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How to assess breathlessness in chronic obstructive pulmonary disease

Lewthwaite, Hayley ; Jensen, Dennis and Ekström, Magnus LU orcid (2021) In International Journal of COPD 16. p.1581-1598
Abstract

Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between periph- eral pathophysiology (both pulmonary and non-pulmonary) and central perceptual proces- sing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity... (More)

Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between periph- eral pathophysiology (both pulmonary and non-pulmonary) and central perceptual proces- sing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activ- ities, focal periods, or alongside other common COPD symptoms), dimensions of breath- lessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assess- ment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multi- dimensional instruments are available. Borg’s 0-10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field- based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assess- ment in daily life and in relation to exertion in people with COPD.

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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
COPD, Dyspnea, Dyspnoea, Measurement
in
International Journal of COPD
volume
16
pages
18 pages
publisher
Dove Medical Press Ltd.
external identifiers
  • scopus:85108036911
  • pmid:34113091
ISSN
1176-9106
DOI
10.2147/COPD.S277523
language
English
LU publication?
yes
id
f0e46dd9-148e-4f40-9dd1-6fce20e0e937
date added to LUP
2021-07-13 14:53:51
date last changed
2024-06-15 13:26:14
@article{f0e46dd9-148e-4f40-9dd1-6fce20e0e937,
  abstract     = {{<p>Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between periph- eral pathophysiology (both pulmonary and non-pulmonary) and central perceptual proces- sing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activ- ities, focal periods, or alongside other common COPD symptoms), dimensions of breath- lessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assess- ment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multi- dimensional instruments are available. Borg’s 0-10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field- based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assess- ment in daily life and in relation to exertion in people with COPD.</p>}},
  author       = {{Lewthwaite, Hayley and Jensen, Dennis and Ekström, Magnus}},
  issn         = {{1176-9106}},
  keywords     = {{COPD; Dyspnea; Dyspnoea; Measurement}},
  language     = {{eng}},
  pages        = {{1581--1598}},
  publisher    = {{Dove Medical Press Ltd.}},
  series       = {{International Journal of COPD}},
  title        = {{How to assess breathlessness in chronic obstructive pulmonary disease}},
  url          = {{http://dx.doi.org/10.2147/COPD.S277523}},
  doi          = {{10.2147/COPD.S277523}},
  volume       = {{16}},
  year         = {{2021}},
}