Breathlessness measurement should be standardised for the level of exertion

Ekström, Magnus; Elmberg, Viktor; Lindow, Thomas; Wollmer, Per

doi:10.1183/13993003.00486-2018

Cited by 37 publications

(42 citation statements)

References 10 publications

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“… 105 Thus, assessment of breathlessness should optimally be performed at a standardized level of exertion. 103 …”

Section: Limitations To Assessment Of Breathlessness In Daily Lifementioning

confidence: 99%

“…101,102 Another important limitation to daily life assessment is the lack of standardization of assessment conditions including of the person's level of physical activity. 103,104 Breathlessness and exertion are intimately linked, which has several implications: physical activities are likely to vary substantially between individuals (making comparisons of symptom severity difficult between people) as well as for individuals over time (complicating assessment of change and treatment effects). People are likely to reduce their physical activity in the setting of worsening breathlessness to avoid distress from the symptom (which could mask deteriorating symptoms) or increase their activity up to their exertional symptom threshold in response to improvement (which could mask a treatment effect, yielding "false negative" findings for daily life assessments).…”

Section: Limitations To Assessment Of Breathlessness In Daily Lifementioning

confidence: 99%

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How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease

Lewthwaite¹,

Jensen²,

Ekström³

2021

COPD

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Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral pathophysiology (both pulmonary and non-pulmonary) and central perceptual processing. 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 activities, focal periods, or alongside other common COPD symptoms), dimensions of breathlessness 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 assessment, 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 multidimensional 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 assessment in daily life and in relation to exertion in people with COPD.

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“… 105 Thus, assessment of breathlessness should optimally be performed at a standardized level of exertion. 103 …”

Section: Limitations To Assessment Of Breathlessness In Daily Lifementioning

confidence: 99%

Section: Limitations To Assessment Of Breathlessness In Daily Lifementioning

confidence: 99%

How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease

Lewthwaite¹,

Jensen²,

Ekström³

2021

COPD

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“…Rather, these tools assess the limitation breathlessness imposes on specific daily activities. It is important to consider that people who experience chronic breathlessness may consciously or unconsciously adapt their daily activity (e.g., dress/undress with more breaks or walk slower) to avoid the unpleasant sensation [11,37,38]. As a consequence, they may experience the same level of breathlessness and fail to report a change in daily activity intensity and/or volume.…”

Section: Key Pointsmentioning

confidence: 99%

Standardized measurement of breathlessness during exercise

Lewthwaite

Koch²,

Tracey³

et al. 2019

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewExertional breathlessness is common and pervasive across various chronic disease populations. To accurately assess response to intervention and optimize clinical (symptom) management, detailed assessment of exertional breathlessness is imperative. This review provides an update on current approaches to assess exertional breathlessness and presents the need for individualized assessment of breathlessness standardized for the level of exertion. Recent findingsBreathlessness assessment tools commonly invite people to recall their breathlessness while at rest with reference to activities of daily living. To directly quantify breathlessness, however, requires assessment of the dimensions of breathlessness (e.g., sensory intensity, quality, and unpleasantness) in response to a standardized exercise stimulus. Different exercise stimuli (e.g., self-paced, incremental, and constant work rate exercise tests) have been used to elicit a breathlessness response. Self-paced (e.g., 6-min walk test) and incremental exercise tests assess exercise tolerance or endurance, and are not recommended for assessment of exertional breathlessness. Constant work rate tests, however, including recently validated 3min constant-rate stair stepping and walking tests, standardize the exercise stimulus to enable the breathlessness response to be directly quantified and monitored over time.

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“…A limitation was the definition of breathlessness. Optimally, breathlessness should be measured using validated instruments at standardised level of physical activity, 35 but such measurements are rarely available in epidemiological and large-scale studies or across generations. We used available data on breathlessness, using a similar definition in parents and offspring.…”

Section: Discussionmentioning

confidence: 99%

Breathlessness across generations: results from the RHINESSA generation study

Ekström

Johannessen

Abramson

et al. 2021

Thorax

Self Cite

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BackgroundBreathlessness is a major cause of suffering and disability globally. The symptom relates to multiple factors including asthma and lung function, which are influenced by hereditary factors. No study has evaluated potential inheritance of breathlessness itself across generations.MethodsWe analysed the association between breathlessness in parents and their offspring in the Respiratory Health in Northern Europe, Spain and Australia generation study. Data on parents and offspring aged ≥18 years across 10 study centres in seven countries included demographics, self-reported breathlessness, asthma, depression, smoking, physical activity level, measured Body Mass Index and spirometry. Data were analysed using multivariable logistic regression accounting for clustering within centres and between siblings.ResultsA total of 1720 parents (mean age at assessment 36 years, 55% mothers) and 2476 offspring (mean 30 years, 55% daughters) were included. Breathlessness was reported by 809 (32.7%) parents and 363 (14.7%) offspring. Factors independently associated with breathlessness in parents and offspring included obesity, current smoking, asthma, depression, lower lung function and female sex. After adjusting for potential confounders, parents with breathlessness were more likely to have offspring with breathlessness, adjusted OR 1.8 (95% CI 1.1 to 2.9). The association was not modified by sex of the parent or offspring.ConclusionParents with breathlessness were more likely to have children who developed breathlessness, after adjusting for asthma, lung function, obesity, smoking, depression and female sex in both generations. The hereditary components of breathlessness need to be further explored.

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Breathlessness measurement should be standardised for the level of exertion

Cited by 37 publications

References 10 publications

How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease

How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease

Standardized measurement of breathlessness during exercise

Breathlessness across generations: results from the RHINESSA generation study

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