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Arch Dis Child. 2000 Oct; 83(4): 325–329.
PMCID: PMC1718493

Children's perception of breathlessness in acute asthma


AIM—To determine whether asthmatic children who present to hospital with hypoxia perceive breathlessness less well than non-hypoxic presenters.
METHODS—A total of 27 children aged 5-16 years (mean age 10) admitted with acute asthma had recordings of oxygen saturation (SaO2), clinical score, forced expiratory volume in one second (FEV1), and breathlessness score (HMP) at admission and at 5, 10, 24,48, and 72 hours after admission. Those defined as hypoxic (SaO2 <92%) at admission were compared with a non-hypoxic group.
RESULTS—Twelve children were hypoxic at admission. Compared with the non-hypoxic group they were younger (8.6 (SD 2.8) v 11.2 (2.8) y, p = 0.02), and had greater airway obstruction (FEV1 32.5 (10)% v 54.3 (26)%, p = 0.0073, 95% confidence interval (CI) −36.9 to −6.6) yet had a trend towards less breathlessness (median HMP 4 v 3, p = 0.062, CI −0.001 to 2.00) at admission. The hypoxic group had a smaller change in breathlessness from admission to discharge, despite a similar improvement in FEV1, reflected in a lower ratio of change in HMP to change in FEV1 (ΔHMP/ΔFEV1) (median ΔHMP/ΔFEV1 0.021%−1v 0.073%−1, p = 0.0081, CI −0.075 to −0.016). Linear regression analysis showed a strong relation between ΔHMP/ΔFEV1 and initial SaO2 (p = 0.004, r = 0.54).
CONCLUSIONS—Asthmatic children who present to hospital hypoxic tend to perceive themselves as less breathless than non-hypoxic children. This may predispose to a future life threatening attack.

