Longitudinal Changes in Patient-reported Dyspnea in Patients with COPD
Open accessAbstract
BACKGROUND: Although guidelines recommend monitoring symptoms in patients with chronic obstructive pulmonary disease (COPD), there is limited information on the longitudinal changes in patient-reported dyspnea (PRD) related to activities of daily living. The hypothesis was that PRD scores on the modified Medical Research Council (mMRC) scale, the self-administered computerized (SAC) transition dyspnea index (TDI), and the University of California San Diego Shortness of Breath questionnaire (UCSD SOBQ) would demonstrate progression over two years. METHODS: Observational cohort study of symptomatic patients with stable COPD evaluated every 6 months for 2 years. Patients rated the impact of activities of daily living on dyspnea using three patient-reported instruments presented in random order, and then performed post-bronchodilator (pBD) spirometry. RESULTS: Seventy patients (37 female/33 male; age: 66 ± 9 years; and pBD forced expiratory volume in one second [(FEV1): 51 ± 16% predicted] participated. Using fixed effects regression modeling, there was significant worsening in the PRD scores with the SAC TDI (-0.9 ± 2.7; p = 0.03) and UCSD SOBQ (+5.7 ± 18.3; p = 0.001), but not with the mMRC scale (p = 0.52). Both pBD FEV1 (p = 0.19) and pBD forced vital capacity (p = 0.65) were unchanged. CONCLUSIONS: Multidimensional instruments (SAC TDI and UCSD SOBQ) demonstrated the frequently observed decline in PRD experienced by patients with COPD. The progression in PRD occurred despite stable lung function. Monitoring PRD provides unique clinical information and should be considered along with measuring lung function to assess patient status over time.
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Deconditioning could, in part, explain the evidence in longitudinal studies for progression in breathlessness severity, despite stable lung function.
“Deconditioning could, in part, explain the evidence in longitudinal studies for progression in breathlessness severity, despite stable lung function.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [28]
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- Authors
- Mahler, D. A., Ward, J., Waterman, L. A., & Baird, J. C.
- Affiliations
- Dartmouth College (US)
- Dartmouth–Hitchcock Medical Center (US)
- Corresponding author
- Mahler, Donald A.
- ORCID
- Mahler, Donald A.
- Venue
- COPD: Journal of Chronic Obstructive Pulmonary Disease
- Publisher
- Informa UK Limited
- Published
- 2012-08-09
- Volume
- 9
- Issue
- 5
- Pages
- 522-527
- ISSN
- 1541-2555 (ISSN-L)
- 1541-2563
- OpenAlex
- W2135319483
- Cited by
- 27
- References
- 51
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 1 · 2021: 5 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 1 · 2015: 2 · 2014: 6 · 2013: 3
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- COPD Journal of Chronic Obstructive Pulmonary Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (2r44hl076888-02)
- National Heart, Lung, and Blood Institute (R44 HL076888-02)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- chronic obstructive pulmonary disease, dyspnea, activities of daily living, Transition Dyspnea Index, modified Medical Research Council scale, symptom progression, lung function, post-bronchodilator spirometry, symptom monitoring
- MeSH terms
- Activities of Daily Living, Aged, Dyspnea, Female, Humans, Longitudinal Studies, Male, Middle Aged, Surveys and Questionnaires, Severity of Illness Index, Spirometry, Cohort Studies, Disease Progression, Pulmonary Disease, Chronic Obstructive, Self Report
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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