Measurement of Dyspnea

Other questionnaires, such as the Baseline and Transition Dyspnea Index (BDI/TDI), ask patients to rate their level of dyspnea upon performing certain tasks, and may include examples such as:

• walking around your home
• dressing yourself
• eating
• taking a bath or shower
• going for a walk
• walking up a flight of stairs
• playing sports
• running
• having a conversation with someone
• singing or humming
• talking in a restaurant (to indicate speaking more loudly than usual)
• talking while walking around your home
• talking while running
• talking while lifting 20 pounds

Patients are generally asked to rate their dyspnea on a "never," "occasionally," "sometimes," "frequently," or "always" basis.

The BDI/TDI provides a multidimensional measurement of dyspnea based on the daily living activities of patients. The Dyspnea Indexes were designed to be administered to symp­tomatic patients as a part of the history. The BDI establishes the baseline level of dyspnea while the TDI indicates a change from baseline in the degree of functional impairment and the magnitude of the task and effort that result in breathlessness.

For the BDI, responses are categorized in grades ranging from Grade 4 (no impairment/takes extreme effort to become breathless) to Grade 0 (very severe impairment/no or little effort results in breathlessness). For the TDI, there are scores of -3 to +3. The BDI/TDI measures dyspnea through 3 domains: functional impairment (the impact of breathlessness on the ability to carry out activities); magnitude of task (the type of task that causes breathlessness); and the magnitude of effort (the level of effort that results in breathlessness). These 3 domains are totaled to create a Focal score. Use of this index can give the health care provider vital information about the progression of the disease. More information on the BDI/TDI is found in Section 3: Health-Related Quality of Life.