To follow are instruments measuring the various qualities of dyspnea (sensory–perceptual experience, affective distress and/or symptom impact or burden).1 We did not categorize instruments based on these qualities, however the user should be familiar with the strengths and limitations of these instruments in that regard. For example, the purpose of measuring dyspnea must first be determined in order to decide on the instrument’s ability to detect the qualities of dyspnea proposed.

While these instruments have all been used in Pulmonary Rehabilitation (PR), some are weaker than others in evaluating dyspnea. For example, the MRC (Medical Research Council) dyspnea scale is not consistently responsive to PR. Also, there is a weakness in the quoted Minimal Important Difference which has been rounded up to “1”. Lastly, the item descriptions are sometimes confusing to patients. Despite these shortcomings, we have elected to include the MRC among our dyspnea measures because of its common use. Other dyspnea measures have not been included because they lack use or responsiveness to PR.

The reader will note that some instruments are health status measures, however, they have subscales that measure dyspnea. We have reviewed only the psychometric properties of these subscales to the extent that they have been reported.

Baseline Dyspnea Index & Translational Dyspnea Index
Borg CR10
Breathlessness Catastrophizing Scale
Chronic Respiratory Questionnaire-Dyspnea domain
Clinical COPD Questionnaire-Dyspnea
Disability Related to COPD Tool
Dyspnoea-12
King’s Brief Interstitial Lung Disease questionnaire©
London Chest Activity of Daily Living Questionnaire
Medical Research Council Dyspnea Score
Multidimensional Dyspnea Profile
Pulmonary Functional Status & Dyspnea Questionnaire
Pulmonary Functional Status & Dyspnea Questionnaire-Modified Dyspnea Domain
Saint George’s Respiratory Questionnaire - Symptom Domain
University of California, San Diego Shortness of Breath Questionnaire
University of Cincinnati Shortness of Breath Questionnaire
Visual Analogue Scale-8 items

We wish to thank Enya Daynes who identified and provided extensive reviews of these instruments. We would also like to the the following PR members for taking the time to edit this list of measures with timely updates: Felicity Blackstock, Linzy Houchen-Wolloff, Suzanne Lareau, Hayley Lewthwaite and Clarice Tang.

Parshall MB et al. An official American Thoracic Society statement: Update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012; 185:435-452.

Baseline Dyspnea Index & Translational Dyspnea Index

	Description
Name of Questionnaire	Baseline Dyspnea Index & Translational Dyspnea Index¹
Abbreviation/Alternate Name	BDI & TDI©
Description:	Originally interviewer-administered rating of severity of dyspnea at a single state. TDI measures changes in dyspnea severity from the baseline (as established by the BDI).
Developer	Donald A Mahler
E-mail	donald.a.mahler@hitchcock.org
Cost	Fees apply to funded academic users, commercial uses. No fees for students, non-funded academic users and clinical practice.²
License required	Permission required and signed user agreement²
Self-or rater-administered	Rater or self-administered
Time to complete	10 minutes
Number of items	24
Domains & categories (#)	3
Name of domains/categories	Functional Impairment, Magnitude of Task, Magnitude of Effort. Recall: during the last two weeks
Scaling of items	Five grades from 0 (very severe) to 4 (no impairment) for each category. TDI rate changes in breathlessness, rated by seven grades ranging from -3 (major deterioration) to +3 (major improvement).
Scoring	Range from 0-12. Lower the scores, worse severity of dyspnea. TDI total scores range -9 to +9.
Test-retest/reproducibility	BDI interobserver agreements for total score (92-94% agreement, weighted K=0.65-0.70) and each category. Test-retest r=0.76.³ TDI interobserver agreement for total score (88-90% agreement, weighted K=0.63-0.65) and each category.¹ Internal consistency Cronbach α=0.80¹ Test-retest for self-administered TDI ICC=0.84⁴
Validity	Correlations with 12MWD r=0.60 p<0.01² Correlations with SGRQ, r=0.69, p<0.013⁵ Correlations with HADs: Anxiety r=0.21, p<0.01, Depression r=0.41 p<0.01⁵
Responsiveness to PR	TDI change 2.3 point change post PR compared to controls (0.2 point change)^3,7
MID	MID Change of ≥1 unit^6,8
Languages	73 translations available from https://eprovide.mapi-trust.org/instruments/baseline-and-transition-dyspnea-indexes
References	Mahler DA et al. Chest. 1984; 85: 751-758. Eakin EG et al. Int J Behav Med. 1995; 2: 118-134. Reardon J et al. Chest. 1994; 105: 1046-1052. Mahler et al. Chest. 2009; 136:1473-1479. Perez T et al. Int J Chron Obstruct Pulm Dis. 2015; 10:1163-1172. Witek TJ et al. Eur Respir J. 2003; 21:267–272. Leupoldt et al. COPD. 2017; 14:66-71. Mahler et al. COPD. 2005; 2:99-103.
Date of most recent changes	November 2022

