{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:10:37Z","timestamp":1774620637287,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[1998,10,1]],"date-time":"1998-10-01T00:00:00Z","timestamp":907200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Poor dyspnea perception might be a risk factor for developing asthma exacerbations. We investigated whether severe asthmatics with recurrent exacerbations (brittle asthma) have different dyspnea perception and sputum cells compared with equally severe, but stable asthmatics, or patients with mild steroid-naive asthma. Fifteen brittle asthmatics (13 female, median age 28 yr [range, 20 to 47 yr]), 15 matched severe-stable asthmatics (14 female, median age 26 yr [range, 17 to 52 yr]), and 11 mild asthmatics (8 female, median age 25 yr [range, 19 to 43 yr]) underwent inhalation tests with methacholine (MCh), and hypertonic saline combined with sputum induction. Dyspnea was assessed by Borg and Visual Analogue Scale (VAS), plotted against the percent fall in FEV1, and expressed as the slope of the regression line (Slope-Borg and Slope-VAS). The brittle and stable asthmatics had poorer perception than patients with mild asthma (Slope-Borg [p = 0.036], Slope-VAS [p &amp;lt; 0.001] for MCh). In patients with brittle asthma the perception was less as compared with severe-stable asthma (Slope-Borg for MCh: p = 0.05). In the severe asthmatics there was an inverse correlation between sputum eosinophilia and Slope-Borg and Slope-VAS (R = \u2212 0.55, p = 0.002 and R = \u2212 0.37, p = 0.049), whereas this correlation was a positive one in the mild asthmatics (R = 0.79, p = 0.012 and R = 0.67, p = 0.05). In conclusion, patients with severe asthma, particularly those with recurrent exacerbations, have blunted perception of dyspnea, which is related to the degree of sputum eosinophilia. This suggests that increased sputum eosinophilia is an indicator of clinical instabililty, and that eosinophilic airways inflammation might affect dyspnea perception in severe asthma. in 't<\/jats:p>","DOI":"10.1164\/ajrccm.158.4.9710087","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:47:41Z","timestamp":1365083261000},"page":"1134-1141","source":"Crossref","is-referenced-by-count":85,"title":["Impaired Perception of Dyspnea in Patients with Severe Asthma: Relation to Sputum Eosinophils"],"prefix":"10.1093","volume":"158","author":[{"given":"JOHANNES C. C. M.in't","family":"VEEN","sequence":"first","affiliation":[{"name":"Lung Function and Biochemistry Laboratory, Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"HERMELIJN H.","family":"SMITS","sequence":"additional","affiliation":[{"name":"Lung Function and Biochemistry Laboratory, Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ANTONIA J. J.","family":"RAVENSBERG","sequence":"additional","affiliation":[{"name":"Lung Function and Biochemistry Laboratory, Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PIETER S.","family":"HIEMSTRA","sequence":"additional","affiliation":[{"name":"Lung Function and Biochemistry Laboratory, Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PETER J.","family":"STERK","sequence":"additional","affiliation":[{"name":"Lung Function and Biochemistry Laboratory, Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ELISABETH H.","family":"BEL","sequence":"additional","affiliation":[{"name":"Lung Function and Biochemistry Laboratory, Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1998,10,1]]},"reference":[{"key":"2026032709035575600_B1","first-page":"601","article-title":"International consensus report on diagnosis and treatment of asthma.","volume":"5","author":"National Heart, Lung, and Blood Institute","year":"1992","journal-title":"Eur. Respir. J."},{"key":"2026032709035575600_B2","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1164\/ajrccm\/154.2_Pt_2.S66","article-title":"Pathology of mild, severe, and fatal asthma.","volume":"154(Suppl.)","author":"Kay","year":"1996","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"2026032709035575600_B3","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1056\/NEJM199412083312302","article-title":"Patterns of asthma mortality in Philadelphia from 1969 to 1991.","volume":"331","author":"Lang","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"2026032709035575600_B4","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S1081-1206(10)63195-X","article-title":"Stabilization of asthma mortality.","volume":"78","author":"Sly","year":"1997","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"2026032709035575600_B5","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1136\/thx.47.6.408","article-title":"Poorly perceived asthma.","volume":"47","author":"Barnes","year":"1992","journal-title":"Thorax"},{"key":"2026032709035575600_B6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1378\/chest.99.1.77","article-title":"Longitudinal study of near fatal asthma.","volume":"99","author":"Ruffin","year":"1991","journal-title":"Chest"},{"key":"2026032709035575600_B7","first-page":"423","article-title":"Bronchial provocation in the study of sensations associated with disordered breathing.","volume":"52","author":"Rubinfield","year":"1977","journal-title":"Clin. Sci. Mol. Med."},{"key":"2026032709035575600_B8","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1164\/ajrccm.152.1.7599850","article-title":"The severity of breathlessness during challenges with inhaled methacholine and hypertonic saline in atopic asthmatic subjects.","volume":"152","author":"Sont","year":"1995","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"2026032709035575600_B9","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1136\/thx.51.8.793","article-title":"Respiratory sensations during bronchial challenge testing with methacholine, sodium metabisulphite, and adenosine monophosphate.","volume":"51","author":"Marks","year":"1996","journal-title":"Thorax"},{"key":"2026032709035575600_B10","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1111\/j.1365-2222.1988.tb02878.x","article-title":"Bronchial responsiveness is not bronchial responsiveness is not bronchial asthma.","volume":"18","author":"Pauwels","year":"1988","journal-title":"Clin. Allergy"},{"key":"2026032709035575600_B11","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1164\/ajrccm\/143.3_Pt_2.S43","article-title":"Osmotic challenges in the assessment of bronchial hyperresponsiveness.","volume":"143 (Suppl.)","author":"Anderson","year":"1991","journal-title":"Am. Rev. Respir. Dis."