Panic Attacks and Perception of Inspiratory Resistive Loads in Chronic Obstructive Pulmonary Disease

• Published in: American journal of respiratory and critical care medicine Vol. 178; no. 1; pp. 7 - 12
• Main Authors: Livermore, Nicole, Butler, Jane E, Sharpe, Louise, McBain, Rachel A, Gandevia, Simon C, McKenzie, David K
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 01.07.2008; American Lung Association; American Thoracic Society
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anxiety; Biological and medical sciences; Chronic fatigue syndrome; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Dyspnea; Dyspnea - complications; Dyspnea - psychology; Female; Females; Forced Expiratory Volume; Humans; Hypotheses; Inhalation; Intensive care medicine; Male; Medical sciences; Middle Aged; Panic attacks; Panic Disorder - complications; Perception; Perceptions; Pneumology; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; Respiratory diseases; Vital Capacity; Work of Breathing; Lung disease; Panic; Intensive care; Respiratory disease; pulmonary disease; Anxiety disorder; Chronic; chronic obstructive; dyspnea; panic attacks; panic disorder; Dyspnea; Panic attack; Bronchus disease; Perception; Chronic obstructive pulmonary disease; Resuscitation
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.200711-1700OC

Panic attacks are common in chronic obstructive pulmonary disease (COPD), and the prevalence of panic disorder is at least 10 times higher than in the general population. In the current study, we examined resistive load perception in patients with COPD with and without panic attacks. We tested competing hypotheses, based on conflicting results of earlier studies, that those patients with COPD with panic attacks or panic disorder would show either heightened or blunted perception of dyspnea as the magnitude of inspiratory resistive loads increased. We compared 20 patients with COPD with panic attacks or panic disorder, 20 patients without panic, and 20 healthy, age-matched subjects using an inspiratory resistive load-testing protocol. We administered a diagnostic interview for panic attacks and panic disorder. We measured perceived dyspnea in response to increasing inspiratory resistive loads (modified Borg scale) and several respiratory variables. Dyspnea ratings increased linearly for all groups as the size of resistive loads increased. No significant differences were found between groups on the respiratory variables. Patients with COPD with panic attacks or panic disorder rated their level of dyspnea significantly higher than did other subjects. Patients with COPD with panic attacks showed heightened sensitivity to inspiratory loads. The result reinforces the influence of psychological factors on symptom perception in this disease.