Dyspnea perception and neurological symptoms in non-severe COVID-19 patients
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COVID-19
Dyspnea perception and neurological symptoms in non-severe COVID-19 patients Josuel Ora 1 & Claudio Liguori 2 & Ermanno Puxeddu 1,3 & Angelo Coppola 1 & Matteo Matino 1 & Mariangela Pierantozzi 2 & Nicola Biagio Mercuri 2,4 & Paola Rogliani 1,3 Received: 4 June 2020 / Accepted: 25 July 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Introduction The relationship between dyspnea and COVID-19 is unknown. In COVID-19 patients, the higher prevalence of neurological symptoms and the lack of dyspnea may suggest common underlying pathogenetic mechanisms. The aim of this preliminary study is to address whether there is a lack of dyspnea in COVID-19 patients and if there is a relationship between neurological symptoms and the perception of dyspnea. Methods A structured interview regarding the occurrence of subjective neurological symptoms was performed and coupled with a questionnaire about the intensity and qualities of dyspnea. Respiratory rate (RR) and an arterial blood gas on room air were concurrently evaluated. Results Twenty-two patients (age 68.4 ± 13.9 years, 13 males and 9 females) were included and divided into two groups according to the Borg dyspnea scale: dyspneic patients BU ≥ 1(DYSP) and non-dyspneic patients BU < 1 (NDYSP). The prevalence of dyspnea overall was 31.8%. The prevalence of neurological symptoms, dyspnea descriptors, RR, pH, PaCO2, PaO2, or lactate was similar between groups. Conclusion This study confirms that the prevalence of dyspnea is low in non-severe COVID-19 patients, but contrary to our hypothesis of a relationship between shortness of breath and neurological symptoms, we have not been able to find any evidence of an impairment in dyspnea perception, either in the DYSP or NDYSP group. Keywords Dyspnea . COVID-19 . dyspnea descriptors . arterial blood gas
Introduction Recently, Bertrand Recansens et al. have observed that patients with COVID-19 perceive less breathlessness than would be expected in their condition, and the lack of dyspnea perception despite the severe respiratory failure leads to intubation [1]. Two main mechanisms have been hypothesized:
* Paola Rogliani [email protected] 1
Respiratory Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
2
Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
3
Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
4
Experimental Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
either a damage of C-pulmonary fibers due to the cytokine storm caused by inflammation or a direct neurotoxic effect of the virus [1]. In COVID-19 patients, the high prevalence of neurological symptoms (36.4%) [2] and the low prevalence of dyspnea (between 19 and 55% according to the studies) [3–5] may suggest an involvement of the neurological pathways involved in dyspnea perception. Dyspnea is a complex symptom defined as “a subjective experience of breathing discomfort that consists of qualitatively distin
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