Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis

Jeffrey J. Swigris, David L. Streiner, Kevin K. Brown, Amanda Belkin, Kathy E. Green, Frederick S. Wamboldt, M. Schwarz, D. A. Zisman, G. Hunninghake, J. Chapman, M. Olman, S. Lubell, L. D. Morrison, M. P. Steele, T. Haram, J. Roman, R. Perez, T. Perez, Jay H Ryu, James P UtzAndrew Harold Limper, C. E. Daniels, K. Meiras, S. Walsh, K. K. Brown, M. Schwarz, C. Bair, D. Kervitsky, J. A. Lasky, S. Ditta, J. De Andrade, V. J. Thannickal, M. Stewart, D. A. Zisman, J. Lynch, E. Calahan, P. Lopez, T. E. King, H. R. Collard, J. A. Golden, P. J. Wolters, R. Jeffrey, I. Noth, D. K. Hogarth, N. Sandbo, M. E. Strek, S. R. White, C. Brown, I. Garic, S. Maleckar, F. J. Martinez, K. R. Flaherty, M. Han, B. Moore, G. B. Toews, D. Dahlgren, G. Raghu, J. Hayes, M. Snyder, J. E. Loyd, L. Lancaster, W. Lawson, R. Greer, W. Mason, R. J. Kaner, V. Monroy, M. Wang, D. A. Lynch, T. Colby, K. J. Anstrom, R. C. Becker, E. L. Eisenstein, N. R. MacIntyre, L. D. Morrison, J. Rochon, M. P. Steele, J. S. Sundy, L. Davidson-Ray, P. Dignacco, R. Edwards, R. Anderson, R. Beci, S. Calvert, K. Cain, T. Gentry-Bumpass, D. Hill, M. Ingham, E. Kagan, J. Kaur, C. Matti, J. McClelland, A. Meredith, T. Nguyen, J. Pesarchick, R. S. Roberts, W. Tate, T. Thomas, J. Walker, D. Whelan, J. Winsor, Q. Yang, E. Yow, H. Y. Reynolds, X. Tian, J. Kiley

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Dyspnea is a hallmark symptom of idiopathic pulmonary fibrosis (IPF), and dyspnea induced physical activity limitation is a prominent driver of quality of life impairment among IPF patients. Methods: We examined response data for the 21 physical activity items (the first 21 of 24) from the University of California San Diego Shortness of Breath Questionnaire (UCSD) collected at baseline in a recently conducted IPF trial. We used Rasch analysis and hypothesis testing with conventional statistical methodology to achieve three objectives: 1) to examine the items to identify the one characteristic that distinguishes one from another; 2) to asses these items for their ability to measure dyspnea severity in IPF; 3) to use the items to develop a dyspnea ruler. Results: The sample comprised 178 subjects. The 21 items fit the Rasch model. There was very strong correlation between Rasch item severity and their metabolic equivalents (METS) values (r = -0.86, p < 0.0001). With the sample stratified on scores from the 21 items, there were significant between group differences in FVC%, DLCO% and distance walked during the six-minute walk test. The dyspnea ruler can be used to put dyspnea levels in a more easily understood clinical context. Conclusions: The first 21 items from the UCSD compose a unidimensional dyspnea-with-activity scale and are both sensibly ordered and distinguished from each other by their METS values. These 21 items can be used confidently to formulate clinically-relevant inferences about IPF patients and should be considered for use as a meaningful endpoint in IPF research.

Original languageEnglish (US)
Pages (from-to)181-188
Number of pages8
JournalRespiratory Medicine
Volume108
Issue number1
DOIs
StatePublished - Jan 2014

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Idiopathic Pulmonary Fibrosis
Dyspnea
Metabolic Equivalent
Exercise
Equidae
Quality of Life

Keywords

  • Dyspnea
  • Functional capacity
  • Idiopathic pulmonary fibrosis
  • Quality of life

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Swigris, J. J., Streiner, D. L., Brown, K. K., Belkin, A., Green, K. E., Wamboldt, F. S., ... Kiley, J. (2014). Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis. Respiratory Medicine, 108(1), 181-188. https://doi.org/10.1016/j.rmed.2013.12.009

Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis. / Swigris, Jeffrey J.; Streiner, David L.; Brown, Kevin K.; Belkin, Amanda; Green, Kathy E.; Wamboldt, Frederick S.; Schwarz, M.; Zisman, D. A.; Hunninghake, G.; Chapman, J.; Olman, M.; Lubell, S.; Morrison, L. D.; Steele, M. P.; Haram, T.; Roman, J.; Perez, R.; Perez, T.; Ryu, Jay H; Utz, James P; Limper, Andrew Harold; Daniels, C. E.; Meiras, K.; Walsh, S.; Brown, K. K.; Schwarz, M.; Bair, C.; Kervitsky, D.; Lasky, J. A.; Ditta, S.; De Andrade, J.; Thannickal, V. J.; Stewart, M.; Zisman, D. A.; Lynch, J.; Calahan, E.; Lopez, P.; King, T. E.; Collard, H. R.; Golden, J. A.; Wolters, P. J.; Jeffrey, R.; Noth, I.; Hogarth, D. K.; Sandbo, N.; Strek, M. E.; White, S. R.; Brown, C.; Garic, I.; Maleckar, S.; Martinez, F. J.; Flaherty, K. R.; Han, M.; Moore, B.; Toews, G. B.; Dahlgren, D.; Raghu, G.; Hayes, J.; Snyder, M.; Loyd, J. E.; Lancaster, L.; Lawson, W.; Greer, R.; Mason, W.; Kaner, R. J.; Monroy, V.; Wang, M.; Lynch, D. A.; Colby, T.; Anstrom, K. J.; Becker, R. C.; Eisenstein, E. L.; MacIntyre, N. R.; Morrison, L. D.; Rochon, J.; Steele, M. P.; Sundy, J. S.; Davidson-Ray, L.; Dignacco, P.; Edwards, R.; Anderson, R.; Beci, R.; Calvert, S.; Cain, K.; Gentry-Bumpass, T.; Hill, D.; Ingham, M.; Kagan, E.; Kaur, J.; Matti, C.; McClelland, J.; Meredith, A.; Nguyen, T.; Pesarchick, J.; Roberts, R. S.; Tate, W.; Thomas, T.; Walker, J.; Whelan, D.; Winsor, J.; Yang, Q.; Yow, E.; Reynolds, H. Y.; Tian, X.; Kiley, J.

In: Respiratory Medicine, Vol. 108, No. 1, 01.2014, p. 181-188.

Research output: Contribution to journalArticle

Swigris, JJ, Streiner, DL, Brown, KK, Belkin, A, Green, KE, Wamboldt, FS, Schwarz, M, Zisman, DA, Hunninghake, G, Chapman, J, Olman, M, Lubell, S, Morrison, LD, Steele, MP, Haram, T, Roman, J, Perez, R, Perez, T, Ryu, JH, Utz, JP, Limper, AH, Daniels, CE, Meiras, K, Walsh, S, Brown, KK, Schwarz, M, Bair, C, Kervitsky, D, Lasky, JA, Ditta, S, De Andrade, J, Thannickal, VJ, Stewart, M, Zisman, DA, Lynch, J, Calahan, E, Lopez, P, King, TE, Collard, HR, Golden, JA, Wolters, PJ, Jeffrey, R, Noth, I, Hogarth, DK, Sandbo, N, Strek, ME, White, SR, Brown, C, Garic, I, Maleckar, S, Martinez, FJ, Flaherty, KR, Han, M, Moore, B, Toews, GB, Dahlgren, D, Raghu, G, Hayes, J, Snyder, M, Loyd, JE, Lancaster, L, Lawson, W, Greer, R, Mason, W, Kaner, RJ, Monroy, V, Wang, M, Lynch, DA, Colby, T, Anstrom, KJ, Becker, RC, Eisenstein, EL, MacIntyre, NR, Morrison, LD, Rochon, J, Steele, MP, Sundy, JS, Davidson-Ray, L, Dignacco, P, Edwards, R, Anderson, R, Beci, R, Calvert, S, Cain, K, Gentry-Bumpass, T, Hill, D, Ingham, M, Kagan, E, Kaur, J, Matti, C, McClelland, J, Meredith, A, Nguyen, T, Pesarchick, J, Roberts, RS, Tate, W, Thomas, T, Walker, J, Whelan, D, Winsor, J, Yang, Q, Yow, E, Reynolds, HY, Tian, X & Kiley, J 2014, 'Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis', Respiratory Medicine, vol. 108, no. 1, pp. 181-188. https://doi.org/10.1016/j.rmed.2013.12.009
Swigris JJ, Streiner DL, Brown KK, Belkin A, Green KE, Wamboldt FS et al. Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis. Respiratory Medicine. 2014 Jan;108(1):181-188. https://doi.org/10.1016/j.rmed.2013.12.009
Swigris, Jeffrey J. ; Streiner, David L. ; Brown, Kevin K. ; Belkin, Amanda ; Green, Kathy E. ; Wamboldt, Frederick S. ; Schwarz, M. ; Zisman, D. A. ; Hunninghake, G. ; Chapman, J. ; Olman, M. ; Lubell, S. ; Morrison, L. D. ; Steele, M. P. ; Haram, T. ; Roman, J. ; Perez, R. ; Perez, T. ; Ryu, Jay H ; Utz, James P ; Limper, Andrew Harold ; Daniels, C. E. ; Meiras, K. ; Walsh, S. ; Brown, K. K. ; Schwarz, M. ; Bair, C. ; Kervitsky, D. ; Lasky, J. A. ; Ditta, S. ; De Andrade, J. ; Thannickal, V. J. ; Stewart, M. ; Zisman, D. A. ; Lynch, J. ; Calahan, E. ; Lopez, P. ; King, T. E. ; Collard, H. R. ; Golden, J. A. ; Wolters, P. J. ; Jeffrey, R. ; Noth, I. ; Hogarth, D. K. ; Sandbo, N. ; Strek, M. E. ; White, S. R. ; Brown, C. ; Garic, I. ; Maleckar, S. ; Martinez, F. J. ; Flaherty, K. R. ; Han, M. ; Moore, B. ; Toews, G. B. ; Dahlgren, D. ; Raghu, G. ; Hayes, J. ; Snyder, M. ; Loyd, J. E. ; Lancaster, L. ; Lawson, W. ; Greer, R. ; Mason, W. ; Kaner, R. J. ; Monroy, V. ; Wang, M. ; Lynch, D. A. ; Colby, T. ; Anstrom, K. J. ; Becker, R. C. ; Eisenstein, E. L. ; MacIntyre, N. R. ; Morrison, L. D. ; Rochon, J. ; Steele, M. P. ; Sundy, J. S. ; Davidson-Ray, L. ; Dignacco, P. ; Edwards, R. ; Anderson, R. ; Beci, R. ; Calvert, S. ; Cain, K. ; Gentry-Bumpass, T. ; Hill, D. ; Ingham, M. ; Kagan, E. ; Kaur, J. ; Matti, C. ; McClelland, J. ; Meredith, A. ; Nguyen, T. ; Pesarchick, J. ; Roberts, R. S. ; Tate, W. ; Thomas, T. ; Walker, J. ; Whelan, D. ; Winsor, J. ; Yang, Q. ; Yow, E. ; Reynolds, H. Y. ; Tian, X. ; Kiley, J. / Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis. In: Respiratory Medicine. 2014 ; Vol. 108, No. 1. pp. 181-188.
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abstract = "Background: Dyspnea is a hallmark symptom of idiopathic pulmonary fibrosis (IPF), and dyspnea induced physical activity limitation is a prominent driver of quality of life impairment among IPF patients. Methods: We examined response data for the 21 physical activity items (the first 21 of 24) from the University of California San Diego Shortness of Breath Questionnaire (UCSD) collected at baseline in a recently conducted IPF trial. We used Rasch analysis and hypothesis testing with conventional statistical methodology to achieve three objectives: 1) to examine the items to identify the one characteristic that distinguishes one from another; 2) to asses these items for their ability to measure dyspnea severity in IPF; 3) to use the items to develop a dyspnea ruler. Results: The sample comprised 178 subjects. The 21 items fit the Rasch model. There was very strong correlation between Rasch item severity and their metabolic equivalents (METS) values (r = -0.86, p < 0.0001). With the sample stratified on scores from the 21 items, there were significant between group differences in FVC{\%}, DLCO{\%} and distance walked during the six-minute walk test. The dyspnea ruler can be used to put dyspnea levels in a more easily understood clinical context. Conclusions: The first 21 items from the UCSD compose a unidimensional dyspnea-with-activity scale and are both sensibly ordered and distinguished from each other by their METS values. These 21 items can be used confidently to formulate clinically-relevant inferences about IPF patients and should be considered for use as a meaningful endpoint in IPF research.",
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TY - JOUR

T1 - Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis

AU - Swigris, Jeffrey J.

AU - Streiner, David L.

AU - Brown, Kevin K.

AU - Belkin, Amanda

AU - Green, Kathy E.

AU - Wamboldt, Frederick S.

AU - Schwarz, M.

AU - Zisman, D. A.

AU - Hunninghake, G.

AU - Chapman, J.

AU - Olman, M.

AU - Lubell, S.

AU - Morrison, L. D.

AU - Steele, M. P.

AU - Haram, T.

AU - Roman, J.

AU - Perez, R.

AU - Perez, T.

AU - Ryu, Jay H

AU - Utz, James P

AU - Limper, Andrew Harold

AU - Daniels, C. E.

AU - Meiras, K.

AU - Walsh, S.

AU - Brown, K. K.

AU - Schwarz, M.

AU - Bair, C.

AU - Kervitsky, D.

AU - Lasky, J. A.

AU - Ditta, S.

AU - De Andrade, J.

AU - Thannickal, V. J.

AU - Stewart, M.

AU - Zisman, D. A.

AU - Lynch, J.

AU - Calahan, E.

AU - Lopez, P.

AU - King, T. E.

AU - Collard, H. R.

AU - Golden, J. A.

AU - Wolters, P. J.

AU - Jeffrey, R.

