Am. J. Respir. Crit. Care Med., Volume 158, Number 3, September 1998, 749-753

Language of Dyspnea in Assessment of Patients with Acute Asthma Treated with Nebulized Albuterol

MARILYN L. MOY, MARY L. LANTIN, ANDREW HARVER, and RICHARD M. SCHWARTZSTEIN

Divisions of Pulmonary and Critical Care Medicine and Emergency Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; and Department of Psychology, University of North Carolina-Charlotte, Charlotte, North Carolina

To investigate whether the language of dyspnea provides relevant clinical information in addition to that provided by ratings of overall dyspnea intensity when assessing subjective response to therapy, we conducted a prospective study in a cohort of 25 patients with acute asthma presenting to the emergency department of a tertiary care hospital. Patients received nebulized albuterol treatments every 20 min with a maximum of three doses. At presentation and after each treatment, patients completed spirometry, rated overall dyspnea intensity on a modified Borg scale, and selected phrases that described qualities of breathlessness from a 15-item questionnaire. Paired Student's t tests revealed significant improvements in FEV₁ (from 1.39 ± 0.66 L to 1.80 ± 0.76 L, p < 0.001) and reductions in dyspnea intensity (from 5.12 ± 2.08 to 2.82 ± 1.59, p < 0.001) after the first albuterol treatment. Dyspnea intensity continued to decrease significantly in response to the second treatment, modified Borg rating 2.26 ± 1.52, although there was no positive bronchodilator response. The results from Cochran Q tests revealed that the frequency of the experience of "chest tightness" decreased significantly across the phases of treatment. However, the sensations of "work" or "breathing effort" persisted at the same time that the FEV₁ revealed ongoing airways obstruction. We conclude that attention to the language of dyspnea would alert health care providers to residual air flow obstruction despite decreases in overall dyspnea intensity.

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