Borg CR10

	Description
Name of Questionnaire	Borg’s 0-10 Category Ratio Scale^1,2
Abbreviation/Alternate Name	Borg CR10 scale, 0-10 mBorg
Description:	Nonlinear scaling of descriptors (except for# 6 & 8). Most often to recall breathlessness “right now” in response to an external stimuli (commonly exercise).
Developer	Gunnar Borg
E-mail	https://eprovide.mapi-trust.org/instruments/borg-dyspnea-scale
Cost	Fee schedule at https://borgperception.se/obtain-a-license/
License required	Copyright Borg CR10 scale © Gunnar Borg, 1982, 1998, 2004
Self-or rater-administered	Self-administered
Time to complete	<1 min
Number of items	1
Domains & categories (#)	N/A
Name of domains/categories	N/A
Scaling of items	11, descriptors range from “nothing at all” (0) to “maximal” (10). A rating of >11, selected for “Absolute Maximum/Highest Possible”.
Scoring	0-10
Test-retest/reproducibility	Test-retest: In COPD CPET for 6 weeks.³ Average breathlessness past week = 0.45⁴
Validity	Content: NRS and mBorg “on exertion” (ICC=0.66, 95% CI 0.33–0.85), for “now” (ICC=0.14, 95% CI −0.05–0.33), “average” 0.51 (0.15–0.75), “worst” 0.55 (0.34–0.71) and “rest” 0.33 (−0.09–0.66).⁵ Correlated with minute ventilation (r = 0.98 ± 0.01).⁶
Responsiveness to PR	Outpatient PR. Borg improved isowatt 5.7±1.5 pre and 3.7±1.4 post in asthma; 5.6±1.3 pre and 3.6±0.9 post in COPD (both p<.05).⁸
MID	2 units for “stronger” interventions with large effect sizes > 0.8, such as rehabilitative exercise training or lung volume reduction surgery in emphysema. 1 unit for less intensive interventions with more moderate effects sizes, such as supplemental oxygen or bronchodilator therapy.⁹
Languages	86 translations¹⁰
References	Borg GA. Med Sci Sports Exerc. 1982; 14:377-81 Borg G. Proceedings of the 22nd International Congress of Psychology. Amsterdam, The Netherlands: North Holland Publishing Co; 1980:25–34. O’Donnell DE et al. ERJ. 2009; 34 866-874. Eakin EG et al. Int J Behav Med. 1995;2:118-134. Johnson MJ et al. ERJ. 2016; 47:1861-1864. Mandor M et al. Chest. 1995; 107:1590-1597. Higashimoto Y et al. Resp Investigation. 2020; 58:355-366. Foglio K et al. ERJ. 1999; 13:125-132. Ries AL. J COPD. 2005; 2: 105-110. https://eprovide.mapi-trust.org/instruments/borg-dyspnea-scale#coas_member_access_content
Date of most recent changes	December 2022

Breathlessness Catastrophizing Scale

	Description
Name of Questionnaire	Breathlessness catastrophizing Scale¹
Abbreviation/Alternate Name	BCS
Description:	Adapted from the pain catastrophizing scale, evaluates catastrophizing with breathlessness.
Developer	BK Soloman et al.
E-mail	brahm.solomon@gmail.com
Cost	Free
License required	N/A
Self-or rater-administered	Self-administered
Time to complete	5-10 minutes¹
Number of items	13
Domains & categories (#)	NA
Name of domains/ categories	NA
Scaling of items	5-point scale 0=not at all, 4= all the time.
Scoring	Total=sum of 13 items. Range from 0-52 (52 more severe).
Test-retest/ reproducibility	Internal consistency Cronbach’s α 0.96²
Validity	Content validity ICC >0.69 for each item. ²· Factor Analysis, one factor solution.· Concurrent validity to measures of anxiety sensitivity index, Beck Depression scale and COPD self-efficacy, but not performance on 6MWT, non-stop walk test and stair climbing tests.
Responsiveness to PR	Mean change -6.14 p<0.01¹· Improved on 6MWD, Beck Depression Inventory-II; 9-Item Patient Health Questionnaire; COPD Self-Efficacy Scale and BCS, p ≤ .001.¹
MID	NA
Languages	English
References	Ong WJ et al. Clin Rheumatol. 2021; 40:295-301. Solomon BK et al. J Psychosom Res. 2015; 79:62-68.
Date of most recent changes	January 2023

