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Original Research: COPD |

Patient-Reported Dyspnea in COPD Reliability and Association With Stage of Disease

Donald A. Mahler, MD, FCCP; Joseph Ward, RCPT; Laurie A. Waterman, BS; Corliss McCusker, RN; Richard ZuWallack, MD, FCCP; John C. Baird, PhD
Author and Funding Information

Affiliations: From the Dartmouth-Hitchcock Medical Center (Drs. Mahler and Baird, Mr. Ward, and Ms. Waterman), Lebanon, NH; St. Francis Medical Center (Ms. McCusker and Dr. ZuWallack), Hartford, CT; and Psychological Applications, LLC (Dr. Baird), South Pomfret, VT.

Correspondence to: Donald A. Mahler, MD, FCCP, Dartmouth-Hitchcock Medical Center, Medicine, CCM 3-D, One Medical Center Dr, Lebanon, NH 03756-0001; e-mail: donald.a.mahler@hitchcock.org


Funding/Support: This work was supported by a National Institutes of Health grant no. R44 HL076888-02, Small Business Innovation Research (John C. Baird, principal investigator).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1473-1479. doi:10.1378/chest.09-0934
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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 FEV1 (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.

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