Dr. Denis O’Donnell

Dr. Denis O’Donnell

The drive to breathe

What if you felt like you had a football—and an American-sized one at that—lodged in each lung every time you tried to draw breath?

As a medical student in Ireland, Dr. Denis O’Donnell has clear memories of watching helplessly as patients struggled with the debilitating condition known as dyspnea (pronounced dis-knee-ah) or breathlessness, and only having oxygen or opiates to offer. Dyspnea is a common and uncomfortable symptom of many lung diseases. Even with pharmacotherapy and pulmonary rehabilitation, coping can be a daily struggle. And the accompanying psychological effects, such as fear and anxiety and depression, can be as distressing as the physical ones.

Finally and frustratingly, sometimes anticipating the symptom can actually provoke it.

Dr. O’Donnell is a professor of medicine at Queen’s University at Kingston, Ontario. Over his long and illustrious career, he has achieved national and international recognition for his work on understanding, treating, and managing chronic obstructive pulmonary disease (COPD).

People with COPD have an increased “drive to breathe” compared to healthy controls. As their lungs become overinflated even with minimal activity, it produces a sensation of not being able to breathe in, akin to those footballs taking up residence. This heightens the drive to breathe as more ventilation is needed. Unexpectedly, Dr. O’Donnell’s research has found that people with mild COPD whose symptoms may not have shown up on traditional spirometry tests, or even those who are at risk, also have this higher drive to breathe, and that the damage to the lungs may start much earlier than was previously believed.

COPD affects the small airways and the surrounding blood vessels, and even mild cases may have extensive inflammation. Although there has been a tendency to not treat people until their symptoms become problematic, early intervention to control inflammation that is starting to cause small changes may be of benefit. The changes are subtle at rest and greater with stress such as exercise, which may account for the “drift toward inactivity” that is often observed even in mild cases. It’s possible that medication or other methods to control inflammation might keep people active longer and improve their quality of life.

Dr. O’Donnell credits the significant funding he has received from The Lung Association over the years as a vital contributor to the productivity of his lab and its 300-plus publication record. “Without a shadow of a doubt” they would not have realized such success without this funding source. He also gives a full measure of credit to his patients, many of whom voluntarily give their time and limited energy to breathe during demanding physiological studies, in the interests of helping others, if not themselves.