Chronic Respiratory Questionnaire-Dyspnea domain

	Description
Name of Questionnaire	Chronic Respiratory Questionnaire- Dyspnea domain (only)¹
Abbreviation/Alternate Name	CRQ-D
Description	The following lists information on the Dyspnea domain only. (Refer to HRQOL for complete details on the CRD.) Patients select up to 5 activities that are important to them and score from extremely breathless to no breathlessness.
Developer	GH Guyatt, H Schünemann McMaster University and modified by University Hospitals of Leicester
E-mail	milo@mcmaster.ca and pulmonaryrehab@uhl-tr.nhs.uk (modified)
Cost	Contact McMaster Industry Liaison Office (MILO) milo@mcmaster.ca For modified Free for own use. Cost £27 + P&P
License required	Yes. Copyright © 2001 McMaster University, Hamilton, Ontario, CA Modified (CRQ-SR) is protected under copyright may be photocopied for own use, but not be used for pharmaceutical company sponsored research without prior permission from Glenfield Hospital.
Self-or rater-administered	Interviewer¹ or self-administered²
Time to complete	5 minutes for the domain
Number of items	5 (dyspnea)
Domains & categories (#)	4
Name of domains/ categories	Dyspnea, fatigue, emotion and mastery
Scaling of items	Extremely breathless (1), Very (2), Quite (3), moderately (4), Some (5), A little (6), No breathlessness (7)
Scoring	Mean score 1-7 on domain
Test-retest/ reproducibility	Test-retest- ICC 0.83² Internal consistency- range α= 0.53 to 0.91 on dyspnea domain^2,4,5,6
Validity	Content validity was not explored for the dyspnea domain due to low reliability of the comparator measure.²
Responsiveness to PR	Variable response to PR 0.75 95% CI 0.56 to 1.03⁸
MID	MID= 0.5 per domain⁷
Languages	46
References	Guyatt GH et. al. Thorax. 1987; 42:773–778. Williams JEA et al. Thorax. 2001; 56:954-959. Williams JE et al. Thorax. 2003; 58:515-518. Wijkstra PJ et. al. Thorax. 1994; 49: 465–467. Reda AA et. al. Respir Med. 2010; 104: 1675–1682. Schűnemann HJ et. al. J COPD. 2005; 2: 81–89. Redelmeier D et. al. J Clin Epidemiol. 1996; 49: 1215–1219. McCarthy B et al. Cochrane Database Syst Rev. 2015. 23: CD003793
Date of most recent changes	December 2022

Clinical COPD Questionnaire-Dyspnea

	Description
Name of Questionnaire	Clinical COPD Questionnaire
Abbreviation/Alternate Name	CCQ
Description:	A health status measure of clinical control of COPD. One domain evaluates symptoms (dyspnea, cough and phlegm).
Developer	Van der Molen et al.
E-mail	t.van.der.molen@med.rug.nl
Cost	No charge for: students, physicians, clinical practice or academic users. Fees may apply for: healthcare organizations, commercial users & internet companies.
License required	Copyrighted. CCQ© may not be changed, translated or sold (paper or software) without permission of Thys van der Molen.
Self-or rater-administered	Self-administered
Time to complete	<1 minute
Number of items	Total of 10 items across 3 domains. Symptom domain consists of 4 items, 2 of the 4 relate to dyspnea.
Domains & categories (#)	Symptom (2 items relate to dyspnea)
Name of domains/ categories	Symptoms, functional state, mental state
Scaling of items	7-point likert scale (0-6). Lower scores indicate better symptoms.
Scoring	Mean score of items on symptom domain 0-32 divided by 4 items.
Test-retest/ reproducibility	Test-retest for total score ICC 0.94¹ Internal consistency Cronbach’s α for symptoms 0.65-0.78²
Validity	Content validity- symptoms of SGRQ 0.65-0.78. ² Correlation post PR with SGRQ symptoms was 0.14 (p<.001); with CRQ dyspnea -0.46 (p<.001).⁴
Responsiveness to PR	Responsive to rehabilitation with improvements of -0.4 points.³
MID	MID 0.4^{2, 3}
Languages	Translated into 60+ languages (https://ccq.nl/?page_id=4).
References	van der Molen T et al. Health Qual Life Outcomes. 2003; 1:1-10. Zhou Z et al. Respirology. 2017; 22: 251-262. Alma H et al. NPJ Prim Care Respir Med. 2016; 26: 1-8. Kon SSC et al. Thorax. 2014; 69:793-798.
Date of most recent changes	December 2022

