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Original Research: Signs and Symptoms of Chest Disease |

Prospective Use of Descriptors of Dyspnea to Diagnose Common Respiratory DiseasesDescriptors of Dyspnea for Diagnosis

Andrew S. Chang, BS; Jeffrey Munson, MD; Alex H. Gifford, MD; Donald A. Mahler, MD, FCCP
Author and Funding Information

From the Geisel School of Medicine at Dartmouth (Mr Chang and Drs Munson, Gifford, and Mahler), Hanover, NH; and the Section of Pulmonary and Critical Care Medicine (Drs Munson, Gifford, and Mahler), Dartmouth-Hitchcock Medical Center, Lebanon, NH.

CORRESPONDENCE TO: Donald A. Mahler, MD, FCCP, Valley Regional Hospital, 243 Elm St, Claremont, NH 03743; e-mail: mahlerdonald@gmail.com


Dr Mahler is currently at the Valley Regional Hospital (Claremont, NH).

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):895-902. doi:10.1378/chest.15-0308
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Published online

BACKGROUND:  Although patients may find it difficult to describe their breathing discomfort, most are able to select statements among a list to describe their experience. The primary objective of this study was to examine sensitivity and specificity of descriptors of breathing discomfort prospectively in patients with common respiratory conditions as well as those patients who had refractory dyspnea.

METHODS:  Outpatients answered “Yes” or “No” for each of 15 statements describing breathing discomfort, next selected the best three that most closely applied, and then completed the Hospital Anxiety Depression Scale-Anxiety subscale. Sensitivity, specificity, and predictive values were calculated for the descriptors by diagnosis.

RESULTS:  “Work/effort” descriptors were selected as the best three by patients with COPD (n = 68), respiratory muscle weakness (n = 11), and refractory dyspnea (n = 17). Along with “work/effort” descriptors, “My chest feels tight” was among the best three in asthma (n = 22), with 38% sensitivity and 88% specificity. Along with “work/effort” descriptors, “My breathing is shallow” was among the best three in interstitial lung disease (n = 8), with 33% sensitivity and 84% specificity. Affective descriptors “frightening” (61% vs 31%, P = .002) and “awful” (66% vs 37%, P = .004) were reported more frequently in those with high anxiety scores compared with low anxiety scores.

CONCLUSIONS:  Although no descriptor achieved satisfactory sensitivity and specificity for identifying a particular condition, chest “tightness” was unique for asthma, whereas “shallow breathing” was unique for interstitial lung disease. Affective descriptors were associated with high anxiety scores.


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