AU - Noth, I.

AU - Hogarth, D. K.

AU - Sandbo, N.

AU - Strek, M. E.

AU - White, S. R.

AU - Brown, C.

AU - Garic, I.

AU - Maleckar, S.

AU - Martinez, F. J.

AU - Flaherty, K. R.

AU - Han, M.

AU - Moore, B.

AU - Toews, G. B.

AU - Dahlgren, D.

AU - Raghu, G.

AU - Hayes, J.

AU - Snyder, M.

AU - Loyd, J. E.

AU - Lancaster, L.

AU - Lawson, W.

AU - Greer, R.

AU - Mason, W.

AU - Kaner, R. J.

AU - Monroy, V.

AU - Wang, M.

AU - Lynch, D. A.

AU - Colby, T.

AU - Anstrom, K. J.

AU - Becker, R. C.

AU - Eisenstein, E. L.

AU - MacIntyre, N. R.

AU - Morrison, L. D.

AU - Rochon, J.

AU - Steele, M. P.

AU - Sundy, J. S.

AU - Davidson-Ray, L.

AU - Dignacco, P.

AU - Edwards, R.

AU - Anderson, R.

AU - Beci, R.

AU - Calvert, S.

AU - Cain, K.

AU - Gentry-Bumpass, T.

AU - Hill, D.

AU - Ingham, M.

AU - Kagan, E.

AU - Kaur, J.

AU - Matti, C.

AU - McClelland, J.

AU - Meredith, A.

AU - Nguyen, T.

AU - Pesarchick, J.

AU - Roberts, R. S.

AU - Tate, W.

AU - Thomas, T.

AU - Walker, J.

AU - Whelan, D.

AU - Winsor, J.

AU - Yang, Q.

AU - Yow, E.

AU - Reynolds, H. Y.

AU - Tian, X.

AU - Kiley, J.

PY - 2014/1

Y1 - 2014/1

N2 - Background: Dyspnea is a hallmark symptom of idiopathic pulmonary fibrosis (IPF), and dyspnea induced physical activity limitation is a prominent driver of quality of life impairment among IPF patients. Methods: We examined response data for the 21 physical activity items (the first 21 of 24) from the University of California San Diego Shortness of Breath Questionnaire (UCSD) collected at baseline in a recently conducted IPF trial. We used Rasch analysis and hypothesis testing with conventional statistical methodology to achieve three objectives: 1) to examine the items to identify the one characteristic that distinguishes one from another; 2) to asses these items for their ability to measure dyspnea severity in IPF; 3) to use the items to develop a dyspnea ruler. Results: The sample comprised 178 subjects. The 21 items fit the Rasch model. There was very strong correlation between Rasch item severity and their metabolic equivalents (METS) values (r = -0.86, p < 0.0001). With the sample stratified on scores from the 21 items, there were significant between group differences in FVC%, DLCO% and distance walked during the six-minute walk test. The dyspnea ruler can be used to put dyspnea levels in a more easily understood clinical context. Conclusions: The first 21 items from the UCSD compose a unidimensional dyspnea-with-activity scale and are both sensibly ordered and distinguished from each other by their METS values. These 21 items can be used confidently to formulate clinically-relevant inferences about IPF patients and should be considered for use as a meaningful endpoint in IPF research.

AB - Background: Dyspnea is a hallmark symptom of idiopathic pulmonary fibrosis (IPF), and dyspnea induced physical activity limitation is a prominent driver of quality of life impairment among IPF patients. Methods: We examined response data for the 21 physical activity items (the first 21 of 24) from the University of California San Diego Shortness of Breath Questionnaire (UCSD) collected at baseline in a recently conducted IPF trial. We used Rasch analysis and hypothesis testing with conventional statistical methodology to achieve three objectives: 1) to examine the items to identify the one characteristic that distinguishes one from another; 2) to asses these items for their ability to measure dyspnea severity in IPF; 3) to use the items to develop a dyspnea ruler. Results: The sample comprised 178 subjects. The 21 items fit the Rasch model. There was very strong correlation between Rasch item severity and their metabolic equivalents (METS) values (r = -0.86, p < 0.0001). With the sample stratified on scores from the 21 items, there were significant between group differences in FVC%, DLCO% and distance walked during the six-minute walk test. The dyspnea ruler can be used to put dyspnea levels in a more easily understood clinical context. Conclusions: The first 21 items from the UCSD compose a unidimensional dyspnea-with-activity scale and are both sensibly ordered and distinguished from each other by their METS values. These 21 items can be used confidently to formulate clinically-relevant inferences about IPF patients and should be considered for use as a meaningful endpoint in IPF research.

KW - Dyspnea

KW - Functional capacity

KW - Idiopathic pulmonary fibrosis

KW - Quality of life

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JF - Respiratory Medicine

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