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A 60
year old business executive seeks your advice about a worsening
sense of shortness of breath that he has been experiencing. In
high school and college, he was a competitive athlete, but in
the last 35 years he has been too busy with his work and family
to get any regular exercise. He decided recently to start jogging
again and is distraught over the "heavy breathing" he
experiences when trying to run a 9-minute mile. Pulmonary function
tests, chest radiograph, and cardiac stress test are all normal.
Question
3.3
The most
likely explanation for the patient's respiratory discomfort is:
 | Anxiety |
 | Misperception
due to previous experience as an athelete |
 | Depression |
 | An
undiagnosed cardiopulmonary disease |
Finally, dyspnea may
itself affect physiological and behavioral responses. In a previous
question we examined the breathing discomfort experienced by an
individual with severe COPD who, as a result of his breathlessness,
had altered his lifestyle in a way that changed his physiology
(he developed peripheral muscle and cardiovascular deconditioning).
This negative feedback loop, or downward spiral of deconditioning,
is illustrated in the following figure:
| Figure
3.1: The Dyspnea Spiral
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| Reprinted
from Haas F, Salazar-Schicchi J, Axen K. Desensitization
to dyspnea in chronic obstructive pulmonary disease.
In: Casaburi R, Petty TL, eds. Principles and Practice
of Pulmonary Rehabilitation. Philadelphia, PA, WB Saunders
Company; 1993:241-25. |
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