Geisel School of Medicine at Dartmouth, Hanover, NH.
Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Chest. 2015 Oct;148(4):895-902. doi: 10.1378/chest.15-0308.
Although patients may find it difficult to describe their breathing discomfort, most are able to select statements among a list to describe their experience. The primary objective of this study was to examine sensitivity and specificity of descriptors of breathing discomfort prospectively in patients with common respiratory conditions as well as those patients who had refractory dyspnea.
Outpatients answered "Yes" or "No" for each of 15 statements describing breathing discomfort, next selected the best three that most closely applied, and then completed the Hospital Anxiety Depression Scale-Anxiety subscale. Sensitivity, specificity, and predictive values were calculated for the descriptors by diagnosis.
"Work/effort" descriptors were selected as the best three by patients with COPD (n = 68), respiratory muscle weakness (n = 11), and refractory dyspnea (n = 17). Along with "work/effort" descriptors, "My chest feels tight" was among the best three in asthma (n = 22), with 38% sensitivity and 88% specificity. Along with "work/effort" descriptors, "My breathing is shallow" was among the best three in interstitial lung disease (n = 8), with 33% sensitivity and 84% specificity. Affective descriptors "frightening" (61% vs 31%, P = .002) and "awful" (66% vs 37%, P = .004) were reported more frequently in those with high anxiety scores compared with low anxiety scores.
Although no descriptor achieved satisfactory sensitivity and specificity for identifying a particular condition, chest "tightness" was unique for asthma, whereas "shallow breathing" was unique for interstitial lung disease. Affective descriptors were associated with high anxiety scores.
尽管患者可能难以描述其呼吸不适，但大多数患者能够从列表中选择语句来描述其体验。本研究的主要目的是前瞻性检查常见呼吸疾病患者和难治性呼吸困难患者的呼吸不适描述符的敏感性和特异性。
门诊患者对描述呼吸不适的 15 个语句回答“是”或“否”，然后选择最能准确描述其症状的三个语句，并完成医院焦虑抑郁量表-焦虑分量表。根据诊断计算描述符的敏感性、特异性和预测值。
COPD（n = 68）、呼吸肌无力（n = 11）和难治性呼吸困难（n = 17）患者选择“费力”描述符作为最能准确描述其症状的前三个描述符。在哮喘（n = 22）患者中，与“费力”描述符一起，“我的胸部感到紧绷”也是前三个描述符之一，其敏感性为 38%，特异性为 88%。在间质性肺疾病（n = 8）患者中，与“费力”描述符一起，“我的呼吸很浅”是前三个描述符之一，其敏感性为 33%，特异性为 84%。在焦虑评分较高的患者中，报告了更频繁的情感描述符“吓人”（61% vs 31%，P =.002）和“可怕”（66% vs 37%，P =.004）。
虽然没有描述符能够达到识别特定疾病的理想敏感性和特异性，但胸部“紧绷感”是哮喘的独特症状，而“浅呼吸”是间质性肺疾病的独特症状。情感描述符与高焦虑评分相关。
