Relative breathless: Comparison with others can affect feelings of breathlessness.

ContentslistsavailableatScienceDirect

Biological

Psychology

j ou rn a l h o m epa g e : w w w . e l s e v i e r . c o m / l o c a t e / b i o p s y c h o

Abstracts

Proceedings

of

the

20th

annual

meeting

of

the

International

Society

for

the

Advancement

of

Respiratory

Psychophysiology

(ISARP)

Leuven,

Belgium,

September

27–29,

2013

夽

Elke

Vlemincx

UniversityofLeuven,Leuven,Belgium

The 20th annual meeting of the International Society for theAdvancementofRespiratoryPsychophysiologytookplaceon September27–29, 2013inLeuven, Belgium.In thefootstepsof ISARP’s history, the meeting’s attendees represented a variety of disciplines (psychology, biology, physiology, medicine) shar-inganinterestinthephysiologicalandpsychologicalmechanisms ofbreathing, both froma fundamentaland clinicalperspective. Researchersandclinicalpractitioners,seniormembers,new mem-bersandstudentspresentedtheirworkduringoralpresentations inoneofthesymposiaorininteractivediscussionsduringposter session.

Thefocusofthefirstsymposiumwastheinteractionbetween emotionsandthedynamicsoftherespiratoryandthe cardiovas-cularsystem.P.Lehrergaveatheoreticaloverviewofhowsystem andcontroltheorycanimproveourunderstandingofrespiratory andcardiovascular (in)stabilityduringemotionsand stress,and in health and disease.C. Sevoz-Couche discussed theeffects of respiratoryloadsoncardiovascularmeasuresofstress.M. Grass-mannpresenteddataonrespiratorymeasuresduringmentalload in a specificsample of pilotcandidates.J. vanDixhoorn talked abouttherelationbetweenrespiratorysymptomsandgeneral dis-tressandupperthoracicbreathing.E.Vlemincxpresentedresults onthereliefeffects ofsighs.J.-M.Ramirez introducedhiswork on the neurobiology of sighs, discussing the different cellular mechanismgeneratingandmodulatingsighsinthepre-boetzinger complex.

Duringthesecondsymposium,theneuralprocessingof dys-pneawasdiscussedindepth.K.Pattinsonreviewedtheadvantages, thechallenges and the pitfalls when using FMRI toinvestigate neural mechanisms of breathing and breathing symptoms. T. Similowski gave an overview of studies investigating the role ofthesupplementarymotor areainrespirationand respiratory symptomsusingTMS,EEGandFMRI. M.C.Stoeckelpresented a studyinvestigatingthebrainregionsinvolvedintheanticipation ofdyspneausingFMRI.A.vonLeupoldtshowedFMRIdataofthe influencesofgeneticsandcatastrophizingontheneuralsubstrates

夽 Abstractsaregiveninalphabeticalorder.

ofanticipationandperceptionofdyspnea.K.C.Evanspresentedan arterialspinlabeledFMRIstudyshowingdifferentialeffectsofair hungeroninsularactivationinhealthypersonsandpanicdisorder patients.P.W.Davenportconcludedthesymposiumpresentinga respiratoryafferentintegrationmodelofdyspnea.

The third symposium consisted of a profound discussionof potentialtreatmentsandtreatmentimplicationsforasthmaand COPD. A.Harver presentedthe outcomesofa pulmonary reha-bilitation in COPD patients. S. Miller showed the importance ofpsychologicalcomorbiditiesin femaleCOPDpatients, specifi-cally,forpractice.P.Lehrerdiscussedthepreliminaryresultsof a heart rate variability biofeedback trialin asthma patients. D. KoinisMitchellexplainedtheresponsebehaviorsinurban fam-ilieswithchildrenwithasthma,andhowtheyrelatetoasthma symptoms.

Inthefourthsymposium,theimportanceofswallowing,cough and urge tocoughfor airway protectionwasdiscussed in var-iouspatient groups. E.Silvermanpresented data ontheeffects of expiratorymusclestrengthtraining in swallow-related qual-ityoflifeinpatientswithmultiplesclerosis.P.Davenport, K.W. Hegland and M. Troche discussed the reduced sensitivity to coughandurgetocoughinducedbycapsaicininvariouspatient groups,suchassarcopeniaandParkinson’sdiseasewithorwithout dysphagia.

Thefifthsymposiumconsistedofthediscussionofdyspneaand asthmaperceptioninbothhealthypersonsandasthmapatients. K.Arcoleodescribedethnicandsociodemographicdifferencesin illnessrepresentationsofparentsoftheirchildren’sasthmaand howtheserelatetotheirasthmacontrol.J.Feldmanshowedthe effectsofdepressionandanxietyofbothchildrenwithasthmaand caregiversonasthmaperceptionandasthmacontrol.S.Petersen discussedhowsocialcomparisonsinfluencedyspneaperception. M.Walentynowiczpresenteddataondyspneamemoryinhighvs. lowhabitualsymptomreporters.

Duringtheinvitedaddresses,K.Schruersintroduceda trans-speciesexperimentalmodelofpanic,supportedbyanoverviewof studiesinpanicpatients,healthypersonsandrodents.T.Troosters discussedtheeffectivityofphysicalactivityinpulmonary rehabil-itationprograms.

http://dx.doi.org/10.1016/j.biopsycho.2014.11.013

Respiratorycompensatoryresponsestohypercapniafollowing multipleover-pressurizationblastinjuriesinrats

SherryAdams1_{,JillianA. Condrey}1_{,Hsiu-WenTsai}1_,VictorPrima2_,

StanislavI.Svetlov2,3_{,PaulW.Davenport}1

1_{Department of Physiological Sciences, University of Florida,}

Gainesville, FL 32610, USA2_{Banyan Laboratories Inc., Alachua,}

FL,USA3_{DepartmentofPhysiologyandFunctionalGenomics,}

Univer-sityofFlorida,Gainesville,FL,USA

Background.Anover-pressurizationblast(OB)injuryinrats repli-catestraumaticbrain injury(TBI). Soldierscansustainmultiple TBIsfromexposuretoIEDs.TheOBinjuryisaclosed-headbrain injurythat isreproducible,repeatableandresultsin alterations in respiratory reflexes.The rat OB model was used totest the hypothesisthat multipleOBexposures wouldresultin changes in the response to hypercapneic challenge. Methods. The ani-malswereanesthetizedandinstrumentedwithdiaphragmEMG (dEMG)andthenallowedtorecover3–7days.ThefirstOBinjury wasproducedbyacompressedair-drivenshocktubedirectedat thedorsalsurfaceofskullwithanaveragepeakoverpressureof 80.08_±8.59.Theanimalswereallowedtorecoverfor14days.The secondOBinjury wasproducedwithasabovewithanaverage peakoverpressureof80.53±12.18.HypercapneictrialswithdEMG recordingswereobtained48hpre-OBand48hpost-OB1and48h post-OB2.Thehypercapneictrialstartedwith2.5minofbaseline recordingwith100%O2,thentheanimalswereexposedto4%CO2

for5minfollowedby2.5minofpost-hypercapniabaselineat100% O2.dEMGwasrecordedonPowerLabusedtodetermineintegrated

dEMGamplitude,inspiratorytime(Ti),expiratorytime(Te),total

breathtime (Ttot)andfrequency. Results.For pre-OB, post-OB1

andpost-OB2,4%CO2significantlyincreasedamplitude.Ti,Teand

Ttotsignificantly decreased duringhypercapnia. Therewereno significantdifferencesbetween pre-OB, post-OB1 and post-OB2 duringthemid-hypercapneicperiodinamplitude,Ti,Te,Ttotand frequency. There was a significant treatment effect pre-OB vs. post-OBforonlyTeduringtheend-hypercapneicperiod,Tewas significantlylongerinthepost-OBtrials.Discussion.Theseresults suggestthat OB injury modulated thehypercapneic ventilatory response. The second OB injury did not produce an additional effectonhypercapneicsensitivity.

Inhibitionofthestartlereflexduringinteroceptivethreat: A shiftinattentio?

ManuelaG.Alius,Christiane A.Pané-Farré,Andreas Löw,AlfonsO. Hamm

Department of Biological and Clinical Psychology, University of Greifswald,Germany

Background.Respirationisessentialforlife.Therefore,the restric-tion of breathing is a highly aversive state. Research showed thatthestartlereflexispotentiatedduringacompletebreathing occlusion,whichisin linewiththetypically potentiatedstartle reflex during aversive emotional states. However, studies also indicatedthatthestartleamplitudetoanacousticprobeisreduced when attention is allocated away from the auditory channel, as might be the case when subjects are confronted with an interoceptivethreatlikerestrictedbreathing.Method.Therefore, wemeasuredstartlereflex,respirationandERPs (probe-evoked P3)in34 participantsduringphaseswearinga“facemaskwith tubing”(fourtimes),a“facemaskwithouttubing”(once)or“no facemask”(fourtimes)inawithin-subjectdesign.Duringeachof thesephaseseightacousticstartleprobeswerepresented.Results.

Participants showed the typical pattern of loaded breathing, characterizedbyincreasedinspiratoryflowrate,tidalvolumeand minuteventilation accompaniedby slowerbreathing frequency

duringthe“facemaskwithtubing”condition.Furthermore,they reportedhigher subjective unpleasantness and a higher degree ofsubjectivebreathingrestriction.Thispatternwasnotobserved duringphases “face mask withouttubing”and “no face mask”. Interestingly,thestartlereflexwasinhibited,when participants worethefacemask,eitherwithorwithouttubing,comparedtono facemask.Moreover,theamplitudeoftheprobeP3wasreduced duringphaseswithfacemaskcomparedtonofacemask,indicating thatattentionwasshiftedawayfromtheacousticstartleprobes towardsthepossibleinteroceptivethreat,andinturn,leadingtoa reductionofstartleamplitude.Discussion.Studyresultsindicated thatstartleresponsesarealsomodulatedbyattentionalprocesses incross-modaldesignstypicallyusedwhenstudyinginteroceptive threat.

Influence ofparentalasthmaillness representationson chil-dren’scontrollermedicationuseandasthmacontrol

KimberlyArcoleo1_{,JonathanFeldman}2

1_{The Ohio State University, College of Nursing, Columbus, OH,}

USA2_{Yeshiva University, Ferkauf Graduate School of Psychology,}

Bronx,NY,USA

Background.Researchexaminingparents’asthmaillness repre-sentations (AIR) on compliance withtheir children’s controller medication regimen and subsequent asthma control is in its infancy.Parentalethnicity,education,age,povertystatus, depres-sion,andacculturationmaybeafactorinAIRsalignedwiththe lay model of asthma management; which has been associated withinadequatemedicationregimensand increasednumber of acutevisits.Methods.1-yearlongitudinalstudyof300Mexican andPuertoRicanmothersand300childrenages5–12w/asthma recruitedfrom2school-basedhealthcentersandBreathmobilein Phoenix,AZand1pediatricasthmaandallergyclinicinBronx,NY. InterviewsandchildPFTsatbaselineand3,6,9,and12months; medical recordreviews at12 months. Preliminaryresultsfrom N=245 baseline interviews. SEM examined direct and indirect effectsofparentcharacteristicsandAIRsonchildren’scontroller medicationuseandclinician ratedasthmacontrol.Results.The data fit the hypothesized model well (RMSEA=.04, CFI=.90, X2_{=.19).Parentsreportinglowerdepressivesymptoms,notliving}

in poverty, higher education, and Mexican ethnicity had AIRs aligned with the professional model. No effects observed for acculturation.AIRscongruentwiththeprofessionalmodelwere associated withincreased controller medicationuseand better asthmacontrol.Therewasasignificantindirecteffectofparents’ educationthroughAIRSoncontrollermedicationuseandatrend forethnicityandpoverty.Therewerenosignificantindirecteffects ofparentcharacteristicsonAIRs,controllermedicationuseand asthma control. Discussion. These preliminary findings reveal significant ethnic and sociodemographic differences in asthma illness representations which are directly related to children’s controller medication use and asthma control. During clinical encounterswithparents,weneedtoassesstheseillnessbeliefsin ordertoarriveatasharedasthmamanagementplanwhichwill resultinoptimalhealthoutcomesforthechild.

Perceived control increases effort in a breathing challenge despiteincreasedperceivedstimulusintensity

JessicaBaeske1_{,SibyllePetersen}2

1_{University of Dortmund, Department of Rehabilitation Sciences,}

Germany2_{KULeuven,ResearchGrouponHealthPsychology,Belgium}

particularlyinindividualshighinnegativeaffect.However,little is known on whether increased breathing effort under higher perceivedcontrolmight mediatetherelationshipbetween dys-pneaandperceivedcontrol.Method.Wemanipulatedperceived controlandself-efficacyin50healthyparticipants(n=24,higher perceivedcontrolHPC/n=26,lowerperceivedcontrolLPC).All par-ticipantscompletedthreebreathingtaskswithrespiratoryloadsof 6,9,and16cmH2O(orderrandomized).Wemeasuredrespiratory

flowandpressurebreathbybreathandparticipantsratedstimulus intensity.Furthermore,participantscompletedquestionsonstate andtraitnegativeaffect,successinperformingthebreathingtask, andtraitlocusofcontrol.Results.IntheHPCgroup,ratingsof stim-ulusintensityandunpleasantnessweresignificantlyhigherthan intheLPCgroup.However,intheHPCgroupinspiratorypressure andflowwerealsohigherindicatinghighereffort.Furthermore, perceivedsuccessincompletingthetaskwashigherintheHPC groupdespitehigherdyspnearatings.Locusofcontrolhad signif-icantinfluenceonrespiratory effort,butonlyin theLPCgroup. Negativeaffecthadnosignificantinfluenceonresults.Discussion.

Resultssuggestthathigherperceivedcontrolisrelatedtohigher effortinvested in a breathing task despiteincreased perceived stimulus intensity. Results suggest that increasing perceived self-efficacy can substantially increase respiratory exercise performance.

Modulation of chewing, swallow andrespiration duringthe stimulationoftwocorticalmasticatoryareasintheratbrain

JillianA.Condrey,Hsiu-WenTsai,PaulW.Davenport

DepartmentofPhysiologicalSciences,UniversityofFlorida,Gainesville, FL,USA

Background.Theoralphaseofswallowisundercognitivecontrol whereasthepharyngeal phase isunderreflexand cortical con-trol. Thereare distinct corticalmasticatory areas,CMAs, which inducedifferentpatternsofjawmovementswhenstimulated:the A-areaintheorofacialmotorcortexandtheP-areaintheinsular cortex.SwallowingisinhibitedduringA-areastimulationbutnot P-areastimulation.Chewingis notcoordinatedwithrespiration while swallowingis;pharyngeal phase swallowapnea protects theairway from aspiration. Theneural integration of chewing, swallowingandbreathingarepoorlyunderstood.Wetestedthe hypothesisthatstimulationoftheA-areawillnotalterbreathing but will inhibit swallowing, however, P-area stimulation will elicitswallows that causea modulationin breathing. Methods.

AnimalswereimplantedwithEMGelectrodesunilaterallyinthe caudal digastricus, inferior pharyngeal constrictor, diaphragm and bilaterallyin themasseter and cranialdigastricus muscles. After4–7days recovery,theratswereanesthetizedand placed ina stereotaxicapparatus.TheCMAswereexposed. A-areaand P-area were stimulated using a concentric electrode at 30Hz, 0.02ms pulsewidth with1–10strains.Swallows were elicited by probing the oropharynx before, during and after cortical stimulation.Results.Swallowselicitedbeforecorticalstimulation increased Te and Ttot. A-area stimulation elicited only chewing

muscleactivitywithnosignificanteffectonTi,TeorTtot.P-area

stimulation elicited swallow muscle activity and increased Te and Ttot withno chewing.Swallows occurredafter the cessa-tionofP-area stimulation.Increasedstimulusmagnitudeinthe P-area recruited chewing and increased breathing frequency.

Discussion. These results suggest that A-area stimulation acti-vates motor pathways that induce chewing but do not inhibit swallow or respiration. P-area stimulation activates pathways thatelicitswallowsandmodulatebreathingpattern.Wesuggest thattheseareasareinvolvedincognitivecontrolofupperairway behavior.

Emotional influences on symptom reporting: The effects of emotionregulation

ElenaConstantinou, Maaike Van denHoute, Katleen Bogaerts,Ilse VanDiest,OmerVandenBergh

HealthPsychology,UniversityofLeuven,Belgium

Background.Concurrentprocessingofunpleasantstimuliinduces elevatedsymptomreporting,especially inpersonswhoare vul-nerable towards symptom over-reporting. The present study examines whether applying an emotion regulation technique, i.e., affectlabeling,can reversethese effects. Method.Students (N=61, 7males)completedsix pictureviewingtrials, including either pleasant or unpleasant pictures (10 pictures×6s each per trial) under three conditions: merely viewing, emotional labeling or content (non-emotional) labeling. After each trial, valence and arousal ratings and a symptom checklist, which included two respiratory sensations, were completed. Results.

Repeated Measures ANCOVAs with scores on habitual symp-tom reporting (HSR) as a continuous predictor indicated that unpleasantpictureviewingledtoanincreaseinsymptomreports compared tothepleasant trials.Labeling(eitheremotionallyor non-emotionally) the unpleasant pictures significantly reduced the reporting of both symptoms in general and respiratory specific ones compared to merely viewing. Furthermore, HSR scores predicted elevated symptom reports after unpleasant pictureviewing,butbothlabelingconditionsreducedthiseffect.

Discussion. Applying an emotion regulation strategy, such as labeling emotional stimuli, can reduce the augmenting effects of unpleasant cueson thesubjective experience and reporting ofsymptoms. Thesefindingsprovide indicationsfor the useful-nessofemotion-regulationstrategiesforhighhabitualsymptom reporters.

