ABSTRACT
This chapter focuses on the sensory-perceptual intensity and quality of dyspnea in chronic obstructive pulmonary disease (COPD) and on their neurophysiological underpinnings. It considers concepts of the origins of breathing discomfort in healthy individuals during exercise. The chapter examines the role of abnormal respiratory mechanics in exertional dyspnea and exercise intolerance across the continuum of COPD. It identifies targets for effective therapeutic intervention to ameliorate this distressing symptom. Dyspnea, the perception of breathing discomfort, is the most troublesome symptom reported by patients with COPD. During exercise in healthy individuals, the selected qualitative descriptors at the limits of tolerance allude mainly to the work/effort domain. Interventions such as anxiolytics, opiates, cognitive-behavioral modification, and pulmonary rehabilitation are believed to primarily address the affective dimension of dyspnea. The chapter shows that unsatisfied inspiration has its neurophysiological origins in neuromechanical dissociation or uncoupling of the respiratory system.
