LANGUAGE OF DYSPNEA IN ASSESSMENT OF PATIENTS WITH ACUTE ASTHMA TREATED WITH NEBULIZED ALBUTEROL

To investigate whether the language of dyspnea provides relevant clini cal information in addition to that provided by ratings of overall dys pnea intensity when assessing subjective response to therapy, we condu cted a prospective study in a cohort of 25 patients with acute asthma presenting to the emergency department of a tertiary care hospital. Pa tients received nebulized albuterol treatments every 20 min with a max imum of three doses. At presentation and after each treatment, patient s completed spirometry, rated overall dyspnea intensity on a modified Borg scale, and selected phrases that described qualities of breathles sness from a 15-item questionnaire. Paired Student's t tests revealed significant improvements in FEV1 (from 1.39 +/- 0.66 L to 1.80 +/- 0.7 6 L, p < 0.001) and reductions in dyspnea intensity (from 5.12 +/- 2.0 8 to 2.82 +/- 1.59, p < 0.001) after the first albuterol treatment. Dy spnea intensity continued to decrease significantly in response to the second treatment, modified Borg rating 2.26 +/- 1.52, although there was no positive bronchodilator response. The results from Cochran Q te sts revealed that the frequency of the experience of ''chest tightness '' decreased significantly across the phases of treatment. However, th e sensations of ''work'' or ''breathing effort'' persisted at the same time that the FEV1 revealed ongoing airways obstruction. We conclude that attention to the language of dyspnea would alert health care prov iders to residual air flow obstruction despite decreases in overall dy spnea intensity.