Measures of dyspnea in pulmonary rehabilitation

Abstract

Dyspnea is the main symptom perceived by patients affected by chronic respiratory diseases. It derives from a complex interaction of signals arising in the central nervous system, which is connected through afferent pathway receptors to the peripheral respiratory system (airways, lung, and thorax). Notwithstanding the mechanism that generates the stimulus is always the same, the sensation of dyspnea is often described with different verbal descriptors: these descriptors, or linguistic 'clusters', are clearly influenced by socio-individual factors related to the patient. These factors can play an important role in identifying the etiopathogenesis of the underlying cardiopulmonary disease causing dyspnea. The main goal of rehabilitation is to improve dyspnea; hence, quantifying dyspnea through specific tools (scales) is essential in order to describe the level of chronic disability and to assess eventual changes after intervention. Improvements, even if modest, are likely to determine clinically relevant changes (minimal clinically important difference, MCID) in patients.Currently there exist a large number of scales to classify and characterize dyspnea: the most frequently used in everyday clinical practice are the clinical scales (e.g. MRC or BDI/TDI, in which information is obtained directly from the patients through interview) and psychophysical scales (such as the Borg scale or VAS, which assess symptom intensity in response to a specific stimulus, e.g. exercise).It is also possible to assess the individual's dyspnea in relation to specific situations, e.g. chronic dyspnea (with scales that classify patients according to different levels of respiratory disability); exertional dyspnea (with tools that can measure the level of dyspnea in response to a physical stimulus); and transitional (or 'follow up') dyspnea (with scales that measure the effect in time of a treatment intervention, such as rehabilitation).

Reported dyspnea and fatigue using different scales during the physical effort in COPD

“…In clinical settings, MBS is the most used scale during exercise (10,12,14,19) and to determine the training intensity of patients with COPD (8). Moreover, researchers (11) assessed its use during asthmatic crisis and obtained satisfactory results, therefore recommending MBS to the initial assessment of patients suffering with an asthmatic crisis, as well as their response to treatment.…”

“…The most employed patient-reported scales during exercise are the modified Borg Scale (MBS) and the visual analogical scale (VAS) (10,12,14,19). Nevertheless, other scales are available, as examples, the ratings of perceived exertion (RPE) (15) and pictured scales, such as the Whaley & Wong glasses scale (GS) and the Wong-Baker faces scale (FS) (18).…”

Aplicación del test de caminata de 6 minutos en la valoración del sujeto con EPOC

“…Al inicio y final de la aplicación del test se debe evaluar la magnitud de la disnea, empleando la escala psicofísica de Borg, (versión modificada) que posee un rango de 0 a 10 puntos, siendo cero la ausencia total de dificultad respiratoria y 10 el máximo posible, como se observa en la Tabla 2 (42,47,48).…”

Postoperative exercise training is associated with reduced respiratory infection rates and early discharge: A case-control study

“…10 Before the study the patients were familiarised with the Borg scale, and its end points included zero for the absence of dyspnoea and 10 " the most severe level of dyspnoea you could imagine or have ever undergone". By pointing to the scale, the patients perceived dyspnoea at rest and at the end point of the exercise.…”