Bedsidemethodtoassessdyspnea-paincounter-irritation

L.Dangers,L.Laviolette,T.Similowski,C.Morelot-Panzini

Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-SalpêtrièreandER10,UniversitéParis6PierreetMarieCurie,Paris, France

Background. Counter-irritation is the attenuation of a painful sensationby a newlyoccurring heterotopicstimulusthat must benoxious in nature.Dyspnea-pain counter-irritation hasbeen described with experimental dyspnea of the work/effort type, withdyspneainhibitinglaserevokedcorticalpotentialsandRIII flexion reflex.Painpressure threshold (PPT) usingalgometryis aneasytouseandreliablemodeltoinduceacuteexperimental pain.Theeffectofexperimentalwork/effortdyspneaonPPThas not beenstudied. Theobjective of thestudywas toassess the effects of experimental work/effort dyspnea on PPT. Methods.

forassessingdyspnea-paincounterirritationthatcouldbeapplied inpatientpopulations.

Afferentintegrationofrespiratorysensoryinformation medi-atingdyspnea

PaulW.Davenport

DepartmentofPhysiologicalSciences,UniversityofFlorida,USA Ithaslongbeenrecognizedthatcognitiveperceptionsof respi-ratory sensations has multiple expressions. These expressions havedivergentandconvergentsensoryelements.Theintegration ofthe multiplesensory systems affectedby respiratory stimuli allows for a high level of specificity for discrimination of the origin and modality of the respiratory perturbation. A model is proposed (the respiratory afferent integrator) to provide a sensory neural processing framework for understanding how multiple afferent systems mediate unique respiratory sensory modalities.Afferentsarethefirstorderofinputforsensoryneural processingofrespiratorystimuli.Theafferentsaremodulatedby ventilatory related changes in mechanics, blood, cerebrospinal fluidandenvironmentalstate.Multiplepopulationsofafferents project to specific neurons within the central nervous system synapsingonsecondorderafferentintegratorneurons.Thesecond orderneuronsreceiveconvergent anddivergentafferent inputs formingsubpopulationsofneuronsthatareactivatedbyunique combinationsofinputsfromgroupingsofsensoryafferents.The second order subpopulations have convergent and divergent projection combinations on higher order neural networks. In thisinitialiterationoftheafferentintegratormodelofdyspnea, specificrespiratory sensations are elicited asa result of higher brainnetworkactivationbymultiplesensorysystemtransduction ofrespiratory relatedstimuli formingmodality specificafferent convergenceson second order afferent integratorneurons that form subpopulation projections to higher brain center neural networks.

Interoceptivefearconditioningandpanicdisorder:A differen-tialdesignusinginspiratoryresistiveloadsand35%CO2

KlaraDeCort1*_{,IlseVan Diest}2_{,Anouk Janssen}1_{,Meike Pappens}2_,

OmerVandenBergh2_{,LiesGoossens}1_,EricGriez1_{,KoenSchruers}1,3 1_{MaastrichtUniversity,InstituteforMentalHealthandNeuroscience,}

TheNetherlands2_{University ofLeuven, ResearchGroupHealth}

Psy-chology, Belgium3_{University of Leuven, Center for Learning and}

ExperimentalPsychopathology,Belgium

Background.Interoceptivefearconditioninghasbeenproposedto explainwhyonlyaminorityofthepersonswhoeverexperienced a panic attack develop panic disorder. Method. In this study, interoceptivefearlearningwasinvestigatedwithpanic-relevant inspiratory resistive loads as conditioned stimuli and a single inhalationof35%CO2astheunconditionedstimulus.Highandlow

anxietysensitivityhealthyparticipants(N=66)receivedeithera moderateintensityloadfollowedbytheUCS(CS+)andalightload followedbyroomairbreathing(CS−)orthereversedcombination. ThreeCS+and3CS−acquisitiontrialswerefollowedbythesame numberoftesttrialsinwhichnoUCSwereadministered.Results.

Self-reportedanxiety,breathing behavior andskinconductance duringtheCSsintheacquisitionphase wasdominatedbymere respondingtothedifferencesinloads,especiallyinparticipants scoringlowonanxietysensitivity.Despite theseloadeffects in acquisition,learning-related differencesin thetest phase could bedemonstratedinallmeasurements.Withregardtobreathing behaviorsignificantdifferentrespondingshoweduptothelight loadasCS+comparedtoasCS_−.Whereasforself-reportedanxiety a conditioning effect was shown towards the moderate load.

Furthermore,a significantconditioningeffect emerged for skin conductance responses. Interestingly, although discriminative learning seems irrespective of anxiety sensitivity, participants scoring high on anxiety sensitivity stayed aroused during the testphase. Discussion.Thepresentstudygives indicationsthat slightfeelingsofdyspneacanbecomeapredictorofpanicattacks afterconditioning.Moreover,participantsscoringhighonanxiety sensitivityappeartomaintainahigherlevelofanxietyandarousal acrossthetesttrialsindicatingreducedextinction.Thisseemsin linewiththeclinicalfeatureofpersistentanticipatoryanxietyin PDpatients,evenintheabsenceofapanicattack.

CorrelatesofsymptomconfusioninLatinoswithasthmaand panicdisorder

NinaEisenberg1_{,JonathanFeldman}1,2

1_{Ferkauf Graduate School of Psychology, Yeshiva University,}

USA2_{Department of Epidemiology and Population Health, Albert}

EinsteinCollegeofMedicine,YeshivaUniversity,USA

Background. Panic disorder is more common in adults with asthmathanthegeneralpopulation.Confusionbetweenasthma and panic symptoms is common and can interfere with both asthmaand anxietymanagement. Theaimofthis studywasto identifycorrelatesof symptom confusionin Latino adults with comorbid asthma and panic disorder. Methods. Data for these analyses(N=55)were takenfrombaseline assessmentsas part of a larger randomized-controlled treatment study for Latinos withcomorbidasthmaandpanicdisorder.Interviewersassessed allDSM-IV-TRpanicattacksymptomsandratedtheparticipant’s abilitytodistinguishbetweenpanicandasthmasymptomsusing a 5-point scale. Assessment also included physician-classified asthma severity,control, and the PanicDisorder SeverityScale (PDSS). Pearson correlations and one-way analysis of variance wereusedtoexploreassociationsandbetween-groupdifferences.

Results. Symptom confusion was significantly associated with number of reported cardio-respiratory panic symptoms (r=.31, p=.02) but not somatic (r=.12, p=.40) or cognitive symptoms (r=.03, p=.83). There were no significant differences between asthmaseveritycategoriesonabilitytodistinguishbetweenpanic andasthmasymptoms(F[2,48]=1.07,p=.35),andnosignificant associationbetween ability todistinguishsymptoms and panic disorder severity (r=.07, p=.64). Differences between asthma control categories approached significance for ability to distin-guishbetweenpanicandasthmasymptoms(F[2,48]=2.75,p=.07). Oneitem includedinassessment ofasthma control,a ratingof subjectiveinterferenceduetoasthma,wasassociatedwith symp-tomconfusion(r=.32,p=.03).Discussion.Abilitytodistinguish betweenpanic and asthma symptomswas not associated with asthma severity or panic severityin this population. However, symptomconfusionwasassociatedwithacardio-respiratorypanic symptomconstellationandgreatersubjectiveimpairmentdueto asthma.

Airhungerevokesgreateranxietyandinsularcorticalactivity inpanicdisorderthaninhealthyindividuals:Anarterialspin labeledfMRIstudy

KarleytonC.Evans1,2_{,Tian-YueSong}1_{,JaredP.Zimmerman}1_,Michael

J.Gustin1_{,DonaldG.McLaren}2,3

1_{DepartmentofPsychiatry,MassachusettsGeneralHospital,Boston,}

MA,USA2_{HarvardMedicalSchool,Boston,MA, USA}3_Departmentof

Neurology,MassachusettsGeneralHospital,Boston,MA,USA

Thispulsed arterialspin-labeled functionalmagnetic resonance imaging(pASL-fMRI)studytestedfordifferentiallimbicregional cerebralblood flow (rCBF) in PDpatientscompared tohealthy controls(HCs)during air hungerstimuli. Method.Thirty-seven subjects(19-PD/18-HC)werefirstdiagnosticallyscreenedandthen trainedtoreceivemechanicalventilationviamouthpieceduring twomockscansessions.Subjectssubsequentlyunderwenta 16-minpASL-fMRIscan (3-T; TR/TE/TI1/TI2=3000/15/600/1600ms) onmechanicalventilation.Airhungerwasprovokedduring80-s periodsoflowtidalvolume(Vt; mean=0.67L),alternatingwith

relief periodsof high Vt (mean=1.08L)at constant respiratory

rate (12bpm) and constant elevated end-tidal carbon dioxide (4.1mmHg above resting level). Anxiety ratings were assessed duringandimmediatelyafterthescan.Between-grouprCBFeffects ofairhungerweretestedviaapriorismallvolumecorrected anal-yses(amygdala,insularandanteriorcingulatecortices)performed within SPM8. Results. Periods of low Vt evoked significantly

greaterair hungersensation(7.6±1.8vs.4.3±1.8)and anxiety (7.5±1.7vs.1.8±1.9)inthePDgroupcomparedtotheHCgroup (0–10scales)andwerealsoassociatedwithsignificantlygreater rCBFin therightinsula inthePDgroup.Themagnitudesofair hungersensationandanxietywerecorrelatedwiththemagnitude ofchangeininsularrCBFfromhightolowVtperiods.Conclusion.

