title: Dyspnea scales in the assessment of illiterate patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Multiple physiological, psychological, social and environmental factors may affect the perception of dyspnea. Although different scales have been used to record the severity of dyspnea in subjects with chronic obstructive pulmonary disease (COPD), none has reported evaluating the properties of such tools in illiterate patients. The objective of this study was to evaluate the reliability and features of concurrent validity of 4 dyspnea scales in illiterate (IL) subjects with COPD.
  
  
  METHODS
  One hundred COPD patients submitted to spirometry and were asked to score their breathlessness using a visual analogue scale (VAS), a numerical rating scale (NRS), the Borg scale (BS), and the basal dyspnea index (BDI). Each scale was presented to the patients before and after they had performed spirometry and measurement of residual volume. The obtained scores were analyzed according to the literacy status of the patients.
  
  
  RESULTS
  Thirty-three patients were classified as IL and 67 as literate (L). Both groups showed similar respiratory impairment and median scores of dyspnea (VAS, L = 45.0, IL = 49.0; NRS, L = 5.0, IL = 5.0; BS, L = 3.0, IL = 3.0; BDI, L = 5.0, IL = 4.0). No significant differences were found between the dyspnea scores obtained before and after spirometry for all scales in both groups. The degree of correlation between forced expiratory volume in 1 second (FEV1) and usual dyspnea evaluated by BDI did not show a statistical difference between the two groups (L, r = 0.37; IL, r = 0.51).
  
  
  CONCLUSIONS
  The employed dyspnea scales showed comparable reliability in both L and IL COPD subjects.
authors.affiliation: Department of Medicine, University of São Paulo-Medical School of Ribeirão Preto, Brazil. jabmarti@fmrp.usp.br
authors.forename: J A
authors.initials: JA
authors.lastname: Martinez
authors.forename: L
authors.initials: L
authors.lastname: Straccia
authors.forename: E
authors.initials: E
authors.lastname: Sobrani
authors.forename: G A
authors.initials: GA
authors.lastname: Silva
authors.forename: E O
authors.initials: EO
authors.lastname: Vianna
authors.forename: J T
authors.initials: JT
authors.lastname: Filho
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D004522:Educational Status; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D013147:Spirometry; D011795:Surveys and Questionnaires