Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma

doi:10.1016/S0099-1767(00)90093-X

Journal of Emergency Nursing

Volume 26, Issue 3, June 2000, Pages 216-222

https://doi.org/10.1016/S0099-1767(00)90093-X Get rights and content

Abstract

Introduction: Rapid assessment and monitoring is essential for patients with acute bronchospasm. However, tools for measuring dyspnea or the state of being short of breath are often limited to peak flow, blood gas analysis, and asking patients multiple questions about their breathing at a time when they find speaking difficult. We thus decided to examine a tool called the modified Borg scale (MBS) that had the potential to provide quick, easy, and rapid information about a patient’s subjective state of dyspnea. This 0 to 10 rated scale gave our ED patients a device they could use to measure and evaluate their dyspnea. For this reason, we added it to the triage assessment practice and included it in all posttreatment assessment notes on patients with exacerbations of asthma or chronic obstructive pulmonary disease (COPD) who were seen in the emergency department and urgent care clinic. Study Questions: (1) Can patients with acute bronchospastic asthma or COPD adequately communicate their level of dyspnea using the MBS? (2) Does subjective improvement in the patient’s dyspnea using the MBS correlate with improvements in pulmonary functions as measured by the peak flow meter and cutaneous oxygen saturation (Sao₂)? Methods: Routine and triage assessment of subjective dyspnea using the MBS was instituted at a hospital emergency department serving adult veterans. Concurrently, the MBS was added to our standardized treatment protocol for management of patients with bronchospasm. ED and urgent care records were reviewed to collect baseline and postrespiratory treatment data on peak expiratory flow rates (PEFR), MBS scores, and Sao₂ percentages. Results: Four hundred male veterans aged 24 to 87 years presented with a chief complaint of dyspnea. The assessing physician identified 102 of these patients as having acute bronchospasm; 42 were diagnosed with asthma, and 60 were diagnosed with COPD. All study patients with acute bronchospasm were able to use the MBS to rate their perception of severity of dyspnea. As the peak flow measurements increased, the MBS scores of difficulty breathing decreased. For the asthma groups, the mean MBS score decreased from 5.1 at triage baseline to 2.4 after treatment. This finding indicated that a significant correlation existed between the change in MBS scores and the change in PEFR from pretreatment to posttreatment scores (r = –.31, P <.05). As the peak flow increased, the MBS scores decreased. Sao₂ only slightly improved in the asthma group compared with the COPD group. For patients with COPD, the mean MBS score decreased from 6.0 at triage baseline to 3.0 after treatment. This finding indicated that a significant correlation also existed between the change in MBS scores and the change in PEFR from pretreatment to posttreatment scores (r = –.42, P <.001). Cutaneous oxygen saturation also improved in the COPD group after treatment. The modality of treatment ordered by the physician was metered dose inhaler or nebulizer. These treatment modalities had no effect on the aforementioned results in the asthma or COPD group. Conclusions: The MBS is a valid and reliable assessment tool for dyspnea. This study demonstrated that it correlated well with other clinical parameters and could be useful when assessing and monitoring outcomes in patients with acute bronchospasm. Patients who used the MBS rated it with a high degree of satisfaction on ease of use and found that the language in this scale adequately expressed their dyspnea. The ED triage and primary care nursing staff rated the MBS as highly satisfactory, stating that it was quick and easy to use. Respiratory assessment in the triage notes and nursing notes were streamlined to consistently include 3 respiratory measures: PEFR, MBS, and Sao₂. Long respiratory narratives were found to be unnecessary in many cases. In addition, the MBS helped to include an important element of subjective assessment when evaluating the severity of dyspnea. (J Emerg Nurs 2000;26:216-22)

Section snippets

Methods

This retrospective chart review study was conducted at the emergency department and urgent care clinic at the VA San Diego Health Care System in San Diego, Calif. The MBS was added to the clinical protocol for management of patients with acute bronchospasm (Figure 2).

. Protocol for management of patients with acute bronchospasm at the Emergency Department and Urgent Care Clinic at the VA San Diego HealthCare System, San Diego, Calif.

According to the protocol, the MBS was administered by the

Results

Of the 400 charts initially selected for complaint of dyspnea, 102 patients met the inclusion criteria. The patients who were excluded had diagnoses of flu (n = 199), bronchitis (n = 29), congestive heart failure (n = 33), and pneumonia (n = 37).

Participants were all men between the ages of 24 and 87 (mean age, 59 years). Forty-two patients were diagnosed with asthma and 60 had COPD. The attending ED physician evaluated all patients after they were triaged and ordered β₂-agonist albuterol with

Discussion

Our data suggest that the MBS can be used in the emergency department as an accurate tool to measure subjective dyspnea in patients with acute bronchospasm. In addition, we demonstrated that it correlated well with other clinical parameters often used in the emergency department.

An unintentional discovery in this study was that the type of respiratory treatment prescribed by the physician(s) did not influence the patients’ subjective rating of dyspnea. This fact further strengthened our belief

Conclusion

This study was limited to a relatively small group of adult men with bronchospasm who were treated and released from an emergency department or urgent care clinic. An expanded study with a general population might reveal even higher correlation scores and could generate valuable outcome measures that could have a positive impact on how we assess, treat, and document the common sensory description of having dyspnea or shortness of breath. We believe that the MBS can be an invaluable clinical

Acknowledgements

We thank Marty Shively, RN, PhD, for her endless support and encouragement.

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ResearchUsefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma*

Abstract

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgements

Chest

Chest

Chest

The language of breathlessness

Am Rev Respir Dis

Use of magnitude estimation for estimating the parameters of dyspnea

Nurs Res

Psychophysical bases of perceived exertion

Med Sci Sports Exerc

Research
Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma*