DA Mahler, A Harver, T Lentine, JA Scott, K Beck and RM Schwartzstein
Department of Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USA.

The purposes of this study were: to examine the decriptors of breathlessness chosen by a large sample of patients with cardiorespiratory disease; to determine test-retest reliability of a patient's selection of the descriptors; and to assess whether a patient's recall of the experience of breathlessness is the same as that provoked by physical activity. Questionnaire data were collected at an initial visit for patients who complained of breathlessness and at a second visit in a subgroup of patients. A total of 218 patients who sought medical care for difficulty breathing due to one of seven different conditions were recruited from an outpatient pulmonary disease clinic at a university medical center. Patients selected statements that described qualities of breathlessness from a 15-item questionnaire and completed pulmonary function tests. At a subsequent visit (4 to 15 d later) a subgroup of 16 patients with chronic obstructive pulmonary disease (COPD) repeated the questionnaire at rest (to assess reliability) and after walking in a hallway to provoke a moderate intensity of breathlessness (to compare recall with direct experiences). The relationship among descriptors was evaluated by cluster analysis. The "work/effort" cluster was common for all diagnoses. Each condition was characterized by more than one cluster except COPD. Each diagnosis was associated with a unique set of dusters (e.g., asthma with "work/effort" and "tight," interstitial lung disease with "work/effort" and "rapid" breathing). Percent agreement for all descriptors selected at Visits 1 and 2 (recall) was 79% (r = 0.82; p = 0.001). Percent agreement at Visit 2 between descriptors for recall and for breathlessness provoked by walking was 68% (r = 0.69; p = 0.004). We conclude that patients with different cardiorespiratory conditions experience distinct qualities of breathlessness. Patients' recall of their sensations of breathlessness is reliable and comparable to dyspnea with walking. Employing a questionnaire containing descriptors of breathlessness may help to establish a specific diagnosis and to identify mechanisms whereby a specific intervention relieves dyspnea.

This article has been cited by other articles:

				R. B. Banzett, S. H. Pedersen, R. M. Schwartzstein, and R. W. Lansing The Affective Dimension of Laboratory Dyspnea: Air Hunger Is More Unpleasant than Work/Effort Am. J. Respir. Crit. Care Med., June 15, 2008; 177(12): 1384 - 1390. [Abstract] [Full Text] [PDF]

				J. Han, Y. Zhu, S. Li, J. Zhang, X. Cheng, O. Van den Bergh, and K. P. Van de Woestijne The Language of Medically Unexplained Dyspnea Chest, April 1, 2008; 133(4): 961 - 968. [Abstract] [Full Text] [PDF]

				A. von Leupoldt, S. Balewski, S. Petersen, K. Taube, S. Schubert-Heukeshoven, H. Magnussen, and B. Dahme Verbal Descriptors of Dyspnea in Patients With COPD at Different Intensity Levels of Dyspnea Chest, July 1, 2007; 132(1): 141 - 147. [Abstract] [Full Text] [PDF]

				D. E. O'Donnell, R. B. Banzett, V. Carrieri-Kohlman, R. Casaburi, P. W. Davenport, S. C. Gandevia, A. F. Gelb, D. A. Mahler, and K. A. Webb Pathophysiology of Dyspnea in Chronic Obstructive Pulmonary Disease: A Roundtable Proceedings of the ATS, May 1, 2007; 4(2): 145 - 168. [Abstract] [Full Text] [PDF]

				M. D. Lougheed, T. Fisher, and D. E. O'Donnell Dynamic hyperinflation during bronchoconstriction in asthma: implications for symptom perception. Chest, October 1, 2006; 130(4): 1072 - 1081. [Abstract] [Full Text] [PDF]

				C. Coli, M. Picariello, L. Stendardi, M. Grazzini, B. Binazzi, R. Duranti, and G. Scano Is there a link between the qualitative descriptors and the quantitative perception of dyspnea in asthma? Chest, August 1, 2006; 130(2): 436 - 441. [Abstract] [Full Text] [PDF]

				N Ambrosino and M Serradori Determining the cause of dyspnoea: linguistic and biological descriptors Chronic Respiratory Disease, July 1, 2006; 3(3): 117 - 122. [PDF]

				D. A. Mahler Mechanisms and Measurement of Dyspnea in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2006; 3(3): 234 - 238. [Abstract] [Full Text] [PDF]

				P. Laveneziana, P. Lotti, C. Coli, B. Binazzi, L. Chiti, L. Stendardi, R. Duranti, and G. Scano Mechanisms of dyspnoea and its language in patients with asthma. Eur. Respir. J., April 1, 2006; 27(4): 742 - 747. [Abstract] [Full Text] [PDF]

