Development of Self‐Administered Versions of Modified Baseline and Transition Dyspnea Indexes in COPD

Figures & data

Table 1.  Major Changes Made in the SAC Versions of the BDI and TDI from the Original Instruments

Baseline Dyspnea Index
• Changed criterion in magnitude of task from “climbing three flights of stairs” to “climbing one flight of stairs.”
Transition Dyspnea Index
• Provided insert on the computer screen of the descriptor that the patient selected for the corresponding component of the BDI in order to remind the patient of his/her original dyspnea status (see Figure 1).
• Created a bidirectional visual analog scale for each component of the TDI. Patient pressed an up or down key to move a vertical bar up for improvement or down for deterioration in dyspnea compared with the baseline dyspnea status (see Figure 1).

Figure 1. Example of the self‐administered computerized version for the “functional impairment” component (labeled “activities” on the graph) of the transition dyspnea index (TDI). By pressing the up or down arrow on the keyboard, the patient could move the vertical bar up (for improvement) or down (for deterioration) to represent a change in dyspnea. An insert is present in the left portion of the figure which reminds the patient of his/her selection at baseline. (Full color version available online.)

Table 2.  Grades and Descriptors for the Practice Session Related to the Experience of Being Tired

Grade	Descriptor
NONE	I have not felt tired.
SLIGHT	I have felt tired occasionally.
MODERATE	I have felt tired about half the time.
SEVERE	I have felt tired much of the time.
VERY SEVERE	I have felt tired all of the time.

Table 3.  Grades and Descriptors for each Component of the Self‐Administered and Computerized Version of the BDI

Baseline dyspnea index
Functional impairment
NONE	I can perform usual activities without shortness of breath.
SLIGHT	I am short of breath in at least one activity, but have not completely stopped any activity.
MODERATE	I can't do at least one usual activity due to shortness of breath.
SEVERE	I can't do most or all activities due to shortness of breath.
VERY SEVERE	I can't do most or all activities and would be unable to work due to shortness of breath.
Magnitude of task
NONE	I am short of breath only with extraordinary tasks, such as carrying very heavy loads on level ground, lighter loads uphill, or running. No shortness of breath with ordinary tasks.
SLIGHT	I am short of breath only with major tasks, such as walking up a steep hill, climbing one or more flights of stairs, or carrying a moderate load on level ground.
MODERATE	I am short of breath with average tasks, such as walking up a gradual hill, climbing less than one flight of stairs or carrying a light load on the level.
SEVERE	I am short of breath with light tasks, such as walking on level ground or standing.
VERY SEVERE	I am short of breath at rest, while sitting, or lying down.
Magnitude of effort
NONE	I am short of breath only with the greatest imaginable effort.
SLIGHT	I am short of breath with extreme effort. I must pause only if the activity requires extreme effort.
MODERATE	I am short of breath with moderate effort. I need to pause and it takes longer to complete the task than the average person.
SEVERE	I am short of breath with little effort. I need to pause frequently and it takes at least 50 % longer to complete the task than the average person.
VERY SEVERE	I am short of breath with no effort.

Table 4.  Correlations Between the BDI/TDI Total Scores and Lung Function

Lung function	SAC BDI	Interviewer BDI
FVC	0.41; p = 0.04	0.33; p = 0.11
FEV1	0.28; p = 0.17	0.28; p = 0.17
IC	0.47; p = 0.02	0.41; p = 0.05
Lung function	SAC TDI	Interviewer TDI
Δ FVC	0.40; p = 0.05	0.37; p = 0.07
Δ FEV1	0.38; p = 0.06	0.45; p = 0.02
Δ IC	0.39; p = 0.06	0.45; p = 0.02

Lung function measures are percent predicted.

Correlation values are Pearson coefficients.

*Mean value of two interviewers.

Figure 2. Relationship between baseline dyspnea index (BDI) total scores represented as mean value of the scores obtained by two interviewers (abscissa) and the self‐administered scores (ordinate) in 25 patients with chronic obstructive pulmonary disease. The line represents the best linear fit.

Figure 3. Relationship between transition dyspnea index (TDI) total scores represented as mean value of the scores obtained by two interviewers (abscissa) and the self‐administered scores (ordinate) in 25 patients with chronic obstructive pulmonary disease. The line represents the best linear fit.