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Question: Dyspnoea persisting despite treatments of underlying causes requires symptomatic approaches. Medical hypnosis could provide relief without the untoward effects of pharmacological approaches. We addressed this question through experimentally induced dyspnoea in healthy humans (inspiratory threshold loading -excessive inspiratory effort- and carbon dioxide stimulation -air hunger-) MATERIAL AND METHODS: 20 volunteers (10 women, 21-40) were studied on 4 separate days. The order of the visits was randomised in two steps, firstly "inspiratory threshold loading first" versus "carbon dioxide first" group (n=10 in each group), secondly "medical hypnosis first" versus "visual distraction first" subgroup (n=5 in each subgroup). Each visit comprised three 5-minutes periods (reference, intervention, washout) during which participants used visual analog scales to rate dyspnoea's sensory and affective dimensions and after which they completed the Multidimensional Dyspnea Profile., Results: Medical hypnosis reduced both dimensions of dyspnoea significantly more than visual distraction (inspiratory threshold loading: sensory reduction after 5 min 34% of full VAS versus 8% -p=0.0042-; affective reduction 17.6% versus 2.4% -p=0.044-; carbon dioxide; sensory reduction after 5 min 36.9% versus 3% -p=0.0015-; affective reduction 29.1% versus 8.7% -p=0.0023-). The Multidimensional Dyspnea Profile showed more marked sensory effects during inspiratory threshold loading and more marked affective effects during carbon dioxide stimulation., Answer to the Question: Medical hypnosis was more effective than visual distraction at attenuating the sensory and affective dimensions of experimentally induced dyspnoea. This provides a strong rationale for clinical studies of hypnosis in persistent dyspnoea patients., (Copyright ©The authors 2024.)

Background: In critically ill patients receiving mechanical ventilation, dyspnoea is frequent, severe and associated with an increased risk of neuropsychological sequelae. We evaluated the efficacy of sensory interventions targeting the brain rather than the respiratory system to relieve dyspnoea in mechanically ventilated patients., Methods: Patients receiving mechanical ventilation for ≥48 h and reporting dyspnoea (unidimensional dyspnoea visual analogue scale (Dyspnoea-VAS)) first underwent increased pressure support and then, in random order, auditory stimulation (relaxing music versus pink noise) and air flux stimulation (facial versus lower limb). Treatment responses were assessed using Dyspnoea-VAS, the Multidimensional Dyspnea Profile and measures of the neural drive to breathe (airway occlusion pressure ( P 0.1 ) and electromyography of inspiratory muscles)., Results: We included 46 patients (tracheotomy or intubation n=37; noninvasive ventilation n=9). Increasing pressure support decreased Dyspnoea-VAS by median 40 mm (p<0.001). Exposure to music decreased Dyspnoea-VAS compared with exposure to pink noise by median 40 mm (p<0.001). Exposure to facial air flux decreased Dyspnoea-VAS compared with limb air flux by median 30 mm (p<0.001). Increasing pressure support, but not music exposure and facial air flux, reduced P 0.1 by median 3.3 cmH 2 O (p<0.001)., Conclusions: In mechanically ventilated patients, sensory interventions can modulate the processing of respiratory signals by the brain irrespective of the intensity of the neural drive to breathe. It should therefore be possible to alleviate dyspnoea without resorting to pharmacological interventions or having to infringe the constraints of mechanical ventilation lung protection strategies by increasing ventilatory support., Competing Interests: Conflict of interest: M. Decavèle reports personal fees from Isis Medical, outside the submitted work. M. Dres reports grants and personal fees from Lungpacer Inc., outside the submitted work. T. Similowski reports personal fees from ADEP Assistance, AstraZeneca France, Boehringer Ingelheim France, Chiesi France, GSK France, Lungpacer Inc., Novartis France and Teva France, outside the submitted work; and in addition has a patent for a brain–ventilator interface licensed, and patents for a protection device for intubation and a noncontact thoracic movement imaging system pending. A. Demoule reports personal fees from Medtronic, Baxter, Hamilton and Getinge, grants and personal fees from Philips and Respinor, personal fees and nonfinancial support from Fisher & Paykel, grants from the French Ministry of Health, and grants and nonfinancial support from Lungpacer, outside the submitted work. All other authors have nothing to disclose., (Copyright ©The authors 2024. For reproduction rights and permissions contact permissions@ersnet.org.)

