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Journal Watch

Journal Watch. Jeffrey P Schaefer, MD May 8, 2007. Today's Article. This article is ‘overwhelming’ !!!. Background. we believe that body organs respond to emotional state asthma patients may experience ‘stress-associated breathlessness’ without increased airway obstruction

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Journal Watch

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  1. Journal Watch Jeffrey P Schaefer, MD May 8, 2007

  2. Today's Article

  3. This article is ‘overwhelming’ !!!

  4. Background • we believe that body organs respond to emotional state • asthma patients may experience ‘stress-associated breathlessness’ without increased airway obstruction • mental state may alter measurements of breathing

  5. Objectives • strained breathing may trigger breathlessness in asthma patients • asthma patents will feel more breathless with the same breathing pattern or with a stress induced breathing pattern

  6. Methods • ‘Study of Harm’ • normals: exposure  ?  ‘disease’ • asthma: exposure  ?  ‘disease’ • Exposure  arithmetic task • Disease  altered breathing •  breathlessness

  7. Patients • Well Children 9-13 years (7) • Children with Asthma 9-14 yr (8) • stable disease and free of infx x 1 mo • FEV1 > 70% of predicted • continue inhaled corticosteroid • STOP bronchodilator x 24 hr • informed consent

  8. Exposure ‘subtraction’

  9. Measurements • magnetometer respiration band • electromyography electrodes • Borg breathlessness scale

  10. Results

  11. Timing of Resp Muscle Activity • Phase Angle • maximum EMG should occur at maximum chest expansion • at baseline: • asthmatic children • reduce EMG activity earlier in inspiration • tend to have abdominal strain in inspiration whereas normal have abdominal strain in expiration • these effects diminish during arithmetic (distracted)

  12. ‘phase reversal’ with math*A & B*  chest expansionC & D*  frontal diaphragm EMG

  13. no sig difference  this was a ‘wash’

  14. What does this all mean?

  15. Author’s remarks • asthmatic children tend to ‘control their breathing’ possibly to reduce turbulent airflow / irritation • breathing became ‘closer to normal’ during arithmetic • WHY? • distraction  probably not • interaction between CNS and breathing in the setting of disability?

  16. Are the results of the study valid? • comparison groups similar except for factor under consideration? • similar measurements in both groups? • follow-up sufficient? • temporal relationship correct? • dose response gradient? • What are the results? • association between exposure and outcome? • precision of risk estimate? • Will the results help me in caring for my patients? • applicable to my practice? • magnitude of the risk? • stop the exposure?

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