Breathlessness in COPD: linking symptom clusters with brain activity

FINNEGAN, S.L., HARRISON, O.K., HARMER, C.J., HERIGSTAD, Mari, RAHMAN, N.M., REINECKE, A. and PATTINSON, K.T.S. (2021). Breathlessness in COPD: linking symptom clusters with brain activity. European Respiratory Journal, 58 (5), p. 2004099.

Breathlessness in COPD linking symptom clusters with brain activity.pdf - Published Version
Creative Commons Attribution.

Download (1MB) | Preview
Official URL:
Open Access URL: (Published version)
Link to published version::


Rationale: Current 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. Methods: A 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. Results: We 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 to the high symptom load 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). Conclusions: This 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 multi-modal models of breathlessness in identifying behavioural phenotypes, and for advancing understanding of differences in breathlessness burden.

Item Type: Article
Uncontrolled Keywords: Affect; Brain; Dyspnea; Humans; Pulmonary Disease, Chronic Obstructive; Syndrome; Respiratory System; 11 Medical and Health Sciences
Identification Number:
Page Range: p. 2004099
SWORD Depositor: Symplectic Elements
Depositing User: Symplectic Elements
Date Deposited: 04 Jan 2022 15:53
Last Modified: 04 Jan 2022 16:00

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics