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Abstract

This essay explores the therapeutic possibilities opened up by literature for breathless patients today. Focusing on King Lear, it considers Shakespeare’s suggestion that we do not breathe as isolated agents but are instead ‘breathed’ by those who know and observe us. Breath emerges as fundamental to early modern personhood. Many breathless patients today still experience the inseparability of breath and aliveness, and breathlessness becomes ‘a way of life’ as they adapt their sense of what is possible in order to accommodate their condition. This life belongs not only to sufferers, however, but also to those who care for them. Considering recent clinical research on vicarious dyspnoea alongside King Lear reveals the existential and therapeutic potential of breath’s intimate, under-recognised relationality.

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Dyspnoea: a multidimensional and multidisciplinary approach.

Louis Laviolette, Pierantonio Laveneziana (2014)

Dyspnoea is a debilitating symptom that affects quality of life, exercise tolerance and mortality in various disease conditions/states. In patients with chronic obstructive pulmonary disease (COPD), it has been shown to be a better predictor of mortality than forced expiratory volume in 1 s. In patients with heart disease it is a better predictor of mortality than angina. Dyspnoea is also associated with decreased functional status and worse psychological health in older individuals living at home. It also contributes to the low adherence to exercise training programmes in sedentary adults and in COPD patients. The mechanisms of dyspnoea are still unclear. Recent studies have emphasised the multidimensional nature of dyspnoea in the sensory-perceptual (intensity and quality), affective distress and impact domains. The perception of dyspnoea involves a complex chain of events that depend on varying cortical integration of several afferent/efferent signals and coloured by affective processing. This review, which stems from the European Respiratory Society research symposium held in Paris, France in November 2012, aims to provide state-of-the-art advances on the multidimensional and multidisciplinary aspects of dyspnoea, by addressing three different themes: 1) the neurophysiology of dyspnoea, 2) exercise and dyspnoea, and 3) the clinical impact and management of dyspnoea.

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The multiple dimensions of dyspnea: review and hypotheses.

Robert Banzett, Richard Gracely, Robert Lansing (2009)

Although dyspnea is a common and troubling symptom, our understanding of the neurophysiology of dyspnea is woefully incomplete. Most measurements of dyspnea treat it as a single entity. Although the multidimensional dyspnea concept has been mentioned for many decades, only recently has the concept been the subject of experimental tests. Emerging evidence has begun to favor the hypothesis that dyspnea comprises multiple dimensions or components that can be measured as different entities. Most recently, studies have begun to show that there is a separable 'affective dimension' (i.e. unpleasantness and emotional impact). Understanding of the multidimensional measurement of pain is far in advance of dyspnea, and has enabled progress in the neurophysiology of pain, including identification of separate neural structures subserving various elements of pain perception. We propose here a multidimensional model of dyspnea based on a state-of-the-art pain model, and review existing evidence in the light of this model.

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Understanding dyspnea as a complex individual experience.

Anja Hayen, Mari Herigstad, Kyle T S Pattinson (2013)

Dyspnea is the highly threatening experience of breathlessness experienced by patients with diverse pathologies, including respiratory, cardiovascular, and neuromuscular diseases, cancer and panic disorder. This debilitating symptom is especially prominent in the elderly and the obese, two growing populations in the Western world. It has further been found that women suffer more strongly from dyspnea than men. Despite optimization of disease-specific treatments, dyspnea is often inadequately treated. The immense burden faced by patients, families and the healthcare system makes improving management of chronic dyspnea a priority. Dyspnea is a multidimensional sensation that encompasses an array of unpleasant respiratory sensations that vary according to underlying cause and patient characteristics. Biopsychological factors beyond disease pathology exacerbate the perception of dyspnea, increase symptom severity and reduce quality of life. Psychological state (especially comorbid anxiety and depression), hormone status, gender, body weight (obesity) and general fitness level are particularly important. Neuroimaging has started to uncover the neural mechanisms involved in the processing of sensory and affective components of dyspnea. Awareness of biopsychological factors beyond pathology is essential for diagnosis and treatment of dyspnea. Increasing understanding the interactions between biopsychological factors and dyspnea perception will enhance the development of symptomatic treatments that specifically address each patient's most pressing needs at a specific stage in life. Future neuroimaging research can provide objective markers to fully understand the role of biopsychological factors in the perception of dyspnea in the hope of uncovering target areas for pharmacologic and non-pharmacologic therapy.

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Publication date (Print): 2021

Publication date (Online): October 02 2021

Pages: 155-174

DOI: 10.1007/978-3-030-74443-4_8

SO-VID: 46b093c2-49d6-4058-96a2-8806fa054f3b

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‘Being Breathed’: From King Lear to Clinical Medicine

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Most cited references 10

Dyspnoea: a multidimensional and multidisciplinary approach.

The multiple dimensions of dyspnea: review and hypotheses.

Understanding dyspnea as a complex individual experience.

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