Disability Related to COPD Tool

	Description
Name of Questionnaire	Disability Related to COPD Tool
Abbreviation/Alternate Name	DIRECT
Description:	Assesses disability due to breathlessness i. e. the physical limitation or functional impact of breathlessness.
Developer	Aguilaniu B; Gonzalez-Bermejo J; Regnault A; Arnould B; Mueser M; Granet G; Bonnefoy M; Similowski T; Dias-Barbosa C
E-mail	antoine.regnault@mapivalues.com
Cost	Freely available in original publication
License required	© 2011, Pfizer and Boehringer Ingelheim
Self-or rater-administered	Self
Time to complete	< 5 min
Number of items	10
Domains & categories (#)	4
Name of domains/categories	Basic Activities of Daily Living (BADL); Instrumental ADL (IADL); Advanced ADL (AADL); Impact on daily life.
Scaling of items	Rating on 4- (0 to 3) or 5-point (0 to 4) Likert scale, anchored by descriptors (“never” to “all of the time”) pertaining to how often the different daily tasks or relationships are impacted by breathlessness.
Scoring	A single, total score (TS) is reported (0–34). Developers propose score >10 indicates noticeable & >20 high levels of disability.
Test-retest/ reproducibility	Cronbach’s α=0.947.¹
Validity	Concurrent: Correlation with SGRQ Symptom (0.61), Activity (0.83), Impact (0.83), TS (0.87). LHS overall handicap score (−0.70) and MMRC dyspnea (0.73).¹ Univariate linear regressions for DIRECT score and BODE index (p=<0.001; R2 = 0.47), post-bronchodilator FEV₁ (p=<0.001; R2 = 0.25), 6MWD (p=< .001; R2 = 0.21) and CCI (p=<0.001; R2 = 0.05).¹
Responsiveness to PR	Change after PR −1.9 (−2.6 to −1.2)²
MID	≥2 units for the DIRECT score²
Languages	French (original), US English
References	Aguilaniu, B et al. Int J COPD. 2011; 6:387-398. Lévesque J et al. Int J COPD. 2019; 14:261-269.
Date of most recent changes	December 2022

Dyspnoea-12

	Description
Name of Questionnaire	Dyspnoea-12¹
Abbreviation/Alternate Name	D-12
Description:	Description of breathlessness related to the different qualitative dimensions of breathlessness. The focal period is “These days”.
Developer	Janelle York
E-mail	j.yorke@salford.ac.uk
Cost	None
License required	No
Self-or rater-administered	Self-administered
Time to complete	<5 min
Number of items	12
Domains & categories (#)	Physical (7 items) and Affective (5 items)
Name of domains/ categories	Physical, Affective
Scaling of items	4-point Likert scale, rated 0= “none”, 1= “mild”, 2= “moderate”, 3= “severe”
Scoring	Summation of scores. Total score (TS) from 0-36, higher scores worse symptoms
Test-retest/ reproducibility	Test-retest: ICC = 0.9, p=0.001.^1, Internal consistency Cronbach’s α: .9¹
Validity	Correlate to Mmrc (r=0.59), SGRQ- Symptoms (r=0.57), Activities (r=0.78), Impacts (r=0.75), Total (r=0.79)²for people with ILD. Negative correlations for both instruments and subscales with FEV₁% pred.³
Responsiveness to PR	· Change following PR in COPD: TS: pre 23.9 ±8.9 vs post 17.6 ±9.4, p<.001.³
MID	TS in COPD 2.68, 95% CI 1.16–4.20, n=27 TS non-COPD (asthma, HF and IPF;) 2.97, 95% CI 1.94–4.00, n=106.⁴ 6 in PR³
Languages	French, Portuguese, Italian, Swedish, Spanish, Arabic, Korean, Urdu, Japanese
References	Yorke J et al. Thorax. 2010; 65:21–26. Yorke et al. Chest. 2011; 139:159-164. Williams M et al. J Pain Symptom Manage. 2022; 63: e75-e87. Beaumont M et al. Clin Respir J. 2021; 15: 413– 419. Ekstrom M et al. J Pain Symptom Manage. 2020; 60: 968-975e1.
Date of most recent changes	December 2022

King’s Brief Interstitial Lung Disease questionnaire©

	Description
Name of Questionnaire	King’s Brief Interstitial Lung Disease questionnaire©¹
Abbreviation/Alternate Name	K-BILD©
Description:	Health status questionnaire for patients with ILD.
Developer	Surinder S Birring
E-mail	kbildenquiries@gmail.com
Cost	Unknown
License required	Copyright https://www.kbild.com/
Self-or rater-administered	Self-administered
Time to complete	<1 minute for breathlessness
Number of items	15= psychological (7), breathlessness & activities (4), chest symptoms (3), financial status (1).
Domains & categories (#)	3
Name of domains/categories	Psychological (KBILD-P); Breathlessness & activities (KBILD-B); Chest symptoms (KBILD-C) & a Total Score (KBILD-T)
Scaling of items	1-7 likert scale with verbal descriptors of frequency.
Scoring	Total Score (TS) and each domain range from 0-100. Higher scores indicate better HRQoL.
Test-retest/Reproducibility	Test-retest ICC= K-BILD-P, 0.91; KBILD-B, 0.96; KBILD-C, 0.86; KBILD-T, 0.94.¹ Internal consistency Cronbach's α coefficient 0.94 for K-BILD-T¹
Validity	FVC (% pred) r=0.38–0.51, DLCO (% pred) r=0.42–0.52, SGRQ range r= −0.59 to -0.89 with KBILD-T and SGRQ TS r= -0.89. KBILD-B with SF36 Physical Component r= 0.70.¹
Responsiveness to PR	Responsive to PR,² Supplementary oxygen,³medical management of cough,⁴ longitudinal change,⁵ associated with survival in ILD & IPF.⁶
MID	MID in PR: KBILD-P= 5.4; KBILD-B=4.4; KBILD-C=9.8 & KBILD-T=3.9.² Non PR MID. KBILD-P=6; KBILD-B=7; KBILD-C=11; KBILD-T=5.⁷
Languages	French, Italian, Swedish, Dutch⁸ also refer to MAPI Trust
References	Patel AS et al. Thorax. 2012; 67:804. Nolan CM et al. Eur Respir J. 2019. 54. Visca D et al. Lancet Respir Med 2018: 6: 759-770. Birring SS et al. Lancet Respir Med 2017: 5: 806-815. Siegert et al. Am J Respir Crit Care Med 2012: 185: A4580. Kim JW et al. Chron Respir Dis 2021; 18: 14799731211033925. Sinha A et al. BMJ Open Respir Res 2019;6:e000363. Wapenaar M et al. Chron Respir Dis 2017; 14:140–150.
Date of most recent changes	December 2022

London Chest Activity of Daily Living Questionnaire

	Description
Name of Questionnaire	London Chest Activity of Daily Living Questionnaire¹
Abbreviation/Alternate Name	LCADL
Description:	Assesses an individual’s perception of dyspnea during ADLs as a result of respiratory disease.
Developers	Garrod R, JC Bestall, EA Paul, JA Wedzicha, PW Jones
E-mail	rachelgarrod1@gmail.com
Cost	None
License required	LCADL© St George’s Hospital Medical School, November 2007. All rights reserved
Self-or rater-administered	Self-administered
Time to complete	5 minutes
Number of items	15
Domains & categories (#)	4
Name of domains/ categories	Self-care, domestic, physical, leisure activities
Scaling of items	1 no breathless, 2 moderate, 3 very breathless, 4 can no longer do, 5 need someone else to do this, 0 wouldn’t do anyway.
Scoring	Total Score 0-75 where 75 is more severe breathlessness
Test-retest/reproducibility	Test-retest ICC= 0.93 [0.82-0.97]² Internal consistency, Cronbachs α= 0.98²
Validity	Concurrent validity with SGRQ activity domain r=0.70²
Responsiveness to PR	Self-care, physical leisure domains and TS.² Self-care, domestic, leisure domains and TS ³ 28% of TS distinguished the functional status in COPD⁴
MID	4 points TS.⁵
Languages	English, Dutch, Korean, French
References	Garrod R et al. Respir Med. 2000; 94:589-596. Garrod R et al. Respir Med. 2002; 96:725-730. Kovelis D et al. J Bras Pneu[1]mol. 2008; 34: 1008–1018. Gulart AA et al. Braz J Phys Ther. 2020; 24:264-272. Bisca GW et al. J Cardiopul Rehabil Prev. 2014; 34:213-216.
Date of most recent changes	December 2022

Medical Research Council Dyspnea Score

	Description
Name of Questionnaire	Medical Research Council Dyspnea Score¹
Abbreviation/Alternate Name	MRC, mMRC (modified)
Description:	Establish grade of breathlessness based on activity level.
Developer	Medical Research Council
E-mail	corporate@mrc.ukri.org
Cost	Free
License required	Permission granted for any use with the statement “Used with the permission of the Medical Research Council”. Also indicate where applicable, any changes made to questions.
Self-or rater-administered	Self-administered
Time to complete	<1 minute
Number of items	1
Domains & categories (#)	NA
Name of domains/categories	NA
Scaling of items	1-5 MRC, or 1-5 including 5a and 5b for modified MRC (mMRC). High scores indicate more severe breathlessness.²
Scoring	1-5
Test-retest/ reproducibility	Test-retest in COPD ICC r=0.82³
Validity	Scores correlate well with the results of other breathlessness scales, lung function measurements and with direct measures of disability such as walking distance.² Questions however may be ambiguous.⁴
Responsiveness to PR	Poor response to PR.^5,6,
MID	1 point⁷
Languages	English
References	Fletcher CM. Proc Royal Soc Med. 1952 577-584. https://www.ukri.org/councils/mrc/facilities-and-resources/find-an-mrc-facility-or-resource/mrc-dyspnoea-scale/ Mahler DA. Chest. 2009; 136:1473-1479. Yorke J et. al. Int J COPD. 2022; 17:2289-2299. Kovelis D et. al. COPD. 2011; 8:334–339. Evans RA et. al. Respir Med. 2009. 103:1070-1075. de Torres JP et. al. Chest. 2002; 121: 1092-1098.
Date of most recent changes	June 2023

Multidimensional Dyspnea Profile

	Description
Name of Questionnaire	Multidimensional Dyspnea Profile¹
Abbreviation/Alternate Name	MDP
Description:	Respondents select 11 items rating the 5 sensory qualities that best describes their breathlessness (overall unpleasantness, intensity of 5 sensory qualities [muscle work/effort, air hunger, chest tightness, mental effort, and breathing a lot], and intensity of five emotional responses of breathlessness (depressed, anxious, frustrated, angry, and afraid).
Developer	R Banzett
E-mail	rbanzett@bidmc.harvard.edu
Cost	Free for student and individual researchers, unfunded studies and individual clinicians. Fee (unspecified) for funded studies for commercial use, healthcare organisations and IT companies.
License required	Multidimensional Dyspnea Profile© 2011 R.B. Banzett. All Rights Reserved. Available via MAPI research trust.
Self-or rater-administered	Self or assisted
Time to complete	5-10 min
Number of items	11
Domains & categories (#)	3 domains and possible sub-scores
Name of domains/ categories	Overall unpleasantness (A1), Immediate Perception (IP), Emotional Response (ER)
Scaling of items	0-10 numeric rating scale, 0 = none and 10 = as much as I can imagine.
Scoring	Total score not recommended. Sub-scores used for IP (0-60, includes SQ and A1) and ER (0-50). If a summary score is sought, the overall unpleasantness (A1, 0-10) score is recommended.
Test-retest/reproducibility	Test-retest: 2 wks. ICC:0.91-0.98², Pooled ICC, IP= 0.85, ER= 0.84³ Internal consistency: Cronbach’s α 0.82-0.95², IP=0.88, ER=0.86³ Factor analysis, two factor structure²
Validity	Concurrent with CATS, HADS and mMRC.⁴
Responsiveness to PR	Yes^5,6
MID	Mixed respiratory diseases: A1 =1 unit, IP=5, ER=3.⁷
Languages	Danish, Dutch, English, Flemish, French (Canada & France), German, Italian, Norwegian, Portuguese (Brazil), Swedish, Turkish.
References	Banzett RB et al. Eur Respir J. 2015; 45:1681-1691. Meek PM et al. Chest. 2012; 141:1546-53. Williams MT et. al. J Pain Symptom Manage. 2022; 63:e75-e87. Williams MT et. al. Eur Respir J. 2017; 49: 1600773. Beaumont M et. al. Chron Respir Dis. 2012; 305-312. Beaumont M et. al. Eur Respir J. 2018; 51: 1701107. Ekström M et. al. Eur Respir J. 2021; 57: 2002823.
Date of most recent changes	March 2023

Pulmonary Functional Status & Dyspnea Questionnaire

	Description
Name of Questionnaire	Pulmonary Functional Status & Dyspnea Questionnaire
Abbreviation/Alternate Name	PFSDQ
Description:	Measures changes in activities related to 79 activities of daily living and dyspnea. Categories of activities include; self-care, mobility, eating, home management, social, and recreational. Dyspnea also measured in relation to suffocation, intensity, severity of dyspnea most days, and overall with daily activities. Activities are relevant for adults of both sexes and reflect various workload requirements.
Developer	Suzanne C. Lareau
E-mail	Suzanne.lareau@ucdenver.edu
Cost	None
License required	Contact developer for use
Self-or rater-administered	Self
Time to complete	17 minutes initially, 15 minutes on repeat testing.
Number of items	164
Domains & categories (#)	2 domains 6 categories
Name of domains/ categories	Domains: activity and dyspnoea. Categories: self care, mobility, home management, eating, recreation, and social.
Scaling of items	Modified Likert 0-10 scale with verbal descriptors. Part 1 (Activity domain), Part 2 (Dyspnea domain) scores range from 0 “no shortness of breath,” to 10 “very severe shortness of breath,” as well as response to single items.
Scoring	Total Score (TS) is the mean score reported of all activities. Calculated by rating of dyspnea for each activity divided by the number of activities rated. Not included are missing data and activites identified as never done. Higher scores indicate worse dyspnea. (Single items not calculated in TS.)
Test-retest/ reproducibility	Test-retest 0.94 for dyspnea TS. The general ratings of dyspnea on most days, today, and with activities 0.54 to 0.77.¹ Internal consistency Both dyspnea and activities= 0.91. Cronbach’s α ranged from 0.88 to 0.94.¹
Validity	Content-Clinical experts and findings related to expected theoretical relationships.¹
Responsiveness to PR	Discriminated between groups following PR vs bilateral lung volune reduction surgery. Reduction in dyspnea with exercise significantly greater reduction (PR = -1.0 vs BLVRS = -2.6, p <0.05).²
MID	NA
Languages	English. Flemish (Dutch), Japanese, Norwegian.
References	Lareau SC et. al. Heart Lung. 1994; 23:242-250. Mercer K et. al. Int J Surg Investig. 1999; 1:139-147. Lareau SC et. al. Heart Lung. 1999; 28:65-73.
Date of most recent changes	January 2023