Thisisthefirstneuroimagingstudytodemonstrategreaterinsular rCBFinanxiouspatientsduringairhungerstimuli.Thefindings providefurtherevidencefortheinsula’scriticalroleindyspnea perception. Given hypotheses related to aberrant interoceptive processing in PD, the findings suggest that this interoceptive dysfunctionmaybemediatedbytheinsula.

Perception of pulmonary function and asthma control: The differentialroleofchildvs.caregiveranxietyanddepression

Jonathan M. Feldman1,2_{, Dara Steinberg}1_{, Haley Kutner}1_{, Nina}

Eisenberg1_{, Kate Hottinger}1_{, Kimberly Sidora-Arcoleo}3_{, Karen}

Warman4_{,DeniseSerebrisky}5

1_{Ferkauf Graduate School of Psychology, Yeshiva University,}

USA2_{Department of Epidemiology and Population Health, Albert}

Einstein College of Medicine, USA3_{Ohio State University College}

of Nursing, USA4_{Department of Pediatrics, Children’s Hospital at}

Montefiore,AlbertEinsteinCollegeofMedicine,USA5_Departmentof

Pediatrics,JacobiMedicalCenter,USA

Background. Theobjective of this study wasto examine child andcaregiveranxietyand depressionaspredictorsofchildren’s perception of pulmonary function, quick relief medication use, andpulmonaryfunction.Priorresearchhasshownrelationships betweenanxietyanddepressionanddifferentaspectsofasthma control and well-being. Asthma and anxiety share strikingly similar symptoms, such as dyspnea, dizziness, chest tightness, chokingandsensationsofsmothering.Theoverlapinsymptoms may lead individuals to mistake anxiety as an asthma attack. Caregiver depressiveand anxietysymptomsare risk factorsfor higher levels of asthma morbidity in children, although most priorstudieshavenotincludedmeasuresofchildren’spulmonary function.Methods.97childrenwithasthma,ages7–11yearsold, reportedtheiranxietyanddepressivesymptomsandcompleted spirometry. Caregivers completed a psychiatric interview. Chil-dren’spredictionsoftheirpeak expiratoryflow werecompared withactualvalues acrosssixweeks.Quickreliefmedicationuse was assessed by Dosers. Results. Children’s anxiety symptoms wereassociatedwithover-perceptionofrespiratorycompromise and greater quick relief medication use. Children’s depressive symptoms were associated with greater quick relief medica-tion use, but not perception of pulmonary function. Children ofcaregivers withan anxietyordepressive disorderhad lower

pulmonaryfunctionthanchildren ofcaregiverswithoutanxiety ordepression.Discussion.Children’sanxietyanddepressionare related toasthmamanagement viaa differentmechanismthan caregiver anxietyand depression. Childanxiety wasassociated witha subjective pattern of over-perception. Caregiver anxiety anddepressionwereriskfactorsforpoorasthmacontrolassessed with objective measures. Interventions focused on improving children’sperceptionofpulmonaryfunctionandtreatingcaregiver psychiatricdisordersmightbeeffectivemechanismsforreducing pediatricasthmamorbidity.

Assessingmentalloadinpilotselection:Takingacloserlookat respiration

Mariel Grassmann1_{, Elke Vlemincx}2_{, Dirk Stelling}1_{, Andreas von}

Leupoldt2_{,OmerVandenBergh}2

1_{DepartmentofAviationandSpacePsychology, GermanAerospace}

CenterDLR,Hamburg,Germany2_{DepartmentofPsychology,}

Univer-sityofLeuven,Leuven,Belgium

Background.Mental loadhasbeen shownto affectrespiratory parameters, potentially impairing information processing and cognitive performance. In the present study we investigated basicand variabilitymeasuresofrespirationundermental load inorder toevaluatetheirsensitivityasworkloadmeasuresand analysewhethertheyarerelatedtocognitiveperformanceinthe contextofpilotselection.Method.Agroupof61pilotcandidates performed a demanding multiple taskand watched a relaxing moviesubsequently.Respirationrateandend-tidalcarbondioxide (etCO2)were measuredcontinuouslyduringbaseline, task, and

recoveryperiod–eachlastingfor6min.Asmeasuresofrespiratory variability, thecoefficient of variation (CV) and autocorrelation (AR)atalagofonebreathwerecomputedonthebasisofa5-min window.Aptitudeofthepilotcandidateswasanalysedusingtheir total performance in the multiple task and their qualification as an airline pilot (i.e., whether they successfully completed the selection process). Results. Performing the multiple task caused anincrease in respirationrateand a decreasein etCO2.

Respiration raterecoveredwhereas etCO2 didnot.BothCVand

ARofrespirationratedecreasedfrombaselinetotaskand fully recovered afterthe task. Thevariability measures ofetCO2 did

notshowanysignificantchange.Cognitiveperformanceaswell aspilotqualificationwasassociatedwithalowerrespirationrate at rest and a stronger increase in respiration rate during task performance. A positive relationship was found between task performanceand ARofrespirationrateatrest.Discussion.Our resultsconfirmpreviousfindingsontheusefulnessofrespiration to monitormental load.In addition,our findings indicate that respiratory measuresare relatedtoperformanceand successin theaptitudetestingforairlinepilots.

PulmonaryrehabilitationinCOPD:Health-relatedexpectations andoutcomes

S.Shafer1_,A.Harver2

1_{School of Nursing, The University of NorthCarolina at Charlotte,}

USA2_{DepartmentofPublicHealthSciences,TheUniversityofNorth}

CarolinaatCharlotte,USA

werestudied.Thesampleincludedfemales(61%)andmales(39%); mostparticipantswerewhite(53%),married(65%),and demon-stratedmultipleco-morbiditiesincludinghypertension(54%)and osteoarthritis(45%).Participantsattendedanaverageof15 reha-bilitationsessionsthatconsistedofbotheducationandphysical conditioning;and completedthesix-minutewalktest(6MWT), the SF-36, and St. George’s Respiratory Questionnaire (SGRQ) beforeandafterrehabilitation.Results.Participantsdemonstrated reliableimprovementsinexercisecapacityasafunctionof pul-monary rehabilitation; the 6MWT increased significantly from 1.078ftto1.256ft(t=−12.9,p<0.000).Significantimprovements occurredingeneralhealthstatusasmeasuredbyboththeSF-36 (t=3.46,p<0.001)andtheSGRQ(t=−2.86,p<0.006).Thebenefits ofrehabilitation werenoted in allareasof theSF-36 including vitality (t=−6.86, p<0.000), emotional functioning (t=−3.35, p<0.001), social functioning (t=−4.27, p<0.000), and mental health(t=−4.83,p<0.000). Perceivedphysicalfunctioning,lung function, age, gender, and expectations of worsening health pre-rehabilitationwerereliablepredictors ofpost-rehabilitation distance walked (R2_{=0.50). Discussion. Participation in}

pul-monaryrehabilitationisassociatedwithimprovementsinphysical functioningandqualityoflife.Moreimportantly,health-related expectations–inadditiontophysicalfunctioning,lungfunction, age,andgender–predictimprovementsinexercisecapacitythat followcomprehensivepulmonaryrehabilitation.

Developmentofareliabledyspnoeamodelforusewith func-tionalmagneticresonanceimaging

AnjaHayen,MariHerigstad,KatjaWiech,KyleT.S.Pattinson NuffieldDepartmentofClinicalNeurosciences,UniversityofOxford, JRHospital,England

Background. Functional magnetic resonance imaging (FMRI) allows the study of neural mechanisms of dyspnoea. Resistive respiratory loading (to induce dyspnoea) induces changes in end-tidalCO2 (PETCO2) that confounds interpretationof FMRI.

Isocapnia (keeping PETCO2 constant) avoids these confounds,

butnecessitatesa continuousbaselineofmild hypercapnia.We hypothesised that mild hypercapnia would have little subjec-tiveeffectduringunloadedbreathing,butwould makeresistive loadingmore unpleasant (thussmaller resistive loads required toachieve samedyspnea rating). Asintervention studies often requiremultiplesessions,we examinedwhetherhabituation or sensitizationoccurred.Method.Tenhealthynon-smokers(23±6 years, 4 females) participated in one training and four experi-mentalsessions:poikilocapnia(freelyvaryingPETCO2),isocapnia

at 0.4kPa, 0.6kPa, 0.8kPa above baseline (counterbalanced)on five consecutive days. At the beginning of each experimental session,wedeterminedtheloadneededtoevoke50%onavisual analoguescale(VAS) ratingunpleasantness. Thisloadwasthen appliedfor two4-minblocks with3minunloadedbreathing in between(VASratingsevery15s).Participantscompletedthe mul-tidimensionaldyspnoeaprofile(MDP)aftereachsession.Results.

Duringpoikilocapnia,meanPETCO2didnotchange(4.9±0.4kPa)

frombaselineduringloading,butvariedbymorethan0.2kPain 4/10 participants. PETCO2 remained within 0.2kPa of baseline

for 28/30 isocapnic sessions. Hypercapnia increased baseline unpleasantness (12–23%VAS, p=.010), but did not significantly decreasetheloadnecessarytoinduce50%VASdyspnoea(p=.486). Participantsperceivedmorechesttightness(10–37%VAS;p=.028 uncorrected) and increased mental effort (37–56%VAS, p=.017 uncorrected) during resistive loading during isocapnia com-pared with poikilocapnia. Loads required to induce 50%VAS dyspneaunpleasantness remained stable over all experimental sessions. Discussion. No habituation or sensitization occurred.

Hypercapniadidnotamplifytheresponsetoloading,butincreased unpleasantnessduringunloadedbreathing.DespitepotentialFMRI advantages, the hypercapnia necessary for isocapnia may have deleteriouseffectsontheexperimentalmodel.

RespiratorymodificationofthePR-RRinterval–Implications forpsychophysiolog?y

JamesA.J.Heathers

UniversityofSydney,Sydney,Australia

Background. Electrocardiogram (ECG) traces are commonly divided into cardiac cycles between phases, overwhelmingly betweenR-waves.Theseareanalysedinthetimeandfrequency domains,andtheinformationofthevariabilityofthesecyclesis usedtoassessautonomicstate.However,littleattentionispaidto themannerinwhichthesecyclesaredefined.Thisisproblematic, ascycles betweendifferentpeaks inECG phases mayresult in differentspectralinformationifthosepeaksarenotconsistently related.Thishasrecentlybeenobservedduringexercise,butnot at rest.Method. N=14 participantsundergo novel ECG testing whereseparateleadconfigurationsareusedtoidentifytheP-wave (Lewis Lead) and R-wave (modified Lead II), and the timings are compared by either template matching or by identifying localthreshold. These participantsperformedseveral breathing protocols;freebreathing,10sI/Ecyclesata1:2through2:1ratio, briefstaticapnoeaduringinspirationandexpiration,etc.atboth restandduringexercise.Results.DecouplingbetweenthePand Rwavesoftheelectrocardiogramoccursatslowerratesthanthe intrinsicheartbeat(approx90bpm).Duringmaximuminhalation inparticular(i.e.,breathingwitha2:1I/Ecycle),transient tachy-cardiasarereliablyprovokedinnormalsubjects(i.e.,n=10/14)at physiologicalheart rates.During theseperiods,thelinear PRto RPinterval isuncoupledand reversed.Normallaboratorystress contributes only equivocally to this process. Discussion. While twoprimaryrespiratoryvariablesarenotcontrolled(tidalvolume andthelungvolumevis.theHering–Breuerreflex),itseemsthat deepbreathing(especiallywhenatmaximalinspiration)iscapable ofmodifyingtheproportional cyclelengthof individualphases oftheECGona beat-to-beatbasis.Theimmediateproblemthis presentsisthatit challengesthebasisofhow HRVcalculations areperformed,asthe‘recovery’inverserelationshipbetweenPR andRPintervalsclearlyviolatestheassumptiononwhichHRVis calculatedfromRRintervals.

Differences in urge to cough and total coughsproduced in Parkinson’sdiseasevs.healthyadults

Karen W. Hegland1_{, Michelle S. Troche}1_{, Michael Okun}2_{, Paul W.}

Davenport3

1_{Department of Speech, Language, and Hearing Sciences,}

USA2_{Department of Neurology and Neurosurgery, University of}

Florida, USA3_{Department of Physiological Sciences, University of}

Florida,USA

participantsratedtheirUtCona modifiedBorg scale.The total number ofcoughs produced(CrTot) for each ofthethree trials was recorded. An independent samples Mann Whitney U test wasusedtodeterminewhetherthereweresignificantdifferences for UtC and CrTot betweenthe 2 participants groups (PD and healthy).Results.ThereweresignificantdifferencesbetweenPD andhealthyparticipantsforUtC,andmarginallysignificant differ-encesforCrTot.TheseresultsshowthatforPDparticipants,there arefewertotalcoughs produced,and areducedor bluntedUtC comparedtothoseresponsesforhealthyparticipantswhentested atthesameconcentrationofthecapsaicinstimulus.Discussion.

Our understanding of airway protection deficits in Parkinson’s disease (PD) continues to expand, including now reflex and perceptualmeasuresofcough.Thesemeasuresofsensationand perceptionmaybeimportantaswemovetowardsdetermining thefactorsthatsignificantlycontributetotheincreasedmorbidity andmortalityrelatedtoairwayprotectiondeficitsinpeoplewith PD.Specifically,weaimtodevelopabetterunderstandingofwhat affective dimensions maycontribute to theUtC sensation, and howthoseareimpactedbyPD.

Respiratory hypoalgesia: Exploring the effect of respiratory phaseandbreathholdingonthenociceptionflexionreflexand subjectivepain

HassanJafari,JohanVlaeyen,OmerVandenBergh,IlseVanDiest UniversityofLeuven,Belgium

Background. Severalobservations suggest a respiratory modu-lationofpainsensitivity.First,slowanddeepbreathingisoften appliedasastrategytocontrolpain.Second,acutepaintypically triggersaninspiratorygaspthatisfollowedbyapost-inspiratory breath-hold. Given this, the present study hypothesized that respiratory phase and depth of breathing modulate pain sen-sitivity. To test this, we studied the influence of respiratory phase duringspontaneousbreathing (inhalationvs.exhalation), and of instructed breath-holding on pain sensitivity. Method.

Thirty-two healthy individuals receivedsuprathreshold electro-cutaneousstimulationsappliedonthesural nervetoelicitboth Nociception Flexion Reflex (NFR) and pain. Participants rated their perception of pain intensity and unpleasantness, while a pneumographchestbeltwasmeasuringrespiratory cycles.Pain measureswererecordedduring20counterbalancedspontaneous inhalationsandexhalations,andalsoduring3typesofinstructed breath-holds:followingexhalation,at50%,orat80%ofmaximal inspiratory capacity. Results. During spontaneous breathing betweeninhalationandexhalationnosignificantdifferencewas foundforNFR,self-reportedpainandunpleasantness.Nonetheless the NFR, but not self-reported pain and unpleasantness were reduced during breath-holds following exhalation and at 80% of one’s inspiratory capacity compared to breath-holds at 50% of inspiratory capacity. Discussion. In conclusion, respiratory breath-holding modulatespinal nociception sensitivity,but the modulationmightbetooweaktoinfluencethesubjectivepain perception.

Loadcompensationandmagnitudeestimationofinspiratory resistiveloadsinanindividualwithSCI-casestudy

PoonamB.Jaiswal1_{,NicoleJ.Tester}2,3_{,PaulW.Davenport}1

1_{Department of Physiological Science, University of Florida,}

Gainesville, FL, USA2_{Department of Physical Therapy, University}

ofFlorida,Gainesville,FL,USA3_{BrainRehabilitationResearchCenter,}

MalcomRandallVeteransAffairsMedicalCenter,Gainesville,FLUSA

Background. Acute intermittent hypoxia (AIH) treatment improves ventilation in animals with spinal cord injury (SCI)

and may enhance ventilation in individuals with SCI. We pos-tulatedthattendaysof AIHwould improveloadcompensation anddecreaseperceptualsensitivitytoinspiratoryresistiveloads (IRL),inaSCIindividual.Weevaluatedthechangesinventilation and magnitudeestimation(ME) toIRL,beforeand afterAIH,in an individualwithSCI.Method. Thesubject wasa 55-year-old femalewithchronic,incompleteC4–C5injury.Thesubjectreclined ona flatbench and respiredthrough a mouthpiece which was connectedtoaresistive loadingmanifoldviaanon-rebreathing valveandatube.AlightcuedthesubjectwhenanIRL(0,5,15, 30and 50cmH2O/L/s)wasappliedforasingleinspiration.Each

IRLwaspresentedfivetimesinarandomizedblock.Thesubject estimatedthemagnitudeoftheIRLusingamodifiedBorgScale. TherewerefourIRLtrials:Baseline,PostSham,AIHDays1and10. Pressure(P),airflow(AF)andMEwereanalyzedusingoneway RMANOVA.Results.ThesubjecthadasignificantlygreaterPatIRL 30onAIHDay1vs.Baseline(p≤0.01).TheslopeofPvs.IRLwas significantlydecreasedonAIHDay10vs.baseline (p≤0.01).AF wassignificantlyincreasedforIRLs15,30and50onAIHdays1 and10(p≤0.05).TheslopeofAFvs.IRLwassignificantlyincreased onAIHDay10vs.Baseline(p≤0.05).TheslopeofLogMEvs.LogP did not change acrossconditions. Discussion. The decrease in slopeofPvs.IRLandacorrespondingincreaseinslopeofAFvs. IRLsuggestanimprovedabilitytoloadcompensatetorepeated IRLafterAIH.Thisparadigmshowedimprovedloadcompensation withoutalteringtheIRLperceptualsensitivity.

