Relationship between spontaneous dyspnoea and lability of airway obstruction in asthma

1. As marked lability of bronchial obstruction is a risk factor for asthma severity, it may influence dyspnoea, the most common subjective complaint in asthma. We therefore studied the relationship between spontaneous dyspnoea and the degree of bronchial lability, as assessed by the daily variability in peak expiratory flow rate and the bronchial responsiveness to either carbachol or salbutamol, in 33 stable symptomatic asthmatic patients. 2. Three times daily, for 10 consecutive days, the patients rated the intensity of their dyspnoea on a visual analogue scale and immediately afterwards recorded their peak expiratory flow rate. Within the next 5 days, we determined the bronchial response by measuring the forced expiratory volume in 1 s and the specific resistance of airways to either carbachol or salbutamol according to baseline airway obstruction. 3. We characterized dyspnoea for each patient by using two parameters: (1) the relationship with underlying airway obstruction, as assessed by the correlation coefficient r between dyspnoea scores and corresponding values of peak expiratory flow rate (r DSc-PEFR), and (2) the intensity, as assessed by the mean visual analogue scale dyspnoea score adjusted for comparable airway obstruction. Bronchial lability was characterized by (1) variability in mean daily peak expiratory flow rate and (2) bronchial responsiveness to either carbachol (as assessed by the threshold dose and the slope of the dose-response curve) or salbutamol (as assessed by the threshold dose and maximal response). We assessed the relationship between dyspnoea and bronchial lability by correlating each of their respective characteristics. 4. We found large inter-subject differences in both characteristics of dyspnoea, r DSc-PEFR was unrelated to variability in mean daily peak expiratory flow rate and to all characteristics of bronchial responsiveness used, except for maximal salbutamol-induced increase in forced expiratory volume in 1 s (as a percentage of predicted). Adjusted visual analogue scale dyspnoea scores were unrelated to all characteristics of bronchial lability. 5. Our results suggest that spontaneous dyspnoea, as characterized by its intensity at comparable levels of airway obstruction and by its relationship with underlying airway obstruction, is poorly related to the degree of bronchial lability in stable symptomatic asthmatic patients.