Verbal Descriptors of Dyspnea in Patients With COPD at Different Its Intensity Levels

Verbal Descriptors of Dyspnea

Exercise Performance

Experimental conditions differed in their intensity level of dyspnea confirmed by a significant increase in Borg scores from rest (1.8 ± 1.5, slight dyspnea) to cycle ergometer exercise (3.1 ± 1.6, moderate dyspnea) to the 6MWT (4.2 ± 1.6, somewhat severe dyspnea) [all p < 0.001]. Compared to the first day, Borg scores at the 6MWT showed a significant decrease after PR (3.5 ± 1.3) paralleled by a significant increase in the respective distance covered in a 6MWT (457 ± 82 m and 493 ± 84 m) [p < 0.001].


Verbal Descriptors of Dyspnea

Cluster analyses identified five clusters of verbal descriptors: (1) heavy/fast breathing, (2) shallow breathing, (3) obstruction, (4) work/effort, and (5) suffocation (Table 2), which showed different patterns depending on the intensity level of dyspnea (Fig 1). During slight dyspnea at rest, the cluster mean for shallow breathing was greater than all other cluster means (p < 0.05). For moderate dyspnea during cycle exercise, the cluster mean for heavy/fast breathing was greater than all other cluster means (p < 0.001) except shallow breathing. Additionally, the cluster mean for shallow breathing was greater than that for the obstruction cluster (p < 0.01). For somewhat severe dyspnea during the 6MWT, the cluster mean for heavy/fast breathing was greater than all other cluster means (p < 0.001) and the cluster mean for work/effort was greater than for obstruction (p < 0.01). The cluster mean for suffocation was smaller than all other cluster means in all conditions (p < 0.001). No differences in the cluster means were found between patients with FEV1%pred 50%, patients aged 62 years, or female and male patients in any of the conditions improved with My Canadian Pharmacy.

Post hoc tests comparing cluster means between the three conditions demonstrated that all five cluster means increased significantly from rest to 6MWT (p < 0.01) and from cycle exercise to 6MWT (p < 0.01) [Fig 2]. The cluster means for heavy/fast breathing and work/effort showed an additional increase from rest to moderate cycle exercise (p < 0.001 and p < 0.06, respectively) and the highest effect sizes (^2 = 0.43 and (^2 = 0.30, respectively) compared to cluster means for shallow breathing, obstruction and suffocation (^2 = 0.08, 0.15, and 0.11, respectively).

As depicted in Figure 1, the means of all five clusters for the 6MWT showed a significant decrease after PR compared to the first day of PR (p < 0.05).

The cluster means for heavy/fast breathing and work/effort showed the strongest pre-PR/post-PR differences (A = — 1.2 and — 1.0, respectively) and the highest effect sizes (v2 = 0.29 and 0.21, respectively) compared to cluster means for shallow breathing, obstruction and suffocation (A = — 0.6, — 0.7, and — 0.6; v2 = 0.08, 0.11 and 0.15, respectively). The pattern of cluster means for the 6MWT after PR was widely comparable to that of the first day, with the cluster mean for heavy/fast breathing being greater than all other cluster means (p < 0.001), and that for suffocation being smaller than all other cluster means (p < 0.001).

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Verbal Descriptors of Dyspnea in Patients With COPD at Different Its Intensity Levels

Fig1

Figure 1. Mean (± SEM) ratings on the Likert scale for clusters of verbal descriptors of dyspnea at different intensity levels of dyspnea during rest (mean Borg score = 1.8, slight dyspnea), cycle ergometer exercise (mean Borg score = 3.1, moderate dyspnea), 6MWT before PR (mean Borg score = 4.2, somewhat severe dyspnea), and 6MWT after PR (mean Borg score = 3.5).

Fig2

Figure 2. Mean (± SEM) ratings on the Likert scale for separate clusters of verbal descriptors of dyspnea at different intensity levels of dyspnea during rest (white bars), cycle ergometer exercise (shaded bars), and 6MWT before PR (black bars). While all cluster means show significant increases from rest to 6MWT and from cycle exercise to 6MWT, only cluster means for heavy/fast breathing and work/effort show an additional increase from rest to cycle exercise. **p < 0.01, ***p < 0.001, |p < 0.06.