Introduction
chronic breathlessness, cognitive behavioural, breathlessness, depression, COPD
CHRONIC OBSTRUCTIVE PULMONARY DISEASE, COPD
Chronic breathlessness is a key feature of chronic obstructive pulmonary disease (COPD) with symptoms often persisting despite maximal medical therapy. Pulmonary rehabilitation is the best treatment for chronic breathlessness in COPDBreathlessness severity is often poorly explained by objective clinical measures.Between-subject variability in therapeutic response is increasingly recognised as a confounder in clinical trials. A personalised medicine approach aims to identify subgroups of patients that respond to a specific therapy. In psychiatry, brain-derived metrics using functional neuroimaging have taken similar approaches to identifying subtypes of depression that may respond to bespoke therapies.In this study, we aimed to predict improvements in breathlessness during pulmonary rehabilitation by analysing baseline data from a longitudinal experimental medicine study of D-cycloserine on breathlessness during pulmonary rehabilitation. We selected D-cycloserine, which is a partial agonist at the NMDA receptor in the brain, for its action on neural plasticity and influence on brain expectation mechanisms associated with cognitive behavioural therapies.