Generalizationofrespiratorysymptomtriggers

ThomasJanssens,Farah Martens, NathalieStorms, MeikePappens, IlseVanDiest,OmerVandenBergh

HealthPsychology,UniversityofLeuven,Belgium

Background. Behavioralmanagement of asthma requires accu-rate identification of asthma triggers. However, identification of asthma triggers is proneto inaccuracies. Generalization, the tendency to exhibit a conditioned response to a stimulus that resemblesaconditionedstimulus,mayhelpexplainthe develop-mentofinaccuratetriggeridentification.Generalizationcanoccur alongperceptualdimensions,butalsoalongotherdimensionsof similarity,suchasconceptualsimilarityorcategorymembership. Inthisexperiment,westudiedthegeneralizationofasthmatrigger learning and explored individual differences in the acquisition of trigger-symptom contingencies and their generalization to conceptually similar trigger categories. Method. 48 individuals withoutanyhistoryofasthmaorallergiesperformed20breathing trials. Participants rated theirsymptom expectancy for 10 CS+ (e.g.,bird)and10CS−(e.g.,flower)pictures,whichwerefollowed by a 60sinhalation of a 7.5% CO2 air mixture(half of the CS+

trials) or room air (other trials). Finally, they rated symptom intensityandunpleasantness.Either24hor1weekaftersession 1,participantsfilledout ameasureof suffocationfear(SF),and completedsymptomexpectancyratingsand recognitionratings for oldand novelCS+/CS− exemplars,aswellasgeneralization stimuli (e.g., G+, mammals; G−, molds). Results. Participants showed increased expectancies for the CS+ compared to CS− exemplars,whichdevelopedacrosstrials.Duringtherecognition task,symptomexpectanciesgeneralized toCS+stimulithathad notbeenpreviouslypairedwithCO2.HighSFindividualsshowed

Electrophysiologicalcorrelatesofemotionprocessingin dys-pnea

Georgiana Juravle1_{, Cornelia Stoeckel}1_{, Michael Rose}1_{, Matthias}

Gamer1_{,ChristianBüchel}1_{,MatthiasWieser}2_{,AndreasvonLeupoldt}1,3 1_{University Medical Center Hamburg-Eppendorf, Hamburg,}

Germany2_{UniversityofWürzburg,Würzburg,Germany}3_Universityof

Leuven,Leuven,Belgium

Background. Dyspnea is recognized as a threatening bodily sensationand a key symptom in respiratory and psychological disorders. It has been demonstrated that emotional contexts cansubstantiallyinfluenceitsperceptionandneuralprocessing. Nevertheless, little is known about the reverse influence that dyspneacouldhaveontheneuralprocessingofemotion.Inthe presentstudyweexaminedtheinfluenceofdyspneaonemotional pictureprocessing. Methods.The continuous electroencephalo-gram(EEG)wasrecordedwhile20 healthyparticipantsviewed positive, neutral, and negative picture series under conditions of resistive-load-induced dyspnea, auditory noise of matched intensity,aswellasanunloadedbaseline.Results.Results indi-catedattenuatedvisualprocessingduringdyspnea,asindexedby reducedevent-related potential(ERP)amplitudesoftheP1 and the earlyposterior negativity (EPN) deflections, irrespective of picturevalence.Furthermore,boththeEPNandthelatepositive potential(LPP)ERPsexhibitedthecommonlyobservedemotional modulation:Thatis,largermeanERPamplitudeswerefoundfor positiveandnegativepictureviewing,ascomparedtoneutral pic-tureviewing,withoutdifferencesbetweenconditionsofdyspnea, noise,andbaseline.Discussion.Thesefindingsreplicateprevious ERPs results on affective picture processing and suggest that dyspneaimpactsontheearlyattention-relatedneuralprocessing of emotional pictures, but leaves the emotional discrimination betweenthesestimuliintact.

Urban families’ responses to their children’s asthma: What familiesdowhenfacedwithsymptoms

D.KoinisMitchell,C.Esteban,S.J.Kopel,E.L.McQuaid,B.Jandasek,R. Seifer,G.Fritz,R.B.Klein

BrownMedicalSchool/BradleyHasbroResearchCenter,Providence, RI,USA

Background.Thecurrentstudyexaminesthestep-by-step deci-sionmakingandrescueresponsebehaviorsthatasampleofurban familiesimplementwhentheirchildrenhaveasthmasymptoms. Weappliedacodingsystembasedonclinicalguidelines(NHLBI, 2007)tocategorizerescueresponsebehaviorsintoappropriateand inappropriatecategories.We examinedtheassociationbetween asthmaresponsebehaviors,asthmaactivity,andclinically signifi-cantevents(e.g.,EDuse).Weassessedasthmaresponsebehaviors in the context of upper airway function. Method. Data were examinedfrom 200 urban children (aged 7–9) with persistent asthmaandtheirfamiliesenrolledinProjectNAPS.Onequestion from the subscale of The Family Asthma Management System Scale,developedbyourgroup,involvedaskingfamiliesaseriesof questionsthatelicittheresponsestepstakenwhentheirchildren experience asthma. Lung function was assessed (FEV1 percent predicted) via the AM2. Children and caregivers recorded the days when asthma and rhinitis symptoms were present. Peak nasalinspiratoryflowdataandrhinitiscontrolwasalsoassessed.

Results.Forchildrenwithatleast1EDvisit,theasthmaresponse planswerepoorer(Mn=4.6)thanforchildrenwhohadnotbeen

totheED(Mn=5.5).Themajorityofthefamilies(75%)had

inap-propriate rescue plans. Children of families withinappropriate plansreportedmorerhinitissymptomscomparedtochildrenof familieswithappropriate plans(Mn=40%ofmonitoreddaysvs.

11%).Manyfamilies withinappropriateplansreportedgoingto theEDafteronly1albuteroldose.Fewerrhinitissymptomswere reportedamongchildreninfamilieswithanappropriateplanvs. thosewithaninappropriateplan(7%v.30%rhinitissymptomdays, F(1,21)=3.9,p=.05.Discussion.Manyurbanfamiliesinthis sam-pleimplementinappropriateasthmarescueresponsebehaviors, whichappeartobelinkedwithmoreclinicallysignificantevents forasthmaandmorerhinitissymptoms.

Aninterimreportonatwo-centertrialofheartratevariability biofeedbackforasthma

PaulLehrer1_{,FrederickWamboldt}2

1_{Rutgers Robert Wood Johnson Medical School, Piscataway, NJ,}

USA2_{NationalJewishHealth,Denver,CO,USA}

Background.Thisreportisbasedondatafrom36 participants. Itisaninterimanalysisofdatafromanongoingstudy.Method.

Wecomparedtraininginheartratevariabilitybiofeedbackwitha complexcontrolconditionthatincluded1)traininginbreathingat normalrelaxedrespiratoryrate(approx15/min),2)EEG biofeed-backtoincreaseanddecreasealphafromtheOztopFzsites,3) listeningtorelaxingmusic.Thisisatwo-centertrial,performedon patientswithmildormoderatesymptomaticasthma,whoarenot takinginhaledsteroidsorotheranti-inflammatorydrugs.Results.

Thusfarwehavefoundthatbothconditionsproducedsignificant improvementsinmeasuresofpulmonaryfunction,airway inflam-mation,qualityoflife,andgeneralasthmasymptomatology,with asmall advantagetoHRVbiofeedback.Symptomscontinuedto improveafteradministrationofaninhaledsteroidforonemonth.

Discussion.Thusfar,itappearsthatheartratevariability biofeed-backdoesnotsubstitutefor inhaledsteroids. Someelementsof thecontrolconditionmayhaveeffectsthatarealmostaspowerful asbiofeedbackeffects.Howeverthestudywasnotpoweredfor suchasmallsample.Researchiscontinuing.

Anupdateonsystemstheoryforpsychophysiology

PaulLehrer,DavidEddie

Rutgers,TheStateUniversityofNewJersey,USA

feedbackloopscanhelpstimulateoscillationsandexercisecontrol reflexes,butalsocandeprivethesystemofimportantinformation. Empiricalhypothesesderivedfromthisapproacharepresented, includingthatmoderatestressmayenhancehealthand function-ing.

