Chest
The Measurement of Dyspnea: Contents, Interobserver Agreement, and Physiologic Correlates of Two New Clinical Indexes
Section snippets
Construction of the Indexes
Each index contains an arbitrary rating for three categories: functional impairment, magnitude of task needed to evoke dyspnea, and magnitude of effort needed to evoke dyspnea. At the initial or baseline evaluation, the patient’s condition was rated from 0 (severe), to 4 (unimpaired), for each category. The ratings on each of the three categories were added to form a baseline focal score (range, 0 to 12). The lower the total score, the worse the severity of dyspnea.
The transitions or changes in
RESULTS
Observer agreement using the dyspnea indexes is shown in Table 1. For the two technicians, agreement was 92 percent with the baseline focal scores and 90 percent with the transition focal scores. The percentage agreement for the three categories of the two indexes ranged from 85 percent to 94 percent. Values for kw were .70 for the baseline focal scores and .63 for the transition focal scores; this represented substantial agreement.27 The kw values of agreement for the three categories of the
DISCUSSION
In this study two clinical indexes were developed to measure dyspnea. In contrast to previously described methods, such as the four-or five-point rating scale7, 12 or the visual analog scale,23 the baseline and transition dyspnea indexes consisted of three categories which are major factors affecting the development of dyspnea: functional impairment, magnitude of task, and magnitude of effort. Our data demonstrated that a rating based on magnitude of task alone does not indicate the full
ACKNOWLEDGMENTS
The writers thank J. Denos, G. Orlowski, D. Papenfoth, and K. Weigel for their technical assistance and for applying the indexes to grade dyspnea in this study.
REFERENCES (36)
- et al.
Evaluation of the severity of asthma: patients versus physicians
Am J Med
(1980) - et al.
Improvement in bronchial asthma not reflected in forced expiratory volume
Lancet
(1965) - et al.
A new clinical taxonomy for rating change in functional activities of patients with angina pectoris
Am Heart J
(1977) Measurement of pain
Lancet
(1974)- et al.
Grading of pulmonary function impairment by means of pulmonary function tests
Dis Chest
(1967) - et al.
Changes in measured spirometric indices—what is the significance
Chest
(1981) - et al.
The perception of some sensations associated with breathing
Respir Physiol
(1970) Breathlessness and mouth occlusion pressure in patients with chronic obstruction of the airways
Chest
(1979)- et al.
Relation of the regulatory mechanism of repiration to clinical dyspnea
Proc Natl Acad Sci USA
(1935) - et al.
Corticosteroids in chronic airway obstruction: can the patient’s assessment be ignored?
Br J Dis Chest
(1980)
Chronic obstructive lung disease: II
Relationship of clinical and physiologic findings to the severity of airway obstruction. Am Rev Respir Dis
Prognosis of patients with COPD after hospitalization for acute ventilatory failure, a three-year follow-up study
Am Rev Respir Dis
The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population
Br Med J
Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease
Br Med J
Dyspnea and pulmonary function tests
Am Rev Respir Dis
Magnitude scaling of externally added loads to breathing
Am Rev Respir Dis
Perception of changes in airflow resistance in obstructive pulmonary disorders
Am Rev Respir Dis
Committee on research into chronic bronchitis
Instructions for use of the questionnaire on respiratory symptoms
Cited by (1109)
SABR for Early Non-Small Cell Lung Cancer: Changes in Pulmonary Function, Dyspnea, and Quality of Life
2023, International Journal of Radiation Oncology Biology PhysicsWhat Interventions Are Effective for Managing Dyspnea in COPD?
2023, Evidence-Based Practice of Palliative Medicine, Second Edition
Supported by the Medical Research Service, Veterans Administration, The Commonwealth Fund, and the Robert Wood Johnson Foundation grant 6309.