAS  Google Scholar 

  172. Lane, R., Adams, L. and Guz, A. (1990) The effects of hypoxia and hypercapnia on perceived breathlessness during exercise in humans. J. Physiol (Lond.), 429, 579–93.

    Google Scholar 

  173. Lane, R., Adams, L. and Guz, A. (1990) Acidosis and breathlessness in normal subjects. Eur. Respir. J., 3, 142S.

    Google Scholar 

  174. Lane, R., Cockcroft, A. and Guz, A. (1987) Voluntary isocapnic hyperventilation and breathlessness during exercise in normal subjects. Clin. Sci., 73, 519–23.

    PubMed  CAS  Google Scholar 

  175. Robinson, R.W., White, D.P. and Zwillich, C.W. (1987) Relationship of respiratory drives to dyspnea and exercise performance in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 136, 1084–90.

    Article  PubMed  CAS  Google Scholar 

  176. Swinburn, C.R., Wakefield, J.M. and Jones, P.W. (1984) Relationship between ventilation and breathlessness during exercise in chronic obstructive airways disease is not altered by prevention of hypoxaemia. Clin. Sci., 67, 515–9.

    PubMed  CAS  Google Scholar 

  177. Mak, V.H.F., Bugler, J.R., Roberts, C.M. and Spiro, S.G. (1993) Effect of arterial oxygen desaturation on six minute walk distances, perceived effort and perceived breathlessness in patients with airflow limitation. Thorax, 48, 33–8.

    Article  PubMed  CAS  Google Scholar 

  178. Spence, D.P.S., Hay, J.G., Carter, J. et al. (1993) Oxygen desaturation and breathlessness during corridor walking in chronic obstructive pulmonary disease: effect of oxitropium bromide. Thorax, 48, 1145–50.

    Article  PubMed  CAS  Google Scholar 

  179. Stubbing, D.G., Killian, K.J. and Campbell, E.J.M. (1983) Weber’s law and resistive load detection. Am. Rev. Respir. Dis., 127, 5–7.

    PubMed  CAS  Google Scholar 

  180. Gottfried, S.B., Redline, S. and Altose, M.D. (1985) Respiratory sensation in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 132, 954–9.

    PubMed  CAS  Google Scholar 

  181. Gottfried, S.B., Altose, M.D., Kelsen, S.G. et al. (1978) The perception of changes in airflow resistance in normal subjects and patients with chronic airways obstruction. Chest, 73, 286–8.

    PubMed  CAS  Google Scholar 

  182. O’Donnell, A.E. and Webb, K.A. (1993) Exertional breathlessness in patients with chronic airflow limitation. Am. Rev. Respir. Dis., 148, 1351–7.

    Article  PubMed  Google Scholar 

  183. Noseda, A., Schmerber, J., Prigogine, T. and Yernault, J.C. (1993) How do patients with either asthma or COPD perceive acute bronchodilation? Eur. Respir. J., 6, 636–44.

    PubMed  CAS  Google Scholar 

  184. Petrof, B.J., Calderini, E. and Gottfried, S.B. (1990) Effect of CPAP on respiratory effort and dyspnea during exercise in severe COPD. J. Appl. Physiol., 69, 179–38.

    PubMed  CAS  Google Scholar 

  185. O’Donnell, D.E., Sanii, R., Gresbrecht, G. and Younes, M. (1988) Effect of continuous positive airway pressure on respiratory sensation in patients with chronic obstructive pulmonary disease during submaximal exercise. Am. Rev. Respir. Dis., 138, 1185–91.

    Article  PubMed  Google Scholar 

  186. Burki, N.K. (1979) Breathlessness and mouth occlusion pressure in patients with chronic obstruction of the airways. Chest, 76, 527–31.

    Article  PubMed  CAS  Google Scholar 

  187. Dillard, T.A., Hnatiuk, O.W. and McCumber, T.R. (1993) Maximum voluntary ventilation. Spirometric determinants in chronic obstructive pulmonary disease patients and normal subjects. Am. Rev. Respir. Dis., 147, 870–5.

    Article  PubMed  CAS  Google Scholar 

  188. Morgan, A.D., Peck, D.F., Buchanan, D.E., and McHardy, G.J.R. (1983) Effect of attitudes and beliefs on exercise tolerance in chronic bronchitis. Br. Med. J., 286, 171–3.

