An additive interaction between different qualities of dyspnea produced in normal human subjects

We evaluated the sensation of dyspnea induced by hypercapnia alone and a combination of hypercapnia and flow-resistive loading by the use of visual analogue scale (VAS) and the use of 13 listed descriptors in 23 healthy subjects. Hypercapnia alone caused a modest degree of dyspnea characterized by both air hunger and work/effort sensations. An addition of inspiratory flow-resistive loading (IRL) caused an increase in inspiratory difficulty and some attenuation of ‘work/effort.’ The addition of expiratory flow-resistive loading (ERL) caused an increase in expiratory difficulty and attenuation of ‘air hunger.’ The addition of both IRL and ERL caused a marked increase in dyspnea, the amount of which was close to the sum of the increases obtained individually by IRL and by ERL, while the quality of dyspnea was characterized predominantly by work/effort. These results suggest that despite the difference in quality of sensations, the intensity of dyspnea would sum linearly when the two kinds of loads are presented at the same time.