PsychologicalcomorbiditiesinthefemaleCOPDpatient: Impli-cationsforpractice

SarahMiller1_{,EmilyPlowman}2

1_{UniversityofMemphisLoewenbergSchoolofNursing,USA}2_University

ofSouthFlorida,USA

Background. To provide advance practice nurses (APNs) an overviewoftheneedforassessmentofpsychological comorbidi-ties in the female patient with chronic obstructive pulmonary disease(COPD)tobettermanagepatientoutcomesandimprove quality of life. Women withCOPD report lower health-related quality of life (HRQOL) indices and suffer from nearly double the prevalence of anxiety and depressive comorbidities than men.Heightenedemotionalburdenofrespiratorydiseasecanbe partiallyattributedtoanincreaseinsensitivity(hyperperception) ofrespiratoryrelatedsymptomsleadingtoinaccuratesymptom reporting,andcontributingtoasubjectivesenseofpoordisease control.Thisvariedaffectiveandsensorydimensionofrespiration needstobeconsideredbyAPNsandintegratedintostandardized assessment in the clinical setting to optimize individual care and evaluate specific therapeutic interventions. Method. An evidence-based approach to nursing care is incorporated into clinicalpracticesettingstoimprovepatient outcomes.Tomore completelyunderstandtheinteractionsofrespiratory hyperper-ception, psychological comorbidities and COPD in women; an extensive literature search acrossmultiple databases (PubMed, CINAHL,MedlinePluswithfulltext,PsychINFOandHealthSource: Nursing/Academic Edition) was performed by a single rater.

Results.Thelinkbetweensymptomsofanxietyanddepressionin patientswithCOPDiswelldocumentedwiththemostsignificant emerging associative factors identified being: gender, race and age,withfemalegenderbeingthemostsignificant.Theliterature highlightstheneedforadditionalstudiestobetterfacilitateour understandingoftherelationshipbetweenenhancedrespiratory symptomperceptionandpsychologicalcomorbidities.Discussion.

Largerand morerigorousstudiesareneededtofacilitateAPN’s ability to recognize and appropriately care for psychological comorbidities in thefemale COPD patient. Trainingto increase screeningskillsand awarenessneedstobetargetedtoAPNsto provideaclearer understandingofassessing andcaringfor this patientpopulation.

The effect of interoceptive fear conditioning on breathing behavioranddyspneaintensityperceptioninasthmapatients andhealthycontrols

MeikePappens,LaureMeulepas,OmerVandenBergh,IlseVanDiest UniversityofLeuven,Leuven,Belgium

Background.Thehighcomorbiditybetweenasthmaandanxiety disorderssuggeststhatpsychologicalfactorsmightplayarolein asthma.Inthisstudywewantedtoinvestigatetheinfluenceoffear conditioningmechanismsonbreathingbehaviorandself-reported dyspneaintensity.Method.Theconditionedstimulus(CS)wasa smallrespiratoryload(appliedfor8s);theunconditionalstimulus (US)wasabreathing occlusion(appliedfor40%ofthepersonal breathholdingtime).Halfoftheparticipantswereasthmapatients (N=26), half were healthy controls (N=30). The experimental groups(ASTHMA:N=13;HEALTHY:N=15)received6acquisition trialswithpairedCS–USpresentations followedbyanintertrial

interval (ITI, 27–30s). The control groups (ASTHMA: N=13; HEALTHY:N=15)received6 trialsof unpairedpresentationsof CSandUSseparatedbyanITI.Intheextinctionphase,allgroups wereadministered6CS-onlytrials.ThreeCSpre-exposuretrials weregivenbeforeacquisition.Aftereachtrialparticipantsrated theirdyspneaintensityduringtheCS.Results.Intheacquisition phase,Tidalvolume(Vt)significantlydecreasedduringtheCSin

thecontrol butnot in theexperimentalgroups compared with pre-exposure.Respiratoryratealsodecreasedduringacquisition intheexperimentalgroupsbutnotinthecontrolgroups.Results showthatallgroupsreportedmoredyspneaattheendof acqui-sition compared to CS pre-exposure. At the end of extinction the two groups in the experimentalconditionand thehealthy groupinthecontrolconditionreportedsignificantlylessdyspnea thanduringCSpre-exposure.Remarkably,thiswasnotthecase for the asthma group in the control condition, who displayed thesamelevel ofdyspneaattheend ofextinctionasduringCS pre-exposure.Discussion. Ourfindings shedan importantlight ontheroleofsafetylearning/unpredictabilityindyspneaseverity perception and onthe influence of breathing behavior on this perception.

The effect of interoceptive fear conditioning on breathing behavior

MeikePappens,OmerVandenBergh,IlseVanDiest UniversityofLeuven,Leuven,Belgium

Background.Ithasbeendemonstratedthatfearcanbelearned tomild,innocentdyspneabypairingit withanaversiveevent. Traditionallyinfearconditioningresearch,fearmeasuresinclude startleblinkEMG,skinconductanceresponsesandself-reported fear.Breathingbehaviorhashardlybeeninvestigateddespiteits possiblerole in theextensionand aggravationof fear.The aim of the present study was to monitor respiratory responses in an interoceptive fear conditioning paradigm. Method. Fifty-six healthyparticipantsreceivedamildrespiratoryload(10cmH2O/l/s

for8s)asCSandasevererespiratoryload(40cmH2O/l/sfor30s)

asUS.3CSpre-exposuretrialswereadministeredbefore acqui-sition,inwhichtheexperimentalgroup(N)received6explicitly pairedCS–USpresentationsandthecontrolgroup(N)6explicitly unpairedCS–USpresentations.Intheextinctionphase,bothgroups wereexposed to6 CS-onlypresentations.Respiratory measures included respiratory rate (RR) and Tidal volume (Vt). Results.

RR in response totheCS-loaddecreased but toa lesser extent in theexperimentalgroupthan inthecontrolgroup.Thesame patternwasvisibleinVt:whileduringtheCSthecontrolgroup

significantly reduced its Vt over acquisition, the experimental

group didnot. Discussion. Our data showthat fear condition-ing to a respiratory stimulus induces maladaptive respiratory behavior in healthy individuals. These findings highlight the importanceofstudyingrespiratorybehaviorinthecontextoffear conditioning.

FMRIandrespiratorycontrol

KylePattinson

whentryingtounderstandtheneural controlof breathing and breathlessness.Iwillexplainsomeofthestrategiesmygrouphas usedtohelpovercometheseissuesandhowthesehavehelpedus tobetterunderstandtheeffectsofopioidpainkillersontheneural controlofbreathing.

Relativebreathless:Comparisonwithotherscanaffectfeelings ofbreathlessness

SibyllePetersen,OmerVandenBergh UniversityofLeuven,Leuven,Belgium

Background. Social comparison has a longstanding research tradition,showingthatwecannot constructourself-concept in termsofskills,attractiveness,personality,ormoodindependentof comparisonwithothers.Howeverthisperspectivehasrarelybeen appliedtoperceptionofbodilysensationsandsymptoms. Further-more,littleisknownondifferentialeffectsofsocialcomparison onself-report and exercise behavior. Methods. In four studies withhealthyindividualsandindividualswithasthmaandChronic ObstructivePulmonaryDiseasewetestedthehypothesisthatsocial comparison affects perceptionof breathlessnessand breathing-relatedbehavior.Inallstudies,participantsreceivedinformation about others less or more likely to experience breathlessness during physical activity (upward and downward comparison standards).Inallstudies,participantscompletedbreathingTasks withexternal respiratory loads of low to moderate magnitude (6–20cmH2O)orstandardizedexercisetests(six-minutewalking

test,6MWT)andgaveself-reportofbreathlessness.Intwo stud-ies,we measuredinspiratory pressure and flow. Results.In all studies,social comparisonhadasignificanteffectonself-report ofdyspnea.Furthermore,we foundeffects ofsocial comparison oninspiratorypressureandflowandonperformanceinexercise tests.However,effectswerestrongestinloadsoflowtomedium magnitude(6–9cmH2O).Discussion.Socialcomparisoncanbias

the perception of dyspnea and can change breathing behavior andexerciseperformanceinhealthyindividualsand individuals withrespiratory disease. Social cognitive processes may be an importantsourceofbiasinsymptomperceptionandreportand exercisebehavior.

The relationship between voluntary cough production and swallowsafetyinindividualswithamyotrophiclateralsclerosis

E.K.Plowman,S.A.Watts,A.Domer,J.Gaziano,S.Miller,T.E.Pitts,D. Estores,J.Richter,K.Donoghue,C.Gooch,T.Vu

UniversityofSouthFlorida,DepartmentsofCommunicationSciences andDisordersandNeurology,USA

Background.Coughisanessentialairwayprotectivemechanism andisparticularlyimportantforthosewithdisordered swallow-ing.Withthenecessityforfine-tunedlaryngealandrespiratory coordinationfor both cough andswallow, we hypothesizethat dystussia (disorder of cough) maybe predictive of swallowing dysfunction.Theaimofthisstudywastoexaminethe relation-ship between voluntary cough production and swallow safety in persons with Amyotrophic Lateral Sclerosis (ALS). Method.