    Article  CAS  Google Scholar 

  189. Mador, J.M., and Tobin, M.J. (1991) Effect of alterations in mental activity on the breathing pattern in healthy subjects. Am. Rev. Respir. Dis., 144, 481–7.

    Article  PubMed  CAS  Google Scholar 

  190. Clark, T.J.H., and Cochrane, G.M. (1970) Effect of personality on alveolar ventilation in patients with chronic airways obstruction. Br. Med. J., 1, 273–5.

    Article  PubMed  CAS  Google Scholar 

  191. Hudgel, D.W. and Kinsman, R.A. (1983) Interactions among behavioural style, ventilatory drive and load recognition. Am. Rev. Respir. Dis., 128, 246–8.

    PubMed  CAS  Google Scholar 

  192. Clague, J.E., Carter, J., Pearson, M.G. and Calverley, P.M.A. (1992) Effort sensation, chemoreceptors and breathing pattern during inspiratory resistive loading. J. Appl. Physiol., 73, 440–5.

    PubMed  CAS  Google Scholar 

  193. Oliven, A., Kelsen, S.G., Deal, E.C. and Cherniack, N.S. (1985) Respiratory pressure sensation. Relationship to changes in breathing pattern in patients with chronic obstructive lung disease. Am. Rev. Respir. Dis., 132, 1214–8.

    PubMed  CAS  Google Scholar 

  194. Nishimura, N., Suzuki, A., Yoshioka, A. et al. (1992) Effect of aminophylline on brain tissue oxygen tension in patients with chronic obstructive lung disease. Thorax, 47, 1025–9.

    Article  PubMed  CAS  Google Scholar 

  195. Bardsley, P.A. (1993) Chronic respiratory failure in COPD: is there a place for a respiratory stimulant? Thorax, 48, 781–4.

    Article  PubMed  CAS  Google Scholar 

  196. Moser, K.M., Luchsinger, P.C., Adamson, J.S. et al. (1973) Respiratory stimulation with intravenous doxapram in respiratory failure: a double-blind co-operative study. N. Engl. J. Med., 288, 427–31.

    Article  PubMed  CAS  Google Scholar 

  197. Calverley, P.M.A., Robson, R.H., Wraith, R.H. et al. (1983) The ventilatory effect of doxapram in normal man. Clin. Sci., 65, 65–9.

    PubMed  CAS  Google Scholar 

  198. Powles, A.C., Tuxen, D.V., Mahood, C.B., et al. (1983) The effect of intravenously administered almitrine, a peripheral chemoreceptor agonist, on patients with chronic air-flow obstruction. Am. Rev. Respir. Dis., 127, 284–9.

    PubMed  CAS  Google Scholar 

  199. Connaughton, J.J., Douglas, N.J., Morgan, A.D. et al. (1985) Almitrine improves oxygenation when both awake and asleep in patients with hypoxia and carbon dioxide retention caused by chronic bronchitis and emphysema. Am. Rev. Respir. Dis., 132, 206–10.

    PubMed  CAS  Google Scholar 

  200. MacNee, W., Connaughton, J.J., Rhind, G.B. et al. (1986) A comparison of the effects of almitrine or oxygen on pulmonary arterial pressure and right ventricular ejection fraction in hypoxic chronic bronchitis and emphysema. Am. Rev. Respir. Dis., 134, 559–65.

    PubMed  CAS  Google Scholar 

  201. Watanabe, S., Kanner, R.E., Cutiilo, A.G. et al. (1989) Long term effects of almitrine bismethylate in patients with hypoxic chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 140, 1269–73.

    Article  PubMed  CAS  Google Scholar 

  202. Bardsley, P.A., Howard, P., De Backer, W. et al. (1991) Two years’ treatment with almitrine bismethylate in patients with hypoxic chronic obstructive pulmonary disease. Eur. Respir. J., 4, 308–10.

    PubMed  CAS  Google Scholar 

  203. Skatrud, J.B. and Dempsey, J.A. (1983) Relative effectiveness of acetazolamide versus medroxyprogesterone acetate in the correction of chronic carbon dioxide retention. Am. Rev. Respir. Dis., 127, 405–12.

