Article Text

Download PDFPDF

Original article
Different dyspnoea perception in COPD patients with frequent and infrequent exacerbations
  1. Giulia Scioscia1,2,
  2. Isabel Blanco1,3,4,5,
  3. Ebymar Arismendi3,4,
  4. Felip Burgos1,3,4,5,
  5. Concepción Gistau1,
  6. Maria Pia Foschino Barbaro2,
  7. Bartolome Celli6,
  8. Denis E O'Donnell7,
  9. Alvar Agustí1,3,4,5
  1. 1Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Barcelona, Spain
  2. 2Department of Medical and Surgical Sciences, Institute of Respiratory Disease, University of Foggia, Foggia, Italy
  3. 3Fundació Clínic per la Recerca Biomèdica, Hospital Clínic, Barcelona, Spain
  4. 4Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
  5. 5Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
  6. 6Pulmonary Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  7. 7Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
  1. Correspondence to Dr Alvar Agustí, Respiratory Institute, Hospital Clínic, Villarroel, 170, Barcelona 08036, Spain; aagusti{at}


Background Some patients with COPD report frequent acute exacerbations (AECOPD) of the disease (FE), whereas others suffer them infrequently (IE). Because the current diagnosis of exacerbation relies on patient's perception of increased symptoms (mostly dyspnoea), we hypothesised that dyspnoea perception might be different in COPD patients with FE (≥2 exacerbations or 1 hospitalisation due to AECOPD in the previous year) or IE (≤1 exacerbation in the previous year), AECOPD being defined by the institution antibiotics and/or steroids treatment, or hospital admission.

Objective To test the hypothesis that dyspnoea perception is increased in FE and/or decreased in IE with COPD.

Methods We compared the perception of dyspnoea (Borg scale), mouth occlusion pressure 0.1 s after the onset of inspiration (P0.1) and ventilatory response to hypercapnia (ΔVE/ΔPETCO2) in 34 clinically stable COPD patients with FE (n=14) or IE (n=20), with similar age, gender, body mass index and degree of airflow limitation. As a reference, we studied a group of age-matched healthy volunteers (n=10) with normal spirometry.

Results At rest, P0.1 was higher in FE than IE and controls (p<0.01). Compared with controls, the ventilatory response to hypercapnia was equally blunted both in FE and IE (p<0.001). Despite similar spirometry, during rebreathing peak Borg score and ΔBorg were higher (p<0.01) in FE and lower (p<0.01) in IE, than in controls.

Conclusions Dyspnoea perception during CO2 rebreathing is enhanced in FE and blunted in IE. These differences may contribute to the differential rate of reported exacerbations in FE and IE.

Trial registration number NCT02113839.

  • Emphysema
  • COPD Exacerbations

Statistics from


  • Contributors GS, IB and EA contributed equally to the article. Conception and design: AA. Field work: GS, IB, EA, FB, CG. Analysis and interpretation: all. Drafting the manuscript for important intellectual content: all.

  • Funding The University of Foggia supported GS during her fellowship in Hospital Clinic, Barcelona (Spain).

  • Competing interests None declared.

  • Ethics approval Ethics Committee of the Hospital Clínic, Universitat de Barcelona (protocol HCP/14/329).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles