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Dyspnea is the major reason that patients with pulmonary diseases seek medical attention. In this paper we present the main scales used to evaluated dyspnea. We described in details the characteristics of Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI): ways of administration, domains, scores and minimally clinical important difference (MCID).
STUDY OBJECTIVE: To assess the utility of a new parameter in the differentiation of dyspnea of cardiac origin from dyspnea of pulmonary origin. METHODS: The peak expiratory flow (PEF) rate and the partial pressure of oxygen in arterial blood (PaO(2)) were measured in 71 patients with the chief complaint of dyspnea. The patients were treated in the hospital, and the final diagnosis (cardiac or pulmonary) of the cause of dyspnea was made at discharge. We defined a new measure, the dyspnea differentiation index (DDI), as (PEF x PaO(2))/1,000. We performed a receiver operating characteristic (ROC) curve analysis of the data to define the measure that best distinguished cardiac from pulmonary dyspnea. The curves also allowed us to establish an optimal cut-off point to distinguish between cardiac and pulmonary dyspnea. RESULTS: Patients with pulmonary dyspnea had a significantly lower mean PEF than patients with cardiac dyspnea (144 +/- 66 vs 267 +/- 97 L/min, respectively; p < 0.001). They also had a lower DDI than patients with cardiac dyspnea (8.4 +/- 4.0 vs 18.4 +/- 7.9 L-mm/min, respectively; p < 0.001). These two measures, PEF and DDI, also best distinguished pulmonary from cardiac dyspnea. PEF was able to diagnose the correct cause of dyspnea in 72% of patients, and DDI was correct in 79% of patients. This compares favorably to the performance of the emergency department physicians, who were able to predict the correct diagnosis in only 69% of patients. CONCLUSION: These results demonstrate that the PEF by itself is useful in differentiating between cardiac and pulmonary causes of dyspnea, but that the calculation of DDI is superior in this regard.
OBJECTIVE: Exercise-related dyspnea is the main symptom of chronic obstructive pulmonary disease (COPD), yet its relation to lung function deterioration is weak. The aim of this study was to evaluate the relation between the patients' usual level of dyspnea and dyspnea caused by a maximum cardiopulmonary stress test or a 6-minute walking test. METHODOLOGY: Thirty-six consecutive patients with stable COPD (age 66 7 years post-bronchodilator FEV1 47 14% of predicted) were studied. In addition to full baseline function testing, all patients underwent stress testing on a cycle ergometer and a 6-minute walking test in a corridor 50 m long. Exercise-induced dyspnea was assessed by the patient on a Borg scale before beginning and after completing each test. Chronic dyspnea during activities of daily living was quantified on the Medical Research Council (MRC) scale. RESULTS: The MRC value was only weakly related to percent of predicted FEV1 (r = 0.34, p = 0.04). Parameters obtained during exercise tests that were associated with the MRC were SaO2 at the end of the 6-minute walking test (r = 0.49, p = 0.004) and change in dyspnea on the Borg scale during the 6-minute walking test (deltaBorg-6mWT, r = 0.54, p = 0.0008) and during the stress test (r = 0.35, p = 0.04). Multiple regression analysis, with the MRC result as the dependent variable, showed that deltaBorg-6mWT and SaO2 at the end of the walking test explained 29% of the variance. CONCLUSION: Severity of chronic dyspnea in COPD patients assessed on the MRC scale is more related to dyspnea triggered by the walking test than with dyspnea induced by cycle ergometer stress testing.
BACKGROUND: Recent research has shown that distinct dimensions in the perception of dyspnea can be differentiated; however, most studies to date have only used a global rating scale for the measurement of this sensation. OBJECTIVES: This study examined the different influence of sensory and affective aspects of perceived dyspnea on the commonly used Borg scale, which measures the global perception of dyspnea. METHODS: Dyspnea was induced in 16 healthy volunteers (mean age 26.2 +/- 6.3 years) by breathing through an inspiratory resistive load (3.57 kPa/l/s) in two experimental conditions (attention and distraction). After each of the two conditions the experienced intensity (i.e., sensory dimension) and unpleasantness (i.e., affective dimension) of dyspnea were rated on separate visual analog scales (VAS), followed by a global rating of dyspnea on the Borg scale. Hierarchical multiple linear regression models were calculated to analyze the predictive validity of VAS ratings of intensity and unpleasantness on the Borg scale ratings. RESULTS: When subjects attended to their breathing, only VAS intensity scores showed a significant influence on Borg scale ratings (p < 0.05). In contrast, only the VAS unpleasantness scores showed a significant influence on Borg scale ratings (p < 0.05) when subjects were distracted. CONCLUSIONS: These findings show that sensory and affective aspects of perceived dyspnea differentially influence the global measure of dyspnea as determined by the Borg scale. A differentiation between these aspects in future studies through the use of separate rating scales could yield more detailed information on the perception and report of dyspnea.
OBJECTIVE: To study the method of quantitative evaluation of dyspnea and to investigate the effects of M-receptor antagonist inhalation on dyspnea in patients with chronic obstructive pulmonary disease (COPD) during exercise. METHODS: Cycle exercise test was used in 27 patients with COPD and the effects of ipratropium bromide, a M-receptor antagonist, by inhalation on dyspnea and exercise capacity in the patients were observed. RESULTS: (1) Dyspnea index as Borg scale was closely correlated with oxygen uptake (V(O2)) during exercise in all the patients. Three variables for quantitative evaluation of dyspnea could be derived from the linear regression line. They were Borg scale slope (BSS), threshold load of dyspnea (TLD), and breakpoint load of dyspnea(BLD). (2) BSS was negatively correlated with forced expiratory volume in one second to forced vital capacity ratio (r = -0.519, P < 0.01) and diffusing capacity of the lungs for carbon monoxide (r = -0.497, P < 0.01) but positively correlated with residual volume/total lung capacity (r = 0.396, P < 0.05). (3) Inhalation of ipratropium bromide could significantly improve BSS [from (12.09 +/- 3.41) BS x L(-1) x min(-1) to (8.57 +/- 2.79) BS x L(-1) x min(-1), P < 0.01] and BLD [from (0.77 +/- 0.19) L/min to (0.81 +/- 0.14) L/min, P < 0.05] during exercise. CONCLUSIONS: (1) BSS, TLD and BLD could be used as reliable and convenient variables in quantitative evaluation of dyspnea in patients with COPD. BSS and BLD could to some extent reflect the severity of the disease. (2) M-receptor antagonists could alleviate dyspnea and increase exercise capacity in patients with COPD.
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The aim of this study was to validate our Dalhousie Dyspnea Scales in children referred for histamine bronchoprovocation challenge. Seventy-four children rated their dyspnea after each FEV(1) measurement following inhalation of doubling histamine concentrations from 0.125 to 8.0 mg/ml by the standard tidal breathing method. Serial FEV(1) and dyspnea rating using the Dalhousie Dyspnea Scales were recorded and Kendall's tau was computed for dyspnea rating versus fall in FEV(1). Subjects were split into those with positive (DeltaFEV(1) >or= 20% with PC(20) <or= 8 mg/ml) or negative histamine challenge test. During histamine inhalation, dyspnea ratings on each of the subscales rose as FEV(1) fell across subjects, whether or not they were histamine-responsive (main effect), and then fell dramatically following relief of induced obstruction by bronchodilator.The Dalhousie Dyspnea Scales are useful and accurate tools to measure dyspnea due to bronchoconstriction in children.
PURPOSE: To develop and psychometrically test the Dyspnea Management Questionnaire (DMQ), a new multidimensional measure of dyspnea in adults with chronic obstructive lung disease. PARTICIPANTS: Eighty-five participants were recruited with diagnoses of chronic obstructive pulmonary disease (COPD, n = 73) and asthma (n = 12). The total sample was predominately female (65%) and married (34%), with 64.9% white and a mean age of 75 years (SD = 9.6, n = 76), diagnosed with pulmonary disease 4.8 years ago (SD = 4.4), 32% requiring the use of supplemental oxygen. Participants were also African American (29.9%), Asian (2.6%), and Hispanic (2.6%); n = 77. METHODS: An initial item pool of 74 items was drawn for the DMQ aided by qualitative interview data, literature review, and pilot testing with 3 adults with COPD. Several analyses were used to reduce the item pool. An interdisciplinary panel of 12 experts evaluated the content validity of the DMQ items. To evaluate test-retest reliability, respondents with stable COPD (n = 26) completed the questionnaire twice within a mean interval of 18 days (SD = 7.17). The DMQ was compared with the Medical Outcomes Study 12-Item Short-Form (SF-12) Health Survey, the Seattle Obstructive Lung Disease Questionnaire, and the Hospital Anxiety and Depression Scale. RESULTS: The resulting DMQ is a 30-item scale that measures 5 conceptually derived dimensions: dyspnea intensity, dyspnea-related anxiety, fearful activity avoidance, self-efficacy for activity, and satisfaction with strategy use. It has a 7-point Likert-type scale and third Flesch-Kincaid reading grade level. A panel of 12 experts supported the content validity of the DMQ. It showed high internal consistency (alpha = .87 to .96) and test-retest reliability over 2.5 weeks (intraclass correlation coefficient = 0.71 to 0.95). Dyspnea intensity, dyspnea-related anxiety, and fearful activity avoidance subscales of DMQ-30 and composite score were moderately to highly correlated with 3 Seattle Obstructive Lung Disease Questionnaire dimensions (r = 0.44-0.83), Medical Outcomes Study 12-Item Short-Form scales (r = 0.41-0.57), and Hospital Anxiety and Depression Scale-Anxiety (r = -0.59 to -0.65). Two of DMQ's subscales, self-efficacy for activity and satisfaction with strategy use, correlated mildly with Seattle Obstructive Lung Disease Questionnaire (r = 0.28 and 0.27, respectively). Some very low correlations for DMQ-30's satisfaction with strategy use compared with the Medical Outcomes Study 12-Item Short-Form provided preliminary support for its divergent construct validity. The DMQ-30 discriminated adults with COPD requiring supplemental oxygen from those not requiring it. CONCLUSIONS: The DMQ addresses the need for a more comprehensive, multidimensional assessment of dyspnea, especially for anxious patients with COPD, in order to better guide the appropriate application of dyspnea management interventions and measure pulmonary rehabilitation outcomes. The DMQ can help add insights into the benefit of adjunctive therapies such as psychoeducation, controlled breathing strategies, and cognitive-behavioral approaches in pulmonary rehabilitation for anxious patients with COPD.
OBJECTIVE: To determine the direction and rate of change in the symptom of dyspnea in patients with chronic obstructive pulmonary disease (COPD) whose lung function has worsened over time. DESIGN: Secondary analysis of a longitudinal data set. SETTING: Outpatient clinic. PATIENTS: Thirty-four medically stable male subjects with chronic obstructive pulmonary disease studied for 5.3 +/- 3.5 years, with a mean reduction in FEV1 over the period studied of 330.9 +/- 288.0 mL. Subjects were 63.3 +/- 5.5 years of age at entry into the study. OUTCOME MEASURES: Dyspnea and functional status scores were obtained using the Pulmonary Functional Status and Dyspnea Questionnaire. RESULTS: There was no significant difference in reports of dyspnea from the beginning to the end of the study, despite significant reductions in lung function. Of all activities studied, dyspnea when raising arms overhead was the only activity showing a relationship to the slope of change in FEV1 %. CONCLUSION: These findings suggest that, although patients with chronic lung disease experience varying degrees of deterioration in lung function longitudinally, there is no evidence that they report worsening of dyspnea in tandem with these physiologic changes. In this study, patient ratings of dyspnea longitudinally were not directly linked to changes in lung impairment.
Dyspnea, the major symptom associated with acute exacerbation events of chronic obstructive pulmonary disease (COPD), is a subjective experience. Extensive research has been done on the pathophysiology and affective components of dyspnea; however, the precise physical mechanism of breathlessness remains elusive. One purpose of this narrative research was to explore the affective component of dyspnea/anxiety as described by patients living with COPD characterized by acute illness events. Ten patient-family units participated in interviews during an acute episode of the patient's lung disease. They described their understanding of acute dyspnea as an experience inextricably related to anxiety and emotional functioning. Their stories suggest that given the absence of clear objective measures of illness severity, patient-reported anxiety might provide an important marker during acute exacerbation events. Health care providers need to recognize anxiety as an important and potentially measurable sign of invisible dyspnea for end-stage patients with COPD in acute respiratory distress.
We conducted a randomized clinical trial to evaluate a limited pulmonary rehabilitation program focused on coping strategies for shortness of breath but without exercise training. Eighty-nine patients with COPD were randomly assigned to either 6-week treatment or general health education control groups. Treatment consisted of instruction and practice in techniques of progressive muscle relaxation, breathing retraining, pacing, self-talk, and panic control. Tests of 6-min walk distance, quality of well-being, and psychological function as well as six dyspnea measures were administered at baseline, posttreatment, and 6 months after the intervention. Baseline pulmonary function tests also were obtained. At the end of the 6-week treatment, there were no significant differences between the treatment and control groups on any outcome measure. At the 6-month follow-up, a significant group difference was seen on only one variable, Mahler's transition dyspnea index. The results of this evaluation suggest that a treatment program of dyspnea management strategies, without structured exercise training or other components of a comprehensive pulmonary rehabilitation program, is not sufficient to produce significant improvement in dyspnea, exercise tolerance, health-related quality of well-being, anxiety, or depression.
BACKGROUND: Because there are no child-friendly, validated, self-report measures of dyspnea or breathlessness, we developed, and provided initial validation, of three, 7-item, pictorial scales depicting three sub-constructs of dyspnea: throat closing, chest tightness, and effort. METHODS: We developed the three scales (Throat closing, Chest tightness, and Effort) using focus groups with 25 children. Subsequently, seventy-nine children (29 children with asthma, 30 children with cystic fibrosis. and 20 children who were healthy) aged 6 to 18 years rated each picture in each series, using a 0-10 scale. In addition, each child placed each picture in each series on a 100-cm long Visual Analogue Scale, with the anchors "not at all" and "a lot". RESULTS: Children aged eight years or older rated the scales in the correct order 75% to 98% correctly, but children less than 8 years of age performed unreliably. The mean distance between each consecutive item in each pictorial scale was equal. CONCLUSION: Preliminary results revealed that children aged 8 to 18 years understood and used these three scales measuring throat closing, chest tightness, and effort appropriately. The scales appear to accurately measure the construct of breathlessness, at least at an interval level. Additional research applying these scales to clinical situations is warranted.
In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang [symbol: see text]-[symbol: see text]) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P < 0.01); and that in the treatment group, the cure rate for the wind-cold type of acute bronchitis was significantly higher than that for the wind-heat type of acute bronchitis (P < 0.01).
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