    PubMed  CAS  Google Scholar 

  204. Guyatt, G., Keller, J., Singer, J. et al. (1992) Controlled trial of respiratory muscle training in chronic airflow limitation. Thorax, 47, 598–602.

    Article  PubMed  CAS  Google Scholar 

  205. Smith, K., Cook, D., Guyatt, G.H. et al. (1992) Respiratory muscle training in chronic airflow limitation: a meta-analysis. Am. Rev. Respir. Dis., 145, 533–9.

    Article  PubMed  CAS  Google Scholar 

  206. Macklem, P.T. (1986) The clinical relevance of respiratory muscle research. J. Burns Amberson Lecture. Am. Rev. Respir. Dis., 134, 812–5.

    PubMed  CAS  Google Scholar 

  207. Hill, N.S. (1993) Non-invasive ventilation. Does it work, for whom and how? Am. Rev. Respir. Dis., 147, 1050–5.

    Article  PubMed  CAS  Google Scholar 

  208. Calverley, P.M.A. (1992) Domiciliary ventilation in chronic obstructive pulmonary disease. Thorax, 47, 334–6.

    Article  PubMed  CAS  Google Scholar 

  209. Braun, N.M.T. and Marino, W.D. (1984) Effect of daily intermittent rest of respiratory muscles in patients with severe chronic airflow limitation (CAL). Chest, 85, 593–605.

    Article  Google Scholar 

  210. Cropp, A. and Dimarco, A.F. (1987) Effect of intermittent negative pressure ventilation on respiratory muscle function in patients with severe chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 135, 1056–61.

    PubMed  CAS  Google Scholar 

  211. Gutierrez, M., Beroiza, T., Contreras, G. et al. (1988) Weekly cuirass ventilation improves blood gases and inspiratory muscle strength in patients with chronic airflow limitation and hypercarbia. Am. Rev. Respir. Dis., 138, 617–23.

    Article  PubMed  CAS  Google Scholar 

  212. Zibrak, J.D., Hill, N.S. and Federman, E.C. (1988) Evaluation of intermittent long term negative pressure ventilation in patients with severe chronic obstructive lung disease. Am. Rev. Respir. Dis., 138, 1515–8.

    Article  PubMed  CAS  Google Scholar 

  213. Celli, B., Lee, H., Criner, G. et al. (1989) Controlled trial of external negative pressure ventilation in patients with severe chronic airflow limitation. Am. Rev. Respir. Dis., 140, 1251–6.

    Article  PubMed  CAS  Google Scholar 

  214. Ambrosino, N., Montagna, T., Nava, S. et al. (1990) Short term effect of intermittent negative pressure ventilation in chronic obstructive lung disease patients with respiratory failure. Eur. Respir. J., 3, 502–8.

    PubMed  CAS  Google Scholar 

  215. Scano, G., Gigliotti, F., Duranti, R. et al. (1990) Changes in ventilatory muscle function with negative pressure ventilation in chronic obstructive lung disease. Chest, 97, 322–7.

    Article  PubMed  CAS  Google Scholar 

  216. Strumpf, D.A., Millman, R.P., Carlisle, C.A. et al. (1991) Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 144, 1234–9.

    Article  PubMed  CAS  Google Scholar 

  217. Elliot, M.W., Mulvey, D.A., Moxham, J. et al. (1991) Domiciliary nocturnal intermittent positive pressure ventilation in COPD: Mechanisms underlying changes in arterial blood gas tensions. Eur. Respir. J., 4, 1044–52.

    Google Scholar 

  218. Elliot, M.W., Simonds, A.K., Carroll, M.P. et al. (1992) Domiciliary nocturnal nasal intermittent positive pressure ventilation in hypercapnic respiratory failure due to chronic obstructive lung disease. Thorax, 47, 337–41.

    Article  Google Scholar 

  219. Udwadia, Z.F., Santis, G.K., Steven, M.H. and Simonds, A.K. (1992) Nasal ventilation to facilitate weaning in patients with chronic respiratory insufficiency. Thorax, 47, 715–8.

