Prospective Use of Descriptors of Dyspnea to Diagnose Common Respiratory Diseases

BACKGROUND: 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. METHODS: 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. RESULTS: Work/effort descriptors were selected as the best three by patients with COPD (n = 68), respiratory muscle weakness (n = 11), and refractory dyspnea (n 5 17). Along with work/effort descriptors, My chest feels tight was among the best three in asthma (n 5 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. CONCLUSIONS: Although no descriptor achieved satisfactory sensitivity and specifi city 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.