ArticleThe European respiratory journal2021
Breathlessness in COPD: linking symptom clusters with brain activity.
Article in The European respiratory journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Effects of inspiratory muscle training on inspiratory muscle strength and exercise tolerance in patients with COPD: a meta-analysis and systematic review.Frontiers in medicine · 2026Pooled it
- Trial
- Pulmonary rehabilitation in Iranian outpatients with mustard gas lung disease: a randomised controlled trial.BMJ open · 2024Trial
- Trial
- Broca's area, responsible for speech production, is regulated by lung function.Neural regeneration research · 2026Article
- Resting-state functional MRI analysis of the brain's adaptation to chronic hypoxia: disease and environment.Quantitative imaging in medicine and surgery · 2026Article
- Functional reorganisation of lingual gyrus mediates cognitive impairment in COPD: a multimodal neuroimaging study.ERJ open research · 2026Article
- Abnormal Brain Functional Connectivity in Patients with Chronic Obstructive Pulmonary Disease and Correlations with Clinical and Cognitive Parameters.International journal of chronic obstructive pulmonary disease · 2025Article
- Higher Lifetime Stress and Symptom Burden Contribute to the Occurrence of Shortness of Breath.Seminars in oncology nursing · 2023Article
- The effect of d-cycloserine on brain processing of breathlessness over pulmonary rehabilitation: an experimental medicine study.ERJ open research · 2023Article
- Article
- Baseline Psychological Traits Contribute to Lake Louise Acute Mountain Sickness Score at High Altitude.High altitude medicine & biology · 2022Article
- A common model for the breathlessness experience across cardiorespiratory disease.ERJ open research · 2021Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundCurrent models of breathlessness often fail to explain disparities between patients' experiences of breathlessness and objective measures of lung function. While a mechanistic understanding of this discordance has thus far remained elusive, factors such as mood, attention and expectation have all been implicated as important modulators of breathlessness. Therefore, we have developed a model to better understand the relationships between these factors using unsupervised machine learning techniques. Subsequently we examined how expectation-related brain activity differed between these symptom-defined clusters of participants.
methodsA cohort of 91 participants with mild-to-moderate chronic obstructive pulmonary disease (COPD) underwent functional brain imaging, self-report questionnaires and clinical measures of respiratory function. Unsupervised machine learning techniques of exploratory factor analysis and hierarchical cluster modelling were used to model brain-behaviour-breathlessness links.
resultsWe successfully stratified participants across four key factors corresponding to mood, symptom burden and two capability measures. Two key groups resulted from this stratification, corresponding to high and low symptom burden. Compared with the high symptom burden group, the low symptom burden group demonstrated significantly greater brain activity within the anterior insula, a key region thought to be involved in monitoring internal bodily sensations (interoception).
conclusionsThis is the largest functional neuroimaging study of COPD to date, and is the first to provide a clear model linking brain, behaviour and breathlessness expectation. Furthermore, it was possible to stratify participants into groups, which then revealed differences in brain activity patterns. Together, these findings highlight the value of multimodal models of breathlessness in identifying behavioural phenotypes and for advancing understanding of differences in breathlessness burden.
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