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Selected References

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  • Carswell F. Thirty deaths from asthma. Arch Dis Child. 1985 Jan;60(1):25–28. [PMC free article] [PubMed]
  • Fletcher HJ, Ibrahim SA, Speight N. Survey of asthma deaths in the Northern region, 1970-85. Arch Dis Child. 1990 Feb;65(2):163–167. [PMC free article] [PubMed]
  • Barnes PJ. Blunted perception and death from asthma. N Engl J Med. 1994 May 12;330(19):1383–1384. [PubMed]
  • McFadden ER., Jr Fatal and near-fatal asthma. N Engl J Med. 1991 Feb 7;324(6):409–411. [PubMed]
  • Robertson CF, Rubinfeld AR, Bowes G. Pediatric asthma deaths in Victoria: the mild are at risk. Pediatr Pulmonol. 1992 Jun;13(2):95–100. [PubMed]
  • Newcomb RW, Akhter J. Respiratory failure from asthma. A marker for children with high morbidity and mortality. Am J Dis Child. 1988 Oct;142(10):1041–1044. [PubMed]
  • Kravis LP, Kolski GB. Unexpected death in childhood asthma. A review of 13 deaths in ambulatory patients. Am J Dis Child. 1985 Jun;139(6):558–563. [PubMed]
  • Seddon PC, Heaf DP. Long term outcome of ventilated asthmatics. Arch Dis Child. 1990 Dec;65(12):1324–1328. [PMC free article] [PubMed]
  • Martin AJ, Campbell DA, Gluyas PA, Coates JR, Ruffin RE, Roder DM, Latimer KM, Luke CG, Frith PA, Yellowlees PM, et al. Characteristics of near-fatal asthma in childhood. Pediatr Pulmonol. 1995 Jul;20(1):1–8. [PubMed]
  • Sears MR, Rea HH. Patients at risk for dying of asthma: New Zealand experience. J Allergy Clin Immunol. 1987 Sep;80(3 Pt 2):477–481. [PubMed]
  • Simons FE, Pierson WE, Bierman CW. Respiratory failure in childhood status asthmaticus. Am J Dis Child. 1977 Oct;131(10):1097–1101. [PubMed]
  • Kikuchi Y, Okabe S, Tamura G, Hida W, Homma M, Shirato K, Takishima T. Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. N Engl J Med. 1994 May 12;330(19):1329–1334. [PubMed]
  • Ruffin RE, Latimer KM, Schembri DA. Longitudinal study of near fatal asthma. Chest. 1991 Jan;99(1):77–83. [PubMed]
  • Geelhoed GC, Landau LI, LeSouëf PN. Predictive value of oxygen saturation in emergency evaluation of asthmatic children. BMJ. 1988 Aug 6;297(6645):395–396. [PMC free article] [PubMed]
  • Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed]
  • Wilson RC, Jones PW. A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci (Lond) 1989 Mar;76(3):277–282. [PubMed]
  • Fritz GK, Klein RB, Overholser JC. Accuracy of symptom perception in childhood asthma. J Dev Behav Pediatr. 1990 Apr;11(2):69–72. [PubMed]
  • Rietveld S. Habituation to prolonged airflow obstruction. J Asthma. 1997;34(2):133–139. [PubMed]
  • Wood DW, Downes JJ, Lecks HI. A clinical scoring system for the diagnosis of respiratory failure. Preliminary report on childhood status asthmaticus. Am J Dis Child. 1972 Mar;123(3):227–228. [PubMed]
  • Mihatsch W, Geelhoed GC, Landau LI, LeSouëf PN. Time course of change in oxygen saturation and peak expiratory flow in children admitted to hospital with acute asthma. Thorax. 1990 Jun;45(6):438–441. [PMC free article] [PubMed]
  • Ferguson AC. Persisting airway obstruction in asymptomatic children with asthma with normal peak expiratory flow rates. J Allergy Clin Immunol. 1988 Jul;82(1):19–22. [PubMed]
  • Canny GJ, Levison H. Pulmonary function abnormalities during apparent clinical remission in childhood asthma. J Allergy Clin Immunol. 1988 Jul;82(1):1–4. [PubMed]
  • Hill DJ, Landau LI, McNicol KN, Phelan PD. Asthma--the physiological and clinical spectrum in childhood. Respiratory function studies in its assessment. Arch Dis Child. 1972 Dec;47(256):874–881. [PMC free article] [PubMed]
  • Zach MS, Karner U. Sudden death in asthma. Arch Dis Child. 1989 Oct;64(10):1446–1451. [PMC free article] [PubMed]
  • Boulet LP, Leblanc P, Turcotte H. Perception scoring of induced bronchoconstriction as an index of awareness of asthma symptoms. Chest. 1994 May;105(5):1430–1433. [PubMed]
  • Hutchison AA, Olinsky A. Hypoxic and hypercapnic response in asthmatic subjects with previous respiratory failure. Thorax. 1981 Oct;36(10):759–763. [PMC free article] [PubMed]
  • Moore GC, Zwillich CW, Battaglia JD, Cotton EK, Weil JV. Respiratory failure associated with familial depression of ventilatory response to hypoxia and hypercapnia. N Engl J Med. 1976 Oct 14;295(16):861–865. [PubMed]
  • Weil JV, Byrne-Quinn E, Sodal IE, Filley GF, Grover RF. Acquired attenuation of chemoreceptor function in chronically hypoxic man at high altitude. J Clin Invest. 1971 Jan;50(1):186–195. [PMC free article] [PubMed]
  • Beral V, Read DJ. Insensitivity of respiratory centre to carbon dioxide in the Enga people of New Guinea. Lancet. 1971 Dec 11;2(7737):1290–1294. [PubMed]
  • Scoggin CH, Doekel RD, Kryger MH, Zwillich CW, Weil JV. Familial aspects of decreased hypoxic drive in endurance athletes. J Appl Physiol Respir Environ Exerc Physiol. 1978 Mar;44(3):464–468. [PubMed]
  • Saunders NA, Leeder SR, Rebuck AS. Ventilatory response to carbon dioxide in young athletes: a family study. Am Rev Respir Dis. 1976 Apr;113(4):497–502. [PubMed]
  • Wilson RC, Oldfield WL, Jones PW. Effect of residence at altitude on the perception of breathlessness on return to sea level in normal subjects. Clin Sci (Lond) 1993 Feb;84(2):159–167. [PubMed]
  • Orehek J, Beaupré A, Badier M, Nicoli MM, Delpierre S. Perception of airway tone by asthmatic patients. Bull Eur Physiopathol Respir. 1982 Jul-Aug;18(4):601–607. [PubMed]
  • Sorensen SC, Severinghaus JW. Respiratory insensitivity to acute hypoxia persisting after correction of tetralogy of Fallot. J Appl Physiol. 1968 Sep;25(3):221–223. [PubMed]
  • Edelman NH, Lahiri S, Braudo L, Cherniack NS, Fishman AP. The blunted ventilatory response to hypoxia in cyanotic congenital heart disease. N Engl J Med. 1970 Feb 19;282(8):405–411. [PubMed]
  • Chang KC, Morrill CG, Chai H. Impaired response to hypoxia after bilateral carotid body resection for treatment of bronchial asthma. Chest. 1978 May;73(5):667–669. [PubMed]

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