Dyspnea and symptom amplification in asthma

Background: The severity of a patient's asthma and the intensity with which he describes his dyspnea do not correlate. Objectives: There is an indirect relationship between airway function in asthma and the intensity of dyspnea; this relationship is found only when the measure of a patient's general tendency to exaggerate the intensity of any somatic symptom is considered simultaneously. Methods: Lung function, including spirometry (forced expiratory volume in 1 s, FEV1) and plethysmography (airway resistance, R-aw), dyspnea (Borg scale score) and the tendency to exaggerate (the somatosensory amplification scale score, SSAS) have been quantified in 42 stable asthmatic patients. Results: There was no correlation between the Borg score and any spirometric or plethysmographic measure in these subjects. By contrast, there was a moderate correlation between the Borg score and the SSAS (r = 0.36, p = 0.03). However, when FEV1 or R-aw (abscissa) and Borg scores (ordinate) were converted to residuals, there was a moderate correlation between the residuals and the SSAS score (for FEV1, r = 0.33 and p = 0.05; for R-aw, r = - 0.36 and p = 0.03). Conclusion: A physician may make a reasonable estimate of an asthmatic patient's lung function from the intensity of his complaint only if he - the physician - considers the patient's tendency to symptom amplify as well. Copyright (C) 2007 S. Karger AG, Basel.