    Article  PubMed  CAS  Google Scholar 

  220. Branthwaite, M.A. (1991) Assisted ventilation 6 — Non-invasive and domiciliary ventilation: positive pressure techniques. Thorax, 46, 208–12.

    Article  PubMed  CAS  Google Scholar 

  221. Mitchell-Heggs, P., Murphy, K., Minty, K. et al. (1980) Diazepam in the treatment of dyspnoea in the ‘pink puffer’ syndrome. Q. J. Med., 193, 9–20.

    Google Scholar 

  222. Woodcock, A.A., Gross, E. and Geddes, D.M. (1981) Drug treatment of breathlessness: Contrasting effects of diazepam and promethazine in pink puffers. Br. Med. J., 283, 343–5.

    Article  CAS  Google Scholar 

  223. Supinksi, G., Dimarco, A., Bark, H. et al. (1990) Effect of codeine on the sensations elicited by loaded breathing. Am. Rev. Respir. Dis., 141, 1516–21.

    Article  Google Scholar 

  224. Woodcock, A.A., Gross, E.R., Geliert, A. et al. (1981) Effects of dihydrocodeine, alcohol and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases. N. Engl. J. Med., 305, 1611–6.

    Article  PubMed  CAS  Google Scholar 

  225. Johnson, M.A., Woodcock, A.A. and Geddes, D.M. (1983) Dihydrocodeine for breathlessness in ‘pink puffers’. Br. Med. J., 276, 675–7.

    Article  Google Scholar 

  226. Light, R.W., Muro, J.R., Sato, R.I. et al. (1989) Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis., 139, 126–33.

    Article  PubMed  CAS  Google Scholar 

  227. Akiyama, Y., Nishimura, M., Kobayashi, S. et al. (1993) Effects of naloxone on the sensation of dyspnea during acute respiratory loading in normal subjects. J. Appl. Physiol., 74, 590–5.

    PubMed  CAS  Google Scholar 

  228. Eiser, N., Denman, W., West, E. and Luce, P. (1991) Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the ‘pink puffer’ syndrome. Eur. Respir. J., 4, 926–31.

    PubMed  CAS  Google Scholar 

  229. Woodcock, A.A., Gross, E.R., and Geddes, D.M. (1981) Oxygen relieves breathlessness in ‘pink puffers’. Lancet, i, 907–9.

    Article  Google Scholar 

  230. Davidson, A.C., Leach, R., George, R.J.D. and Geddes, D.M. (1988) Supplemental oxygen and exercise ability in chronic obstructive airways disease. Thorax, 43, 965–71.

    Article  PubMed  CAS  Google Scholar 

  231. Leach, R.M., Davidson, A.C., Chinn, S. et al. (1992) Portable liquid oxygen and exercise ability in severe respiratory disability. Thorax, 47, 781–9.

    Article  PubMed  CAS  Google Scholar 

  232. Schwartzstein, R.M., Lahire, K., Pope, A. et al. (1987) Cold facial stimulation reduces breathlessness induced in normal subjects. Am. Rev. Respir. Dis., 136, 58–61.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. P. M. A. Calverley
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Aintree Chest Clinic, Regional Thoracic Unit, Fazakerley Hospital, Longmoor Lane, Liverpool, L9 7AL, UK

    P. M. A. Calverley (Consultant Physician, Senior Fellow) (Consultant Physician, Senior Fellow)

  2. Department of Medicine, University of Liverpool, UK

    P. M. A. Calverley (Consultant Physician, Senior Fellow) (Consultant Physician, Senior Fellow)

  3. Department of Medicine, (Respiratory Division), Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK

    N. B. Pride (Consultant Physician, Professor of Respiratory Medicine) (Consultant Physician, Professor of Respiratory Medicine)

  4. Royal Postgraduate Medical School, London, UK

    N. B. Pride (Consultant Physician, Professor of Respiratory Medicine) (Consultant Physician, Professor of Respiratory Medicine)

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Calverley, P.M.A. (1995). Ventilatory Control and Dyspnea. In: Calverley, P.M.A., Pride, N.B. (eds) Chronic Obstructive Pulmonary Disease. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-4525-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-4525-9_10

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-412-46450-8

  • Online ISBN: 978-1-4899-4525-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation