SECTION 2: DYSPNEA MEASURES

Test Link, Basic Information Provider |Considerations, Price

The scale subjectively measures exertional dyspnea (Borg 1982 1990) and may be used for perceived exertion. It is easy to use and concise (Mador 1995) and doesnt require recall. Public domain.

Sensitivity, Validity, Reliability

The Borg rating increases linearly with HR and VO2 as exercise intensity increases. It correlates with ventilatory minute volume, CO2 production, lactate accumulation, and body temperature. FEV1 r = 0.88. (See note below regarding r values)

Minimal Important Difference (MID)

Based on retrospective analysis, a MID of 1 unit has been discussed (Cazzola M et al 2008).

Borg Dyspnea Scale (1)

(May be called modified Borg dyspnea scale.)

Modified Borg Dyspnea Scale (Borg G 1970) The Borg scale is a psychophysical measure in which a subject reports symptoms associated with a current physical activity, e.g., exercise. The Borg scale rates dyspnea on a scale of 0-10 to quantify the intensity of dyspnea during activity. The 0-10 scale is the "modified" Borg scale; the original perceived exertion scale was scored from 6-20 (corresponding to heart rate range of 60-200). The modified Borg scale as a perceived symptom scale can be used to rate various symptoms associated with exercise (e.g., breathlessness, muscle fatigue).

See example below.

Modified Medical Research Council (MRC) Scale (2) See example below.

Modified Medical Research Council (MMRC) Dyspnea Scale (Fletcher C 1952) The patient selects a grade on 5-point scale (rating of 0-4) that describes everyday situations or activity levels provoking breathlessness and impairment. The scale requires recall.

The scale uses a simple and standardized method of categorizing disability in COPD (Cazzola M 2008). It quantifies disability related to dyspnea and has been widely used to describe cohorts and stratify interventions including PR in COPD. It has been in use for over 50 years. Public

There is possible underestimation bias due to avoidance of exertion (Rennard S, 2002). The tool has more strength for predictive purposes versus evaluative use. The tool lacks precise limits and may have low sensitivity to change from intervention (Haughney J et al, 2004). There is relatively scarce clinical data on validation, responsiveness, and sensitivity (de Torres J 2002). r = - 0.53 with other dyspnea measures, - 0.42 with FEV1.

N/A

SECTION 2: DYSPNEA MEASURES

Test Link, Basic Information Provider |Considerations, Price
The tool is easily administered.

Sensitivity, Validity, Reliability

The tool is sensitive to various interventions including bronchodilators. It has a high level of reliability and validity among dyspnea measures (Eakin E, et al. 1995). 6MWD r = - 0.40 DLCO r = - 0.67 Inter-rater reliability for the BDI r = 0.83. TDI r = .83.

Minimal Important Difference (MID)

5 points (Kupferberg D, 2005).

University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ)

Validation of a New Dyspnea Measure (Eakin E, Resinkoff P, Prewitt L, et al. 1998). The tool rates ADLrelated breathlessness in 24 various activities on a 6 point scale. If the activity is not performed, the patient estimates their rating. The scale includes 21 ADLs.

The score ranges from 0 to 120 with a higher score associated with greater breathlessness with ADLs. Translations are available at www.MAPI-institute.com The UCSD SOBQ is copyrighted by UCSD. Currently, it is available free (with permission and acknowledgement) for education and research purposes by non-profit organizations. For commercial or for-profit use, UCSD now requires an agreement and charges a negotiable fee. Copyright <year work created> The Regents of the University of California. All Rights Reserved. Permission to copy, modify and distribute any part of the UCSD SOBQ for educational, research and non-profit purposes, without fee, and without a written agreement is hereby granted, provided that the above copyright notice appear in all copies. Those desiring to incorporate the UCSD SOBQ into commercial products or use for commercial purposes should contact the Technology Transfer Office: UCSD, San Diego 9500 Gilman Drive, Mail Code 0910 La Jolla, CA 92093-0910 Ph: (858) 534-5815 FAX: (858) 534-7345 E-MAIL: invent@ucsd.edu

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Test Baseline and Transition Dyspnea Indexes (BDI/TDI) Link, Basic Information
Baseline and Transition Dyspnea Indexes (BDI/ TDI) The tool has baseline and transition dyspnea ratings. The scale rates according to functional impairment, magnitude of the task and the magnitude of effort (Mahler, et al 1984).

Provider Considerations, Price

The BDI rates severity of dyspnea at single point in time. The TDI assesses changes from baseline dyspnea. The BDI scale rates dyspnea on a 5 point scale: 0 = severe, to 4 = unimpaired. The BDI range is 1-12. The TDI uses 7 point scale from -3 (major deterioration) to + 3 (major improvement). The tool is free in non-funded research and individual clinical practice by Clicking Here.

Sensitivity, Validity, Reliability

The BDI significantly correlates with the dyspnea diary (DD) score and symptom and activity components of the SGRQ. The TDI also correlates with changes in the DD, SGRQ symptom and activity scores. Construct validity has been established by the association between baseline FEV1 and BDI and FEV1 with the TDI. (Witek T, Mahler D. 2003).

Minimal Important Difference (MID)

One unit has been described as MID

Standardized Dyspnea Domain of the CRQ

See Chronic Respiratory Questionnaire below in Quality of life instruments.

See Chronic Respiratory Questionnaire below in Quality of Life instruments.

The standardized dyspnea domain of CRQ is very sensitive to change.

SECTION 2: DYSPNEA MEASURES

(1) BORG DYSPNEA SCALE 0 0.5 1 2 3 4 5 6 7 8 9 10 Very, very severe (almost maximal) Maximal Very severe Nothing at all Very, very slight (just noticeable) Very slight Slight Moderate Somewhat severe Severe Exercise Training Zone

(2) MODIFIED MEDICAL RESEARCH COUNCIL (MMRC) DYSPNEA SCALE Grade 0 1 2 3 4 Description of Breathlessness I only get breathless with strenuous exercise. I get short of breath when hurrying on level ground or walking up a slight hill. On level ground, I walk slower than people of the same age because of breathlessness, or have to stop for breath when walking at my own pace. I stop for breath after walking about 100 yards or after a few minutes on level ground. I am too breathless to leave the house or I am breathless when dressing.

r values
*Note on r value or correlation coefficient: The quantity r, called the linear correlation coefficient, measures the strength and the direction of a linear relationship between two variables. The linear correlation coefficient is sometimes referred to as the Pearson product moment correlation coefficient. The value of r is such that -1 < r < +1. The + and signs are used for positive linear correlations and negative linear correlations, respectively. Positive correlation: If x and y have a strong positive linear correlation, r is close to +1. An r value of exactly +1 indicates a perfect positive fit. Positive values indicate a relationship between x and y variables such that as values for x increases, values for y also increase. Negative correlation: If x and y have a strong negative linear correlation, r is close to -1. An r value of exactly -1 indicates a perfect negative fit. Negative values indicate a relationship between x and y such that as values for x increase, values for y decrease. No correlation: If there is no linear correlation or a weak linear correlation, r is close to 0. A value near zero means that there is a random, nonlinear relationship between the two variables.