				M. H. Lavietes Listening to Our Patients Chest, June 1, 2005; 127(6): 1877 - 1878. [Full Text] [PDF]

				J. Han, Y. Zhu, S. Li, X. Chen, C. Put, K. P. Van de Woestijne, and O. Van den Bergh Respiratory Complaints in Chinese: Cultural and Diagnostic Specificities Chest, June 1, 2005; 127(6): 1942 - 1951. [Abstract] [Full Text] [PDF]

				G. Scano, L. Stendardi, and M. Grazzini Understanding dyspnoea by its language Eur. Respir. J., February 1, 2005; 25(2): 380 - 385. [Abstract] [Full Text] [PDF]

				P M Meek Measurement of dyspnea in chronic obstructive pulmonary disease: what is the tool telling you? Chronic Respiratory Disease, January 1, 2004; 1(1): 29 - 37. [Abstract] [PDF]

				M F Muers Opioids for dyspnoea Thorax, November 1, 2002; 57(11): 922 - 923. [Full Text] [PDF]

				A. P. BINKS, S. H. MOOSAVI, R. B. BANZETT, and R. M. SCHWARTZSTEIN ""Tightness"" Sensation of Asthma Does Not Arise from the Work of Breathing Am. J. Respir. Crit. Care Med., January 1, 2002; 165(1): 78 - 82. [Abstract] [Full Text] [PDF]

				F. H. Wilhelm, A. L. Gerlach, and W. T. Roth Slow Recovery From Voluntary Hyperventilation in Panic Disorder Psychosom Med, July 1, 2001; 63(4): 638 - 649. [Abstract] [Full Text] [PDF]

				S. I. RENNARD, W. ANDERSON, R. ZuWALLACK, J. BROUGHTON, W. BAILEY, M. FRIEDMAN, M. WISNIEWSKI, and K. RICKARD Use of a Long-acting Inhaled {beta}2-Adrenergic Agonist, Salmeterol Xinafoate, in Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., April 1, 2001; 163(5): 1087 - 1092. [Abstract] [Full Text]

				A. Harver, D. A. Mahler, R. M. Schwartzstein, and J. C. Baird Descriptors of Breathlessness in Healthy Individuals : Distinct and Separable Constructs Chest, September 1, 2000; 118(3): 679 - 690. [Abstract] [Full Text] [PDF]

				R. M. Schwartzstein and E. J. Mark Case 27-2000- A 61-Year-Old Man with Rapidly Progressive Dyspnea N. Engl. J. Med., August 31, 2000; 343(9): 642 - 649. [Full Text] [PDF]

				M. L. MOY, J. WOODROW WEISS, D. SPARROW, E. ISRAEL, and R. M. SCHWARTZSTEIN Quality of Dyspnea in Bronchoconstriction Differs from External Resistive Loads Am. J. Respir. Crit. Care Med., August 1, 2000; 162(2): 451 - 455. [Abstract] [Full Text] [PDF]

				D. A. Mahler and A. Harver Do You Speak the Language of Dyspnea? Chest, April 1, 2000; 117(4): 928 - 929. [Full Text] [PDF]

				G. E. Hardie, S. Janson, W. M. Gold, V. Carrieri-Kohlman, and H. A. Boushey Ethnic Differences: Word Descriptors Used by African-American and White Asthma Patients During Induced Bronchoconstriction Chest, April 1, 2000; 117(4): 935 - 943. [Abstract] [Full Text] [PDF]

				W. GARDNER Orthostatic increase of respiratory gas exchange in hyperventilation syndrome Thorax, April 1, 2000; 55(4): 257 - 259. [Full Text]

				H. R. Harty, D. R. Corfield, R. M. Schwartzstein, and L. Adams External thoracic restriction, respiratory sensation, and ventilation during exercise in men J Appl Physiol, April 1, 1999; 86(4): 1142 - 1150. [Abstract] [Full Text] [PDF]

				P. Meek Dyspnea . Mechanisms, Assessment, and Management: A Consensus Statement Am. J. Respir. Crit. Care Med., January 1, 1999; 159(1): 321 - 340. [Full Text]

				M. L. MOY, M. L. LANTIN, A. HARVER, and R. M. SCHWARTZSTEIN Language of Dyspnea in Assessment of Patients with Acute Asthma Treated with Nebulized Albuterol Am. J. Respir. Crit. Care Med., September 1, 1998; 158(3): 749 - 753. [Abstract] [Full Text] [PDF]

				D. E. O'Donnell, L. K. L. Chau, and K. A. Webb Qualitative aspects of exertional dyspnea in patients with interstitial lung disease J Appl Physiol, June 1, 1998; 84(6): 2000 - 2009. [Abstract] [Full Text] [PDF]