Cerebral Processing of Respiratory Information and Intervention in Individuals with Respiratory Discomfort: a Study on Electrophysiology, Biomarker, and Functional Magnetic Resonance Imaging

Dyspnea, or breathlessness, is a common symptom experienced by individuals after exercise, when feeling distressed, or with various diseases. High levels of breathlessness can lead to respiratory anxiety in respiratory diseases. Literature have pointed out that the first and foremost goal of treating chronic respiratory diseases is to relieve symptoms of dyspnea. However, the fact that mismatch between perceived symptom and lung function is highly prevalent makes therapy decision more difficult. More than 1/3 of patients with mild chronic obstructive pulmonary disease (COPD) experience moderate-to-severe level of dyspnea. In addition, chest physicians have observed that a certain portion of otherwise healthy individuals with normal lung mechanics experience significant breathlessness. Central mechanism of dyspnea is still not well understood. Mindfulness training, one of the non-pharmacological strategies, was found effective in reducing negative emotions in symptom management. However, the results regarding its effectiveness in perceived breathlessness are mixed. Given that changes in central neural correlates and biomarkers are useful predictors of subjects’ clinical outcomes, the purpose of our project is to investigate brain processing of respiratory sensation in those who have chronic respiratory discomfort with or without COPD diagnosis, and how mindfulness intervention as top-down approach centrally regulate respiratory information processing. In the current 3-year project, we systematically examine respiratory cerebral processing and neural activation patterns in individuals with respiratory discomfort but fair lung functions (RD), patients with mild COPD but high symptom perception (mCOPD), and healthy controls. We further test the effectiveness of our program of mindfulness training for individuals. using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) methods to compare with salivary and serum biomarkers, cardiorespiratory coupling (CRC), and behavioral testing. In the first year, we plan to test cerebral processing of respiratory sensation and CRC in RD, mCOPD, and healthy controls. We hypothesized that the RD and mCOPD groups will show decreased respiratory neural gating function, respiratory interoceptive accuracy, as well as decreased CRC synchronization compared to the controls. In the second year, we plan to recruit more subjects along with the returning subjects in year 1, and randomly assign subjects to the experimental group and a wait-listed sham group for our on-site mindfulness training program. We hypothesize that after training, the experimental group will show increased power of θ/β ratio in EEG recording, CRC synchronization, decreased salivary/serum inflammatory and stress biomarkers. Finally, with a cross-over experimental design, we provide training to the sham groups in the third year and pull results together for comparison. We further hypothesize that the lower levels of these biomarkers are associated with increase grey matter volume in areas including hippocampus and post-cingulate cortex. Our preliminary results in evoked potential data and behavioral testing support the feasibility of this study. We expect to utilize the results of this project for promoting dyspnea prevention and delaying symptom exacerbation for patients with high symptom perception with or without COPD.

Project ID:PC10907-1135
External Project ID:MOST109-2320-B182-008-MY3