Evaluating dyspnoea in chronic obstructive pulmonary disease

Abstract

Dyspnoea is the most common and troubling symptom in patients with chronic obstructive pulmonary disease (COPD) and the severity of the symptom engenders negative impacts on health status, exacerbation rate, healthcare resource utilization and prognosis. Therefore, alleviating dyspnoea is a primary treatment goal for most patients with stable COPD. The objective of improving dyspnoea is supreme in the management of COPD as few therapeutic interventions are disease-modifying in curtailing the underlying problem of accelerated loss of lung function leading to premature disability or death. However, in spite of the well-established fundamental mechanisms that induce dyspnoea in healthy individuals and patients with COPD, as well as the proven effectiveness of multiple and varied therapeutic interventions in reducing dyspnoea in such patients, the clinical evaluation and quantification of dyspnoea remain imprecise. Subjective measurement tools currently used in clinical practice are incapable of grading both immediate and longer-term changes in dyspnoea simultaneously, and repetitive scoring using questionnaires is burdensome for both the patient and observer. This paper reviews the current understanding and management of dyspnoea in COPD and discusses potential improvements in evaluating dyspnoea with the aim of achieving per-sonalization of care for patients with COPD.