University of Cincinnati Dyspnea Questionnaire for Evaluation of Dyspnoea during physical and speech activities in patients with chronic obstructive pulmonary disease: a validation analysis.

University of Cincinnati Dyspnea Questionnaire (UCDQ) was developed to measure the impact of dyspnoea during (1) physical activity (Phys), (2) speech activity (Speech) and (3) simultaneous speech and physical activity (Comb). The aim of this study was to evaluate the validity of UCDQ in COPD patients, comparing it to a large set of dyspnoeic indices and functional parameters. Fifty COPD patients (age 58.7 +/- 9.1 years, FEV1%pred = 39.3 +/- 17.0%, Baseline Dyspnoea Index (BDI) = 4.9 +/- 2.5, Six Minute Walk Distance (6MWD) = 373 +/- 128 m, Symptoms score = 9.4 +/- 2.5; mean +/- SD) participated in the study. We found the following mean scores for the three sections of the questionnaire: Phys = 3.5 +/- 0.9; Speech = 2.4 +/- 1.1; Comb = 4.2 +/- 1.0, meaning that patients report the most breathlessness during the combination of speaking and physical activity and the least breathlessness during speech activities. All three section of UCDQ had significant strong correlation with dyspnoea indices (BDI, Borg, MRC, OCD), 6MWD and symptoms score, which proves its concurrent and construct validity. Differentiation of patients by speech section (=3<) discriminated them significantly with respect to all dyspnoeic indices, symptoms score and 6MWD. All three dimensions of UCDQ had high test-retest reliability - ICC between 0.76 and 0.93. Factor analysis yielded three interpretable factors, as all dyspnoeic indices, three sections of UCDQ, symptoms score and 6MWD were loaded on the first factor. In conclusion, UCDQ provides valid and reliable information about the effect of dyspnoea on speech and daily activities.

Functional parameters in pulmonary bullous emphysema.

OBJECTIVE: 1. compare a large set of functional parameters in patients with bullous emphysema and patients with nonbullous emphysema. 2. To compare a chest radiographs (CHR) and a high resolution computed tomography (HRCT) in the clinical assessment of bullous emphysema. MATERIAL AND METHODS: The study population included 43 stable COPD patients (age = 59 +/- 9 years; pack/year (P/Y) = 39 +/- 19; ATS dyspnea score = 2.3 +/- 0.9; FEV1%pred. = 30 +/- = 10%; KCO%pred. = 49 +/- 16%; 6MWD (six minute walk distance) = 395 +/- 103 m; mean +/- SD). The patients were divided into two groups (patients with and without bullae) by a HRCT. In most of the cases the size of the bullae, measured by CT scan, was less than 15 mm. Twenty two CHRs were read independently by three experienced chest radiologists who had no knowledge of the CT scan data. RESULTS: Statistically significant differences were found between the groups with bullous (n = 19) and nonbullous (n = 24) emphysema in FEV1 (p < 0.001); VC (p = 0.001); BMI (p = 0.018); Borg after exercise (p = 0.021); FEV1/VC% (p = 0.025) and P/Y (p = 0.034). The sensitivity of chest radiographs compared with CT scan regarding the small bullae was very low: 27.7% in radiologist I, 12.3% in radiologist II, and 21.5% in radiologist III. CONCLUSIONS: 1. The patients with bullous emphysema have statistically significant lower lung function indices (FEV1, VC, FEV1/VC%) and BMI than those with nonbullous emphysema. 2. Patients with bullous emphysema have higher level of dyspnea score after 6MWD and higher pack-year smoking status than those with nonbullous emphysema. 3. For the clinical evaluation of emphysema the information derived from a standardised reading of the CXR is not as valuable as that derived from the CT scan.