1. Heni Retnowulan, dr., SpPD-KP
Tempat/Tanggal Lahir : Temanggung, 16 September 1972
Pekerjaan : Staf KSM Paru, RSUP Dr. Sardjito Yogyakarta
Riwayat Pendidikan : FK UGM Tahun 1999
S2 Ilmu Kedokteran Klinis Minat Epidemiologi Klinis Tahun 2004
PPDS 1 Tahun 2007
PPDS 2 Tahun 2014

2. MULTIDIMENSIONAL ASSESSMENT OF DYSPNEA
Heni Retnowulan
Pumonary division-internalMdicine departeent
Faculty of Medicine Gadajah Mada University Sardjito General Hospital
Jogjakarta

3. Dyspnea
“a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity [and] vary in their unpleasantness and in their emotional and behavioral significance” Dyspnoea is a multidimensional experience, and that at least some of the dimensional variation results from different afferent mechanisms
(Benzett dkk, 2015)

4. List of disease processes, symptoms, and activities that may be disturbed by chronic diseases of the airways
(Jones, 1991)

5. Neurophysiology of Dyspnea
(Laviolette dan Laveneziana, 2014)

6. Pathways linking disturbances arising in the lungs to factors that may affect patients' quality of life
(Jones, 1991)

7. Clinical assessment of dyspnoea
to help make a clear diagnosis of the causes(s) of the symptom
to understand the impact of the symptom on the individual
to establish an appropriate management plan

8. Clinical assessment of dyspnoea
History
pattern of breathlessness
presence of other symptoms
impact on a person’s quality of life
current symptomatic treatments for breathlessness
adverse effects of any treatments
all comorbidities
the person’s understanding and interpretation of the symptom
Physical examination
Focus on underlying causes of dyspnea
(Bausewein dkk, 2008)

9. Clinical assessment of dyspnoea
Laboratory evaluation
SPo2
Blood gas analysis
Hemoglobin level
Electrolyte
Radiological examination
Lung function test
Cardiopulmonary exercise test
(Bausewein dkk, 2008)

10. Measurement of dyspnoea
Dyspnoea is a subjective symptom so the person’s report of severity is the most accurate measure.

11. Valid & reliable ...

12. Realiability Internal consistency Test retest Paralel Item analysis
Instrumen
Subtotal score 1
Subtotal score 2
First measurement
Second measurent
Instrumen A
Instrumen B
Internal consistency
Test retest
Paralel
Item score
Total score
Item analysis

13. Measurement tools for dyspnoea
Unidimensional instruments
Multidimensional indirect measure to dyspnea anchored to activities
Disease-specific quality of life instruments : instrument that measure dyspnea with activities and other component of quality of life.

14. Unidimensional instruments
Visual analog scale
Medical research council scale
Oxygen cost diagram

15. Visual Analog Scale
MCID mm

16. Medical Research Council Scale
MCID 1 point score

17. The Oxygen Cost Diagram
MCID 7 mm
The Oxygen Cost Diagram
The administration of the OCD is very rapid (takes about 1-2 minutes) 
 Able to distinguish different levels of disease severity

18. Multidimensional indirect measure to dyspnea anchored to activities
Baseline / transitional dyspnea index (BDI/ TDI)
The university of california sandiego shortness of breath questionnare

19. Baseline / transitional dyspnea index (BDI/ TDI)
Domain
Item
Internal consistency
(α cronbach)
Test retest
Functional impairment 12
0.80
0.76
Magnitude of task
Magnitude of effort
Rated 5 point score (4-no impairment ; 0-severe)
Total score 0 (most dyspnea) to 12 (no dyspnea)
MCID 0,5 : 1 (COPD) point score

20. The university of california sandiego shortness of breath questionnare.
MCID 7 point score
Rated 6 point score (0-not all : 5- unable to do because of breath) -> total score 0-120
Domain
Item
Internal consistency
α (cronbach)
Test retest
Breathlessness during a vaiety of activities of daily living 24
0.91
0.94

21. Disease-specific quality of life instruments : instrument that measure dyspnea with activities and other component of quality of life
The St. George respiratory questionnaire (bahasa)
Multidimensional dyspnoea profile

22. The St George Respiratory Questionnaire
Reliability test in COPD patient
MCID
4,8 -> minimal-moderate
12 point score  large improvement
Domain
(bahasa)
Item
Item total analysis
Internal consistency
Test retest
Symptoms 8
1 dropped
0.76
0.52
Activity 16
Valid
0.93
0.50
Impact 26
0.91
0.71
Total 50
0.95
0.70
(Retnowulan dkk, 2004)

23. The St George Respiratory Questionnaire
Reliability test in asthma patients
Domain
(bahasa)
Item
Item total analysis
Internal consistency
Test retest
Symptoms 8
1 dropped
0.713 --
Activity 16
Valid
0.87
Impact 26
2 dropped
0.827
Total 50
0.905
(Putra dkk, 2012)

24. Multidimensional Dyspnoea Profile

25. α 0.93
α 0.84
(Meek dkk, 2012)

26. Conclusions
Dyspnea is “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity [and] vary in their unpleasantness and in their emotional and behavioral significance”
Dyspnoea is a subjective symptom so the person’s report of severity is the most accurate measure.
Measurement of dyspnea consist of unidimensional and multidimensional measurement
The St. George respiratory questionnaire and Multidimensional dyspnoea profile are examples of multidimensional instrument

27. Thank you