Mahler D A, Harver A, Lentine T, Scott J A, Beck K, Schwartzstein R M
Department of Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USA.
Am J Respir Crit Care Med. 1996 Nov;154(5):1357-63. doi: 10.1164/ajrccm.154.5.8912748.
The purposes of this study were: to examine the decriptors of breathlessness chosen by a large sample of patients with cardiorespiratory disease; to determine test-retest reliability of a patient's selection of the descriptors; and to assess whether a patient's recall of the experience of breathlessness is the same as that provoked by physical activity. Questionnaire data were collected at an initial visit for patients who complained of breathlessness and at a second visit in a subgroup of patients. A total of 218 patients who sought medical care for difficulty breathing due to one of seven different conditions were recruited from an outpatient pulmonary disease clinic at a university medical center. Patients selected statements that described qualities of breathlessness from a 15-item questionnaire and completed pulmonary function tests. At a subsequent visit (4 to 15 d later) a subgroup of 16 patients with chronic obstructive pulmonary disease (COPD) repeated the questionnaire at rest (to assess reliability) and after walking in a hallway to provoke a moderate intensity of breathlessness (to compare recall with direct experiences). The relationship among descriptors was evaluated by cluster analysis. The "work/effort" cluster was common for all diagnoses. Each condition was characterized by more than one cluster except COPD. Each diagnosis was associated with a unique set of dusters (e.g., asthma with "work/effort" and "tight," interstitial lung disease with "work/effort" and "rapid" breathing). Percent agreement for all descriptors selected at Visits 1 and 2 (recall) was 79% (r = 0.82; p = 0.001). Percent agreement at Visit 2 between descriptors for recall and for breathlessness provoked by walking was 68% (r = 0.69; p = 0.004). We conclude that patients with different cardiorespiratory conditions experience distinct qualities of breathlessness. Patients' recall of their sensations of breathlessness is reliable and comparable to dyspnea with walking. Employing a questionnaire containing descriptors of breathlessness may help to establish a specific diagnosis and to identify mechanisms whereby a specific intervention relieves dyspnea.
检查大量心肺疾病患者选择的呼吸急促描述词；确定患者对描述词选择的重测信度；评估患者对呼吸急促体验的回忆是否与体力活动引发的呼吸急促相同。对主诉呼吸急促的患者在初次就诊时以及部分患者在第二次就诊时收集问卷数据。从一所大学医学中心的门诊肺病诊所招募了总共218名因七种不同病症之一而寻求呼吸困难医疗护理的患者。患者从一份15项问卷中选择描述呼吸急促特征的陈述，并完成肺功能测试。在随后的就诊（4至15天后），16名慢性阻塞性肺疾病（COPD）患者的亚组在休息时重复填写问卷（以评估信度），并在走廊行走以引发中度呼吸急促后再次填写问卷（以将回忆与直接体验进行比较）。通过聚类分析评估描述词之间的关系。“工作/努力”聚类对所有诊断都很常见。除COPD外，每种病症都有多个聚类特征。每种诊断都与一组独特的聚类相关（例如，哮喘与“工作/努力”和“紧绷”相关，间质性肺疾病与“工作/努力”和“快速”呼吸相关）。就诊1和就诊2（回忆）时选择的所有描述词的一致率为79%（r = 0.82；p = 0.001）。就诊2时回忆的描述词与行走引发的呼吸急促的描述词之间的一致率为68%（r = 0.69；p = 0.004）。我们得出结论，患有不同心肺病症的患者经历不同特征的呼吸急促。患者对呼吸急促感觉的回忆是可靠的，并且与行走时的呼吸困难相当。使用包含呼吸急促描述词的问卷可能有助于确立具体诊断，并识别特定干预措施缓解呼吸困难的机制。
