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Asessing Shortness of Breath

A reduction in shortness of breath (i.e. dyspnoea) is a robust finding in pulmonary rehabilitation research.

A primary goal of pulmonary rehabilitation is to reduce the patient’s perception of shortness of breath.

Dyspnoea severity should be assessed before and after pulmonary rehabilitation (see Program Evaluation section).

There are a number of measurement tools available for assessing dyspnoea, including:

Some health-related quality of life measures also include dyspnoea as a component. For example, the Chronic Respiratory Disease Questionnaire includes a standardised dyspnoea measure.

Some measures of dyspnoea are useful for clinical assessment (e.g. the MMRC Scale) and can provide a baseline indication of the patient’s status.  However, these scales are not particularly sensitive to interventions such as pulmonary rehabilitation.

Important features of two dyspnoea scales, which are valid, reliable and commonly used, are summarised in the table below.

 

Modified Medical Research Council (MMRC) Scale


Modified BORG Scale


Practical consider-ations


– 5 point scale (0-4)

– Easy to administer


– 10 point scale (0-10)

– Descriptive scale to anchor responses


Domains assessed


– Rates dyspnoea according to different levels of activity


– Breathlessness during a particular task


Key
Features/ Remarks


– Lack of clear limits between grades

– Very useful at baseline to provide a profile of a patient

– Difficult to assess change after an intervention such as pulmonary rehabilitation

– A change of one level is clinically significant

– Modified MRC (0-4) used with BODE index*


– Demonstrated sensitivity to treatment effect

– Advantage – adjectives assist patients to determine intensity


* [BODE Index – body-mass index (B), the degree of airflow obstruction (O), dyspnoea (D), and exercise capacity (E); for further details, see Celli, 2004]