Breathlessness in chronic obstructive pulmonary disease (COPD) is often discordant with airway pathophysiology (“over-perception”). Pulmonary rehabilitation profoundly affects breathlessness, without influencing lung function. Learned associations influence brain mechanisms of sensory perception. We hypothesised that improvements in breathlessness with pulmonary rehabilitation may be explained by changing neural representations of learned associations. In 31 patients with COPD, we tested how pulmonary rehabilitation altered the relationship between brain activity during a breathlessness-related word-cue task (using functional magnetic resonance imaging), and clinical and psychological measures of breathlessness. Changes in ratings of breathlessness word cues positively correlated with changes in activity in the insula and anterior cingulate cortex. Changes in ratings of breathlessness-anxiety negatively correlated with activations in attention regulation and motor networks. Baseline activity in the insula, anterior cingulate cortex and prefrontal cortex correlated with improvements in breathlessness and breathlessness-anxiety. Pulmonary rehabilitation is associated with altered neural responses related to learned breathlessness associations, which can ultimately influence breathlessness perception. These findings highlight the importance of targeting learned associations within treatments for COPD, demonstrating how neuroimaging may contribute to patient stratification and more successful personalised therapy. Pulmonary rehabilitation improves breathlessness by recalibrating the brain's sensory perception networks http://ow.ly/crhy30cQerx

中文翻译：

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通过大脑治疗呼吸困难：肺康复过程中大脑活动的变化

慢性阻塞性肺疾病 (COPD) 的呼吸困难通常与气道病理生理学不一致（“过度感知”）。肺康复会深刻影响呼吸困难，但不会影响肺功能。习得的联想影响感觉知觉的大脑机制。我们假设通过改变学习关联的神经表征可以解释呼吸困难与肺康复的改善。在 31 名 COPD 患者中，我们测试了肺康复如何改变与呼吸困难相关的单词提示任务（使用功能性磁共振成像）期间的大脑活动与呼吸困难的临床和心理测量之间的关系。呼吸困难单词线索评分的变化与脑岛和前扣带皮层活动的变化呈正相关。呼吸困难-焦虑评分的变化与注意力调节和运动网络的激活呈负相关。岛叶、前扣带皮层和前额叶皮层的基线活动与呼吸困难和呼吸困难焦虑的改善相关。肺康复与学习性呼吸困难关联相关的神经反应改变有关，这最终会影响呼吸困难的感知。这些发现强调了在 COPD 治疗中针对学习关联的重要性，展示了神经影像学如何有助于患者分层和更成功的个性化治疗。肺康复通过重新校准大脑的感觉感知网络来改善呼吸困难 http://ow.ly/crhy30cQerx 前扣带皮层和前额叶皮层与呼吸困难和呼吸困难焦虑的改善相关。肺康复与学习性呼吸困难关联相关的神经反应改变有关，这最终会影响呼吸困难的感知。这些发现强调了在 COPD 治疗中针对学习关联的重要性，展示了神经影像学如何有助于患者分层和更成功的个性化治疗。肺康复通过重新校准大脑的感觉感知网络来改善呼吸困难 http://ow.ly/crhy30cQerx 前扣带皮层和前额叶皮层与呼吸困难和呼吸困难焦虑的改善相关。肺康复与学习性呼吸困难关联相关的神经反应改变有关，这最终会影响呼吸困难的感知。这些发现强调了在 COPD 治疗中针对学习关联的重要性，展示了神经影像学如何有助于患者分层和更成功的个性化治疗。肺康复通过重新校准大脑的感觉感知网络来改善呼吸困难 http://ow.ly/crhy30cQerx 肺康复与学习性呼吸困难关联相关的神经反应改变有关，这最终会影响呼吸困难的感知。这些发现强调了在 COPD 治疗中针对学习关联的重要性，展示了神经影像学如何有助于患者分层和更成功的个性化治疗。肺康复通过重新校准大脑的感觉感知网络来改善呼吸困难 http://ow.ly/crhy30cQerx 肺康复与学习性呼吸困难关联相关的神经反应改变有关，这最终会影响呼吸困难的感知。这些发现强调了在 COPD 治疗中针对学习关联的重要性，展示了神经影像学如何有助于患者分层和更成功的个性化治疗。肺康复通过重新校准大脑的感觉感知网络来改善呼吸困难 http://ow.ly/crhy30cQerx