The effect of unpredictability on the perception of breathlessness: a narrative review.
Fabien Pavy, Diana M Torta, Andreas von Leupoldt
PMID 38264214WHAT IT FOUND
Experimental studies found that unpredictable breathlessness triggers more sustained fear and anxiety than predictable breathlessness.
This constant threat worsens the unpleasantness of the sensation, even if the physical intensity remains unchanged, suggesting that managing patient expectations and control is as vital as treating the breathing itself.
Key findings
01Unpredictable breathlessness induces more anxiety and fear than predictable breathlessness, with fear sustained throughout the episode rather than alternating with safe phases.
02Unpredictability primarily affects the unpleasantness of breathlessness rather than its perceived intensity, with inconsistent findings on whether intensity ratings change.
03Trait fear of suffocation amplifies state fear in unpredictable contexts, while high anxiety sensitivity is linked to increased breathlessness unpleasantness.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review included only nine experimental studies. All participants were healthy volunteers, so the findings may not generalize to patients with clinical breathlessness. The studies used various methods to induce breathlessness, making direct comparisons difficult. Results regarding neural correlates and specific physiological markers were inconsistent and scarce.
Declared interests
The research was supported by grants from the Research Foundation Flanders, the Research Fund KU Leuven, and the Flemish Government. No commercial conflicts of interest were declared.
The easy way to misread this
Do not assume that making breathlessness predictable will reduce its physical intensity. The review found that unpredictability primarily increases the unpleasantness and fear associated with breathlessness, while the intensity ratings were not consistently affected. Therefore, interventions should target the emotional and cognitive response to the sensation, not just the sensation itself.