Other studies in the literature have attempted to judge whether or not there are diagnostic clues in the language patients choose to describe their dyspnea or the discomfort they associate with breathing. Mahler et al5 have explored the language that patients with seven different disease states (eg, asthma, congestive heart failure, interstitial lung disease) use to describe their dyspnea. These authors presented their subjects with a list of 15 descriptors. The investigators then asked each patient to walk along a hospital corridor until he felt an intensity of dyspnea equal to a grade of 3, or moderate, on the Borg scale. Patients were then asked to select those descriptors that best characterized their discomfort after the walk. Of interest, only patients with diagnoses associated with airway obstruction (eg, asthma and cystic fibrosis but not COPD) chose terms that imply tightness, such as “tight” or “constricted,” to describe their discomfort. Other terms, such as “work” or “inhalation” were not specific for any diagnostic category. This may make sense from the point of view of the pathophysiology in that asthma and cystic fibrosis, unlike any of the other diagnostic categories, are associated with edema, inflammation, and muscular constriction of the larger airways. The feeling of tightness may be a feeling generated by the stimulation of airway afferents, a physiologic event shared by, and specific to, these two disease entities. A criticism of the work of Mahler et al,5 is, however, that their subjects were asked to choose their words from a list of descriptors that were given to them. In this author’s experience, when patients with asthma are asked to describe their dyspnea using their own words, very few will volunteer a descriptor similar to those given by Mahler et al. Invariably, however, the few patients who do volunteer the word “tight” will have asthma, and the few who volunteer “I can’t breathe in” will have interstitial lung disease or pulmonary emboli. It appears, then, that there is some link between the pathophysiology of a disease and the words that patients choose to describe their discomfort. The fact that very few subjects will use these words, however, should send us another message: that is, it is not reasonable to expect all people, even if they speak the same language, to link the same word or descriptor to a given sensation.