Chest
Volume 96, Issue 6, December 1989, Pages 1247-1251
Journal home page for Chest

Clinical Investigations
The Relationship Between Pulmonary Function and Dyspnea in Obstructive Lung Disease

https://doi.org/10.1378/chest.96.6.1247Get rights and content

Increased importance is now being placed on evaluating dyspnea in patients with obstructive lung disease (OLD). We measured breathlessness at rest, using a Borg scale dyspnea index (BSDI) before and after bronchodilator (albuterol [salbutamol] 200μg) in 93 patients with OLD drawn from a larger population undergoing routine spirometry. The median BSDI declined from 3 to 1 before and after bronchodilator, suggesting improvement in dyspnea. However, there was no correlation between initial or postbronchodilator spirometry and BSDI. The change in FEV1 similarly did not correlate with the change in BSDI (r=0.05). A large bronchodilator response was usually associated with improvement in dyspnea, but the converse was not observed. Thus, of ten patients with an improvement in BSDI of more than two categories, six had a change in FEV1 of 0.1 L or less after bronchodilator. Analyzing a subgroup of 65 dyspneic patients with an initial BSDI of 2 or more revealed the following response groups: those with either a bronchodilator or dyspnea response alone, both together, or neither. Twenty-eight patients (43 percent) responded both subjectively and objectively. Eleven (17 percent) had a bronchodilator response only, 17 (26 percent) had a dyspnea response only, while nine (14 percent) had neither measurable response. We conclude that dyspnea is poorly correlated with results of routine spirometry in patients with OLD. The use of dyspnea ratings may yield information about bronchodilator responsiveness not appreciated by spirometry alone.

Section snippets

Materials and Methods

This study involved sequential outpatients who were referred to the Sir Mortimer B. Davis—Jewish General Hospital for routine pulmonary function testing between March 1 and Oct 1, 1987. Those who were unable to perform spirometry according to the protocol, or who had taken inhaled β-agonist within 1 h of arrival in the laboratory were excluded. One hundred seventy-four patients represented the initial study population screened. They included those with known asthma, COPD, or restrictive lung

Results

Ninety-three (41 male and 52 female) of 174 initially screened subjects conformed to the aforementioned definition of OLD and are included in the subsequent analysis. The mean age of these patients was 68±11 years. The results of spirometry are seen in Table 1.

The correlation between pulmonary function values and dyspnea using either FEV1, FVC, or FEF25-75 was similar. Accordingly, only the former is presented below, although the results were consistent for all three parameters. There was no

Discussion

We found a poor correlation between FEV1, FVC, and FEF25–75 measured by routine spirometry and dyspnea assessed by a Borg scale in patients with OLD. Although dyspnea scores improved after albuterol, the changes in dyspnea did not correlate well with improvement in the above measures of pulmonary function. A very large objective response to albuterol was consistently associated with improvement in dyspnea. However, those with large subjective responses often had insignificant changes in FEV1

ACKNOWLEDGMENT

The authors wish to thank the following pulmonary function technicians—Pierre Kupfer, Carole Egglefield, and Johanne Castonguay—for their diligent work, and Angela Palumbo and Donna Cohen for assistance in preparation of the manuscript.

References (25)

  • GAV Borg

    Psychophysical basis of perceived exertion

    Med Sci Sports Exerc

    (1982)
  • DA Mahler et al.

    Minimizing the effects of dyspnea in COPD patients

    J Respir Dis

    (1987)
  • Cited by (156)

    • Assessment of acute bronchodilator effects from specific airway resistance changes in stable COPD patients

      2014, Respiratory Physiology and Neurobiology
      Citation Excerpt :

      Indeed, stepwise regression analysis with VAS or ΔVAS as independent variable indicated that among all parameters, sRAW or ΔsRAW was the only significant predictor of the level of dyspnea at rest or its change with bronchodilation. Only few studies have assessed the acute effects of bronchodilators on dyspnea at rest (Wolkove et al., 1989; Noseda et al., 1993; Taube et al., 2000; Di Marco et al., 2003). Comparisons are cumbersome because of differences in rating procedures, statistical analyses, ongoing therapeutic treatments, and severity of the disease; however, common to all studies is the range of incidence (55–70%) of patients who perceive a significant improvement of dyspnea at rest, as well as the indication that the concomitant changes of FEV1 are poor or unfit indicators of dyspnea relief.

    View all citing articles on Scopus

    Supported in part by the Fred C. Ullman Family Fund for Pulmonary Studies.

    Presented at the 54th Annual Scientific Assembly, American College of Chest Physicians, Anaheim, Oct 3–7, 1988.

    View full text