Pulmonary Functional Status & Dyspnea Questionnaire-Modified Dyspnea Domain

	Description
Name of Questionnaire	Pulmonary Functional Status & Dyspnea Questionnaire-Modified
Abbreviation/Alternate Name	PFSDQ-M_dys
Description:	Modified from PFSDQ. Assesses frequency & intensity of dyspnea (with and without activities).¹
Developer	Suzanne C. Lareau
E-mail	Suzanne.lareau@ucdenver.edu
Cost	None
License required	Contact developer for use
Self-or rater-administered	Self
Time to complete	7 minutes
Number of items	40
Domains & categories (#)	3, activities, dyspnea, fatigue
Name of domains/categories	Dyspnea with 10 activities, frequency and intensity of dyspnea under 5 conditions
Scaling of items	Modified Likert 0-10 with verbal descriptors. Degree of dyspnea, 0 = none, 1-3 = mild, 4-6 = moderate, 7-9 = severe, 10 = very severe.
Scoring	Total Score (TS) of items on dyspnea with activities. TS=rating of dyspnea for each activity, divided by the number of activities rated. Not included are missing data and activites identified as never done Intensity of 5 independent items (not included in TS).
Test-retest/reproducibility	Test-retest 0.90²for dyspnea. General ratings of dyspnea on most days, today, and with activities r= 0.54 to 0.77.² ICC dyspnea= 0.93²
Validity	Content Clinical experts and findings related related to expected theoretical relationships.¹ Construct PFSDQ-M_dys and SGRQ symptoms r=0.53, p< 0.01; SGRQ activity r=0.70, p= 0.0001²
Responsiveness to PR	Yes^3,4
MID	5 points on PFSDQ-M_dys⁴
Languages	Chinese, Flemish, French, Japanese, Norwegian, Portuguese, Spanish, Swedish.
References	Lareau SC et. al. Heart Lung. 1999; 28:65-73. Kovelis D et. al. J Bras Pneumol. 2008; 34:1008-1018. Pitta F et. al. Chest. 2008; 134:273-280. Regueiro EMG et. al. Respir Res. 2013, 14:58.
Date of most recent changes	February 2023

Saint George’s Respiratory Questionnaire - Symptom Domain

	Description
Name of Questionnaire	Saint George’s Respiratory Questionnaire¹
Abbreviation/Alternate Name	SGRQ
Description:	Disease-specific instrument used in asthma, COPD and other respiratory conditions. Designed to measure impact on overall health, daily life, and perceived well-being. Indirectly measures dyspnea, on the symptom domain. Reporting is over past 3 months
Developer	Paul Jones on behalf of Saint George’s University
E-mail	pjones@sgul.ac.uk
Cost	The St. George's University of London Medical School grants permission for clinicians to use the SGRQ without charge.
License required	For license or electronic copy of Excel-based Scoring Calculator, email Yvonne Forde, email: sgrq@sgul.ac.uk. For commercial organizations, a license fee for use is required.
Self-or rater-administered	Self-administered
Time to complete	<5 minutes for domain
Number of items	8 for symptom domain
Domains & categories (#)	3-activity, symptoms & impacts domains
Name of domains/categories	Symptoms
Scaling of items	Varies with question. Items weighted
Scoring	Range=0-100 (higher score more severe limitations).
Test-retest/ reproducibility	Test-retest (at 2-3 weeks) 0.91 for symptoms² Internal consistency for Asthma r=0.91 COPD r=0.92
Validity	Concurrent^1,2 Symptoms with MRC r=0.13, p<001; 6MWD r=.07, p<.01; FEV₁ r=.01, p=ns²
Responsiveness to PR	Responsive on symptoms does not often meet MID^3,5,6
MID	In general 4 points per domain,⁴ however 7 pts with PR⁷
Languages	76 languages
References	Jones PW et al. Resp Med. 1991; 85:2531. Jones PW et al. Am Rev Respir Dis. 1992; 45:1321-1327. Sciriha A et al. Chron Respir Dis. 2017; 14:352-359. Jones PW. Eur Respir J. 2002; 19:398-404. Ries AL et. al. Chest. 2005; 128:3799-3809. de Torres JP et. al. Chest. 2002; 121:1092-1098. Alma H et. al. Prim Care Respir Med. 2016; 26: doi:10.1038/npjpcrm.2016.41
Date of most recent changes	March 2023

University of California, San Diego Shortness of Breath Questionnaire

	Description
Name of Questionnaire	University of California, San Diego Shortness of Breath Questionnaire¹
Abbreviation/Alternate Name	UCSD SOBQ
Description:	Estimate degree of breathlessness anticipated with activities. Three additional items ask about limitations due to: breathlessness, fear of harm from overexertion and fear of breathlessness.
Developer	Archibald CJ (original),¹ Eakin EG et al. (current version)²
E-mail	aries@ucsd.edu
Cost	Free for educational, clinical, or non-profit research use. For commercial uses or by for-profit organizations, contact the UCSD Technology Transfer Office for licensing.
License required	Copyrighted to the University of California.
Self-or rater-administered	Self-administered
Time to complete	5-10 minutes
Number of items	24 (21 items related to ADLs associated with varying levels of exertion & 3 questions about limitations and fears of breathlessness)
Domains & categories (#)	1 (while several qualitative experiences are asked, they are treated as general dyspnea)
Name of domains/categories	NA
Scaling of items	6-point scale (0 = "not at all" to 5 = "maximal or unable to do because of breathlessness")
Scoring	0-120, higher score is more severe breathlessness.
Test-retest/ reproducibility	Test-retest r=0.94³ Internal consistency Cronbachs α 0.96²
Validity	Significant negative correlation with exercise tolerance (6MWD)² Correlate to self-administered BDI (r=-0.68, p<0.001) and mMRC (r=0.52, p<0.001)⁴
Responsiveness to PR	Found 65% of participants experienced greater than MID improvement in dyspnea post PR among people with ILD⁵
MID	5 points in COPD^5,6, 5-8 points in ILD⁸
Languages	17
References	Archibald CJ et. al. Can J Rehab. 1987; 1:45-54. Eakin EG et.al. Chest. 1998; 113:619-624. Eakin EG et. al. Int J Behav Med. 1995; 2:118-134. Mahler D et al. CHEST. 2009; 136:1473-1479. Ryerson CJ et al. Resp Med .2014; 108: 203-210. Kupferberg DH et. al. J Cardiopulm Rehabil. 2005; 25:370-377. Ries AL. JCOPD. 2005; 2:105-110. Chen T et al. Respir Res. 2021; 22: 202-210.
Date of most recent changes	December 2022

University of Cincinnati Shortness of Breath Questionnaire

	Description
Name of Questionnaire	University of Cincinnati Shortness of Breath Questionnaire¹
Abbreviation/Alternate Name	UCDQ
Description:	Measures impact of dyspnea during (1) physical activity (Phys), (2) speech (Speech) and (3) simultaneous speech and physical activity (Comb) in patients with COPD.¹
Developer	University of Cincinnati
E-mail	NA
Cost	NA
License required	NA
Self-or rater-administered	Self-administered
Time to complete	5-10 minutes
Number of items	30
Domains & categories (#)	3, ten items in each domain
Name of domains/ categories	Physical, Speech and Combined
Scaling of items	Not at all SOB (1), occasional SOB (3), Always SOB or cannot do (5), Not interested (9)
Scoring	0-5 Likert scale
Test-retest/ reproducibility	Test-retest 0.76-0.93² Internal consistency Cronbach's α: Phys 0·79, Speech 0·96, Comb 0·82³
Validity	Correlation coefficient with the MRC 0.74, BDI -0.84¹
Responsiveness to PR	Dyspnea with Speech decreased 60 ±23 to 44 ±20, p<.0001³
MID	NA
Languages	English
References	Lee L et. al. Chest. 1998; 113: 625–632. Hodgev V et. al. Clin Physiol Funct Imaging. 2003; 23:269-274. Binazzi B et. al. Respiration 2011; 81:379-385.
Date of most recent changes	February 2023

Visual Analogue Scale-8 items

	Description
	Description
Name of Questionnaire	Visual Analogue Scale 8 items¹
Abbreviation/Alternate Name	VAS8
Description:	A VAS to measure quality of life in chronic lung disease.¹ An 8-item questionnaire, one item of which explores dyspnea.
Developer	O Hiratsuka & K Kida
Mail	Osamu Nishiyama, M.D., Second Department of Internal Medicine, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466- 8560, Japan
Cost	NA
License required	NA
Self-or rater-administered	Self-administered
Time to complete	5 minutes
Number of items	1
Domains & categories (#)	8
Name of domains/ categories	Well-being, mood, anxiety, dyspnea, headache, housework/job, appetite, social activity.
Scaling of items	10 cm VAS, participant marks on the line where they feel on dyspnea from “unbearable” to “no dyspnea”
Scoring	0-100 per domain, higher score more severe dyspnea.
Test-retest/reproducibility	Test-retest dyspnea domain r=0.75.
Validity	Dyspnea with SGRQ dyspnea domain r= -0.35, p<.05, and Baseline Dyspnea Index (BDI) r=0.31, p<.05.¹ Internal consistency on Total Score Cronbach’s α= 0.85.¹
Responsiveness to PR	Dyspnea improved post PR from 43+22 to 66+27, p<.01 (+23).²
MID	NA
Languages	English and Japanese
References	Hiratsuka T et al. Intern Med. 1993; 32: 832–836. Nishiyama O et al. Respir Med. 2000; 94:1192-1199.
Date of most recent changes	November 2022

Dyspnea/Breathlessness

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