Dyspnea and Hyperinflation in Chronic Obstructive Pulmonary Disease: Impact on Physical Activity

Nathaniel Marchetti; Alan Kaplan

doi:10.3949/ccjm.85.s1.02

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FIGURE 1
The dyspnea spiral¹⁰
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FIGURE 2
Changes in operational lung volumes shown as ventilation increases in (A) healthy individuals and (B) patients with COPD¹⁶
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FIGURE 3
Five-year survival according to (A) percentage of predicted FEV and (B) dyspnea level²⁴
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FIGURE 4
The crucial role of daily activity in patients with COPD³⁴

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TABLE 1

Summary of commonly used dyspnea measures in primary care^5,44,45

Dyspnea measure	Key features	Strengths	Limitations
COPD Assessment Test (CAT)	Evaluates 8 items on a 6-point scale, corresponding to health status impairment in COPD Higher scores represent worse health	Short, simple questionnaire Covers wide range of symptoms Well-validated and reliable Correlates closely with SGRQ Readily available	Does not categorize patients into symptom severity groups for scores in the range of 10–40
Medical Research Council (MRC) Dyspnea Scale	Evaluates everyday situations/ activity levels on a 5-point scale Higher scores represent greater disability	Short, simple questionnaire Well-validated and reliable Relates well to other measures of health status Able to predict future mortality risk Readily available	Less effective at detecting change in response after an intervention than alternative measures Considers dyspnea alone, so does not account for the broader impact of COPD
COPD Control Questionnaire (CCQ)	Evaluates 10 items on a 6-point scale based on the previous week’s symptoms, measuring COPD-related health status Higher scores represent worse health	Short, simple questionnaire Well-validated and reliable Measures functional and mental capacities as well as symptoms Readily available	Does not categorize patients into symptom severity groups
Chronic Respiratory Questionnaire (CRQ)	Evaluates 20 items on a 7-point scale across 4 domains: dyspnea, fatigue, emotional function, mastery Higher scores represent better health-related quality of life	Well-validated and reliable Responds well to changes over time	License required to use questionnaire Longer than alternative dyspnea measures Does not categorize patients into symptom severity groups