Descriptors of breathlessness in cardiorespiratory diseases

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.