Question Addressed: In contrast with pain, dyspnoea is not visible to the general public, who lack the corresponding experiential baggage. We tested the hypothesis that the generalised use of face masks to fight severe acute respiratory syndrome coronavirus 2 dissemination could change this and sensitise people to respiratory health., Methods: General population polling (1012-person panel demographically representative of the adult French population, quota sampling method; 517 (51%) female). 860 (85%) answered "no" to "treated for a chronic respiratory disease" ("respiratory healthy"), and 152 answered "yes" ("respiratory disease"). 14% of respiratory healthy respondents reported having a close family member treated for a chronic respiratory disease (RH-family + ). Respondents described mask-related attitudes, beliefs, inconveniencies, dyspnoea and changes in their respiratory health vision . RESULTS: Compliance with masks was high (94.7%). Dyspnoea ranked first among mask inconveniencies (respiratory disease 79.3%, respiratory healthy 67.3%; p=0.013). "Air hunger" was the main sensory dyspnoea descriptor. Mask-related dyspnoea was independently associated with belonging to RH-family + (OR 1.85, 95% CI 1.16-2.98) and removing masks to improve breathing (OR 5.21, 95% CI 3.73-7.28). It was negatively associated with considering masks effective to protect others (OR 0.42, 95% CI 0.25-0.75). Half the respondents were more concerned with their respiratory health since wearing masks; 41% reported better understanding patients' experiences., Answer to the Question: Wearing protective face masks leads to the mass discovery of breathing discomfort. It raises public awareness of what respiratory diseases involve and sensitivity to the importance of breathing. These data should be used as the fulcrum of respiratory health oriented communication actions., Competing Interests: Conflict of interest: L. Serresse has nothing to disclose. Conflict of interest: N. Simon-Tillaux has nothing to disclose. Conflict of interest: M. Decavèle has nothing to disclose. Conflict of interest: F. Gay has nothing to disclose. Conflict of interest: N. Nion has nothing to disclose. Conflict of interest: S. Lavault has nothing to disclose. Conflict of interest: A. Guerder has nothing to disclose. Conflict of interest: A. Châtelet is an employee of the IFOP polling institute. Conflict of interest: F. Dabi is an employee of the IFOP polling institute. Conflict of interest: A. Demoule reports grants, personal fees and non-financial support from Philips, Respinor and Lungpacer, personal fees from Baxter, Getinge, Lowenstein and Gilead, personal fees and non-financial support from Fisher & Paykel, grants from French Ministry of Health, outside the submitted work. Conflict of interest: C. Morélot-Panzini reports personal fees for lectures and board membership from AstraZeneca, GSK, SOS Oxygène, ADEP, ISIS, Resmed, Chiesi, Menarini, Vivisol, Air Liquide, Lowenstein, Fisher & Paykel, outside the submitted work. Conflict of interest: C. Moricot has nothing to disclose. Conflict of interest: T. Similowski reports personal fees from AstraZeneca France, Boehringer Ingelheim France, TEVA France, Chiesi France, Lungpacer Inc. and ADEP Assistance, personal fees and non-financial support from Novartis France, grants from Air Liquide Medical Systems, outside the submitted work., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

Dynamic hyperinflation is observed during exercise in 60% of patients with clinically stable pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), intensifying exertional dyspnoea. The impact of dynamic changes in respiratory mechanics during exercise on qualitative dimensions of dyspnoea in these patients has not been evaluated.26 patients (PAH n=17; CTEPH n=9) performed an incremental symptom-limited cycle exercise test. Minute ventilation ( V ' E ), breathing pattern, operating lung volumes and dyspnoea intensity were assessed throughout exercise. Dyspnoea quality was serially assessed during exercise using a three-item questionnaire (dyspnoea descriptors). The inflection point of tidal volume ( V T ) relative to V ' E was determined for each incremental test. Changes in inspiratory capacity during exercise defined two groups of patients: hyperinflators (65%) and non-hyperinflators (35%). Multidimensional characterisation of dyspnoea was performed after exercise using the Multidimensional Dyspnea Profile.In hyperinflators, inspiratory capacity decreased progressively throughout exercise by 0.36 L, while remaining stable in non-hyperinflators. The "work/effort" descriptor was most frequently selected throughout exercise in both types of patients (65% of all responses). At the V T / V ' E inflection, work/effort plateaued while "unsatisfied inspiration" descriptors became selected predominantly only in hyperinflators (77% of all responses). In the affective domain, the emotion most frequently associated with dyspnoea was anxiety.In pulmonary hypertension patients who develop hyperinflation during exercise, dyspnoea descriptors referring to unsatisfied inspiration become predominant following the V T / V ' E inflection. As these descriptors are generally associated with more negative emotional experiences, delaying or preventing the V T / V ' E inflection may have important implications for symptom management in patients with pulmonary hypertension., Competing Interests: Conflict of interest: A. Boucly reports personal fees and non-financial support from Actelion Pharmaceuticals and Merck, non-financial support from Bayer HealthCare and GlaxoSmithKline, outside the submitted work. Conflict of interest: C. Morélot-Panzini reports personal fees from AstraZeneca, Chiesi, Boehringer Ingelheim, Novartis, Philips, ADEP and SOS Oxygene, outside the submitted work. Conflict of interest: G. Garcia has nothing to disclose. Conflict of interest: J. Weatherald has nothing to disclose. Conflict of interest: X. Jaïs reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, Bayer HealthCare, GlaxoSmithKline and MSD, outside the submitted work. Conflict of interest: L. Savale reports grants and personal fees from Actelion Pharmaceuticals and Bayer HealthCare, personal fees from GlaxoSmithKline and Merck, outside the submitted work. Conflict of interest: D. Montani reports grants and personal fees from Actelion Pharmaceuticals and Bayer HealthCare, personal fees from GlaxoSmithKline, Novartis, Pfizer and BMS, outside the submitted work. Conflict of interest: M. Humbert has relationships with drug companies including Actelion, Bayer, GSK, Merck and United Therapeutics; in addition to being investigator in trials involving these companies, relationships include consultancy services and membership of scientific advisory boards. Conflict of interest: T. Similowski reports personal fees from AstraZeneca, Boehringer Ingelheim France, GSK, Lungpacer Inc., TEVA, Chiesi and Invacare, personal fees and non-financial support from Novartis, outside the submitted work. Conflict of interest: O. Sitbon reports grants, personal fees and non-financial support from Actelion Pharmaceuticals and GlaxoSmithKline, personal fees from Acceleron Pharmaceuticals, Arena Pharmaceuticals and Gossamer Bio, grants and personal fees from Bayer HealthCare and Merck, outside the submitted work. Conflict of interest: P. Laveneziana reports personal fees from Novartis France and Boehringer France, outside the submitted work., (Copyright ©ERS 2020.)