},{"key":"2026032709035575600_B12","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1172\/JCI118011","article-title":"Perception of bronchial obstruction in asthmatic patients.","volume":"96","author":"Roisman","year":"1995","journal-title":"J. Clin. Invest."},{"key":"2026032709035575600_B13","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1042\/cs0760277","article-title":"A comparison of the visual analogue scale and modified Borg scale for measurement of dyspnea during exercise.","volume":"76","author":"Wilson","year":"1989","journal-title":"Clin. Sci."},{"key":"2026032709035575600_B14","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1183\/09031936.93.05091043","article-title":"Perceived effect on shortness of breath of an acute inhalation of saline or terbutaline: variability and sensitivity of a visual analogue scale in patients with asthma or COPD.","volume":"5","author":"Noseda","year":"1992","journal-title":"Eur. Respir. J."},{"key":"2026032709035575600_B15"},{"key":"2026032709035575600_B16","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1111\/j.1365-2222.1994.tb02725.x","article-title":"Non-invasive assessment of bronchial inflammation in asthma: no correlation between eosinophilia of induced sputum and bronchial responsiveness to inhaled hypertonic saline.","volume":"24","author":"Iredale","year":"1994","journal-title":"Clin. Exp. Allergy"},{"key":"2026032709035575600_B17","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1183\/09031936.96.09122441","article-title":"Repeatability of cellular and soluble markers of inflammation in induced sputum from patients with asthma.","volume":"9","author":"in 't Veen","year":"1996","journal-title":"Eur. Respir. J."},{"key":"2026032709035575600_B18","doi-asserted-by":"crossref","first-page":"715","DOI":"10.2307\/2530051","article-title":"Analysis of covariance using the rank transformation.","volume":"38","author":"Conover","year":"1982","journal-title":"Biometrics"},{"key":"2026032709035575600_B19","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/S0954-6111(06)80266-0","article-title":"Relationship between changes in diurnal variation of expiratory flows, lung volumes and respiratory symptoms after acute asthma.","volume":"85","author":"Boulet","year":"1991","journal-title":"Respir. Med."},{"key":"2026032709035575600_B20","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/0091-6749(91)90239-K","article-title":"Near fatal asthma: clinical and physiologic features, perception of bronchoconstriction and psychologic profile.","volume":"88","author":"Boulet","year":"1991","journal-title":"J. Allergy Clin. Immunol."},{"key":"2026032709035575600_B21","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1056\/NEJM199405123301901","article-title":"Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma.","volume":"330","author":"Kikuchi","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"2026032709035575600_B22","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1152\/jappl.1991.71.6.2183","article-title":"Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea.","volume":"71","author":"Taguchi","year":"1991","journal-title":"J. Appl. Physiol."},{"key":"2026032709035575600_B23","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1164\/ajrccm\/146.2.396","article-title":"Perception of airway obstruction in a random population sample.","volume":"146","author":"Brand","year":"1992","journal-title":"Am. Rev. Respir. Dis."},{"key":"2026032709035575600_B24","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1136\/thx.47.6.410","article-title":"Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale.","volume":"47","author":"Connolly","year":"1992","journal-title":"Thorax"},{"key":"2026032709035575600_B25","first-page":"825","article-title":"The perception of breathlessness in asthma.","volume":"126","author":"Burdon","year":"1982","journal-title":"Am. Rev. Respir. Dis."},{"key":"2026032709035575600_B26","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/0954-6111(95)90123-X","article-title":"Perception of dyspnoea during acute changes in lung function in patients with either asthma or COPD.","volume":"89","author":"Noseda","year":"1995","journal-title":"Respir. Med."},{"key":"2026032709035575600_B27","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1042\/cs0900227","article-title":"Influence of treatment with beclomethasone, cromoglycate and theophylline on perception of bronchoconstriction in patients with bronchial asthma.","volume":"90","author":"Higgs","year":"1996","journal-title":"Clin. Sci."},{"key":"2026032709035575600_B28","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1001\/archinte.1990.00040031604007","article-title":"Dyspnea.","volume":"150","author":"Tobin","year":"1990","journal-title":"Arch. Intern. Med."},{"key":"2026032709035575600_B29","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1164\/ajrccm\/148.6_Pt_1.1452","article-title":"Breathlessness during acute bronchoconstriction in asthma.","volume":"148","author":"Lougheed","year":"1993","journal-title":"Am. Rev. Respir. Dis."},{"key":"2026032709035575600_B30","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/oxfordjournals.bmb.a070002","article-title":"The sensation of breathlessness.","volume":"19","author":"Campbell","year":"1963","journal-title":"Br. Med. Bull."},{"key":"2026032709035575600_B31","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1146\/annurev.ph.49.030187.003143","article-title":"Nervous receptors of the tracheobronchial tree.","volume":"49","author":"Sant'Ambrogio","year":"1987","journal-title":"Annu. Rev. Physiol."},{"key":"2026032709035575600_B32","first-page":"83s","article-title":"Recurrent asthma exacerbations in severe asthma are associated with enhanced airway closure during clinicallly stable episodes (abstract).","volume":"9","author":"in 't Veen","year":"1996","journal-title":"Eur. Respir. J."},{"key":"2026032709035575600_B33"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/158\/4\/1134\/67435592\/ajrccm_158_4_1134.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/158\/4\/1134\/67435592\/ajrccm_158_4_1134.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:04:42Z","timestamp":1774616682000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/158\/4\/1134\/8530159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1998,10,1]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1998,10,1]]},"published-print":{"date-parts":[[1998,10,1]]}},"URL":"https:\/\/doi.org\/10.1164\/ajrccm.158.4.9710087","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1998,10]]},"published":{"date-parts":[[1998,10,1]]}}}