Physiologic measures of voluntary cough production from 10 individuals with ALS showing no videofluoroscopic evidence of penetration/aspiration were examined and compared to 10 ALSparticipantswithevidence ofpenetration/aspiration.Group differenceswereassessedusingaone-wayANOVAand aseries ofSpearman’s Rho correlations performedtoassess thedegree of relationship betweenvoluntary cough measuresand airway safetyduringswallowing.Results.Thepenetrator/aspiratorgroup presented withlower coughvolume acceleration(p<0.05) and longer compression phase duration (p<0.05) voluntary cough

waveforms when compared to the non-penetrator/aspirator group.AsignificantpositivecorrelationwasrevealedbetweenPAS score and cough compressionphase duration (r=0.48, p<0.05) indicatingthat thelongertheduration ofglottic closureduring voluntarycough,thehigherthePASscoreobserved.Discussion.In thisstudy,ALSpatientswhopenetrated/aspirateddemonstrated lesseffectivevoluntarycoughwithaslowercompressionphase. Compressionphaseduration(timeofglotticclosureduringcough) was related to the degree of penetration/aspiration. Measures ofvoluntarycoughmaybeusefulpredictors ofpenetrationand aspirationinindividualswithALS.

Theneurobiologyofthesigh:Fromtherespiratorynetworkto arousal

Jan-MarinoRamirez1,2_{,TatianaDashevskiy}1

1_{Centerfor IntegrativeBrain Research, Seattle Children’s Research}

Institute, Seattle, WA, USA2_{Department of Neurological Surgery,}

UniversityofWashington,Seattle,WA,USA

Background.Here wedescribe theneurobiologicalbasis ofthe sigh,adistinctbreathingbehaviorthathasbeenassociatedwith three specific behavioral roles: (1) sighs monitor changes in brainstates, (2) inducearousal and (3)play a role in resetting breathing variability. These three roles are adaptive and may helptohomeostaticallyregulatebreathingstabilityinnormallife activities,but sighscan alsobemaladaptive: Hypo-arousal and failuretosighhave beenassociated withSIDS,whileincreased breathingirregularitymayprovokeexcessivesighingand hyper-arousal, a behavioral sequence that may play a role in panic disorders.Methods.Allmethodshavepreviouslybeendescribed inWeese-Mayeretal.,2006,andLieskeetal.,2000.Results.We demonstrate that sighs and breathing critically depend onthe pre-Boetzinger complex (preBoetC), a network located within the ventrolateral medulla. Both respiratory patterns continue to be generated upon isolation in a transverse slice. Even in isolation,sighsresetongoingrespiratoryactivityanddecreasethe approximateentropyofrespiratoryactivity.Mechanisticallyour datademonstratethat theP/Q-typecalciumchannel, persistent sodium current-dependent burst mechanisms, intrinsic oxygen sensitivity,aswellasmodulatoryandsynapticinteractionswithin thislocalnetworkcanexplainmanyoftheobservedbehavioral characteristicsofthesigh.Moreover,ourrecentdatasuggestthat gliaplayacriticalroleinthegenerationofthesigh,aslesioning gliaspecificallyabolishes sighs.Discussion.Although breathing and sighs are generated withinthe same local network in the PreBoetC, these activities are characterized by distinct cellular mechanisms.Understanding theneuronal basis of thesighand itsinteractionwithongoing respiratoryactivityisanimportant prerequisitetounravelhowsighsinteractandcontrolhigherbrain functions.

Breathholdingdurationasameasuretoassessdistress toler-ance:Doesitrelatetoexecutivecontro?l

Mathias Schroijen1_{,Stefan Sütterlin}1,2_{, ElenaConstantinou}1_,Omer

VandenBergh1_{,IlseVanDiest}1

1_{Research Group on Healthy Psychology, University of Leuven,}

Belgium2_{Research Unit INSIDE, University of Luxembourg,}

Luxem-bourg

relationship with classical executive function tasks measuring trait-likeinhibitorycapacities.Methods.113studentscompleted acollectiveBHTassessment.A subset(N=58)alsocompleteda series of executive function tasks: the Wisconsin Card Sorting Test measuring cognitive flexibility, the Parametric GO/No-GO measuring response inhibition and the N-back task measuring memory updating. Another subset of these students (N=34) repeatedtheBHTone yearlater. Results.Test–retestreliability over a one-year period was high with (r=.67, p<.001). None of the executive functioning tasks was significantly associated with BHT. Discussion. The lack of associations with execu-tive function tests challenge previous assumptions of active inhibitory control in the breath holding task. However, breath holdinginducedrather moderatelevelsof unpleasantness, sug-gesting that executive control resources were not sufficiently activated due to a low level of perceived distress. Exploratory findingsfurthersuggestthatindividualdifferences(e.g.,in inter-oceptive or anxiety sensitivity) should be taken into account when examining the validity of BHT as a measure of distress tolerance.

Atrans-speciesapproachtopanic

KoenSchruers

School for Mental Health and Neuroscience & Academic Anxiety Center,MaastrichtUniversity,TheNetherlands

Panicisacommonphenomenonofwhichthepathophysiologyis notfullyunderstood.Alongtraditionexistsofexperimentalpanic provocationinthelabbyinhalation ofincreasedconcentrations ofcarbon dioxide.Originally, researchfocusedonpatientswith panic disorder. Recent data show however that panic can be reliably provoked in healthy volunteers as well. This fits the hypothesisthatpanicisafearresponsetobodilyinternalsignalsof dangerandthateverypersonisequippedwithasystemtodetect suchsignals.Methodstoinvestigatetheunderlyingmechanisms include pharmacologicalchallenges, gene–environment interac-tionstudiesandfunctionalneuroimagingstudies.Tostudysome ofthecellularand molecularaspects,theuseofanimalmodels is required. Thislecture willgive an overview of experimental studies into the pathophysiology of panic, starting in patients andthenmoving intohealthyvolunteersandultimatelyalsoin rodents,introducingthefirsttrans-speciesexperimentalmodelof panic.

Dysautnomia induced by inspiratory threshold loading in healthysubjects

Caroline Sevoz-Couche1_{,AnnaL.Hudson}2,3_{,Marie-CécileNiérat}2,4_,

ThomasSimilowski2,4_{,LouisLaViolette}2,4

1_{CR-ICM, UPMC/INSERM,UMR-S975, CNRS UMR7225, Facultéde}

médecineUPMC,Paris,France2_{UniversitéParis6,ER10UPMC,Paris,}

France3_{Neuroscience Research Australia and University of New}

South Wales, Sydney, Australia4_{Assistance Publique-Hôpitaux de}

Paris,GroupeHospitalierPitié-Salpêtrière,ServicedePneumologieet RéanimationMédicale,Paris,France

Background. Dyspnea is a subjective experience of respiratory discomfortassociatedwithnegativeaffects.Assuch,itis bound toaffecttheautonomic balance,buttheseeffects havescarcely beenstudied.Method.Elevennaivehealthysubjects(9women, age 29±7 years, mean±SD) were exposed in random order to3 levelsof inspiratorythreshold loading(ITL, 5mineach)to induceexperimentaldyspneaofthe“work/efforttype”(intensity evaluatedusingavisualanaloguescale).Powersofspectraldensity ofR–Rintervalvariabilitywerecalculatedatbaseline,duringthe inspiratoryloadingandrecovery,withinthefrequencyrangesof

0.04–0.15Hz(lowfrequency,LF)and0.15–0.4Hz(highfrequency). TheLF-to-HFratio(LF/HF),anindexofsympatheticactivity,was calculated.TemporalR–Rintervalvariabilitywasalsocalculated.

Results.Thepeakinspiratorywork/effortsensationintensitywas 26±26,41±26and62±24%offullscale“forlow,mediumand high levels of ITL, respectively. During loading, heart rate and LF/HFincreased,whileHFandtemporal R–Rinterval decreased compared tobaseline spontaneousventilation values. Maximal increases (+15% and +161%, respectively) and decreases(_−35% and−20%,respectively)werefoundafterthefirstITLload, inde-pendently ofits magnitude.Values returned tobaselineduring recovery.Discussion.Anincrease insympatheticactivityand a decreaseinparasympathetictonewereinducedbyfirstexposure toITLanddidnotdependofITLlevel.Therefore,inyounghealthy subject,experimentalinspiratoryloadingcaninduceautonomic imbalance.Inspiratoryloadingcanbeconsideredastressful situa-tionthatcouldhaveimportantrepercussionsonwhole-bodystress responses.

Swallow-relatedqualityoflifechangesbeforeandafter expi-ratory muscle strength training (EMST) in individuals with multiplesclerosis

Erin Silverman1,5,6_{, Paul W. Davenport}1_{, Nan Musson}2_{, Mary}

Edwards2,5_,ToniChiara3,6_{,ChristineSapienza}4,5

1_{Department of Physiological Sciences, University of Florida,}

Gainesville, FL, USA2_{North Florida South Georgia Veteran’sHealth}

System, Malcom Randall VAMC, USA3_{North Florida South Georgia}

Veteran’sHealthSystem,LakeCityVAMC,USA4_{JacksonvilleUniversity,}

Jacksonville,FL,USA5_{BrainRehabilitationandResearchCenter–BRRC,}

MalcomRandallVAMC,Gainesville,FL,USA6_{RehabilitationOutcomes}

ResearchCenter–RORC,MalcomRandallVAMC,Gainesville,FL,USA