Patient-reported dyspnea in COPD reliability and association with stage of disease.
BACKGROUND
Although questionnaires are used frequently with patients to self-report the severity of dyspnea as related to activities of daily living, the reliability of these instruments has not been established. The two purposes of this study were to examine the test-retest reliability of three widely used dyspnea instruments and to compare dyspnea scores at different stages of disease.


METHODS
At paired baseline visits, 101 stable patients with COPD were tested; at paired follow-up visits at 3 months, 89 of these patients were tested. At each visit, patients rated dyspnea with three instruments presented in random order and then performed post-bronchodilator therapy lung function tests.


RESULTS
Patient-reported dyspnea scores and lung function were similar at baseline (interval, 6 +/- 5 days) and follow-up visits (interval, 4 +/- 2 days). Intraclass correlation coefficients at baseline and at follow-up were 0.82 and 0.82, respectively, for the modified Medical Research Council scale; 0.90 and 0.84, respectively, for the self-administered computerized versions of the baseline dyspnea index and transition dyspnea indexes; and 0.95 and 0.89 for the University of San Diego Shortness of Breath Questionnaire results. Dyspnea ratings were significantly related to the stage of disease severity based on percent predicted FEV(1) (p < 0.001).


CONCLUSIONS
Test-retest reliability was acceptable for patient-reported dyspnea scores using three clinical instruments at baseline and at the 3-month follow-up. Our results demonstrate for the first time that patient-reported dyspnea ratings are related to the stage of disease severity.
Mahler
Donald A
DA
Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: donald.a.mahler@hitchcock.org.
Ward
Joseph
J
Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Waterman
Laurie A
LA
Dartmouth-Hitchcock Medical Center, Lebanon, NH.
McCusker
Corliss
C
St. Francis Medical Center, Hartford, CT.
ZuWallack
Richard
R
St. Francis Medical Center, Hartford, CT.
Baird
John C
JC
Psychological Applications, LLC, South Pomfret, VT; Dartmouth-Hitchcock Medical Center, Lebanon, NH.
D000368:Aged; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012650:Self Disclosure; D012720:Severity of Illness Index
Eur Respir J. 2008 Feb;31(2):416-69
18238951
Respir Med. 2006 Oct;100(10):1767-74
16531031
Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55
17507545
Chest. 2002 May;121(5):1434-40
12006425
Eur Respir J. 2004 Jun;23(6):932-46
15219010
COPD. 2004;1(2):165-72
17136984
N Engl J Med. 2004 Mar 4;350(10):1005-12
14999112
Am Rev Respir Dis. 1971 Jan;103(1):57-67
5540840
Chest. 2008 Jun;133(6):1451-1462
18574288
Am J Respir Crit Care Med. 2008 Jan 1;177(1):75-81
17901413
Am J Respir Crit Care Med. 2006 Jul 1;174(1):6-14
16556692
Can Respir J. 2007 Sep;14 Suppl B:5B-32B
17885691
Respir Med. 2007 Mar;101(3):399-410
16914301
Int J Behav Med. 1995;2(2):118-34
16250781
Thorax. 1999 Jul;54(7):581-6
10377201
Eur Respir J. 2007 Jun;29(6):1078-81
17540784
Bull Eur Physiopathol Respir. 1982 May-Jun;18(3):419-25
7074238
Chest. 2002 Apr;121(4):1092-8
11948037
Proc Am Thorac Soc. 2007 May;4(2):145-68
17494725
Am J Respir Crit Care Med. 2007 Jan 15;175(2):144-9
17053207
Chest. 2007 Aug;132(2):477-82
17505032
Br Med J. 1959 Aug 29;2(5147):257-66
13823475
Chest. 2007 Oct;132(4):1283-90
17646223
Eur Respir J. 1994 Apr;7(4):725-9
8005256
Ann Intern Med. 1997 Dec 15;127(12):1072-9
9412309
Eur Respir J. 2006 Apr;27(4):822-32
16585091
Chest. 1998 Mar;113(3):619-24
9515834
Chest. 1992 Aug;102(2):395-401
1643921
N Engl J Med. 2006 Jun 22;354(25):2655-66
16790698