Heni Retnowulan dr Sp PDKP TempatTanggal Lahir Temanggung

Heni Retnowulan, dr. , Sp. PD-KP Tempat/Tanggal Lahir : Temanggung, 16 September 1972 Email Pekerjaan Riwayat Pendidikan : heniretnowulan@yahoo. com : Staf KSM Paru, RSUP Dr. Sardjito Yogyakarta : FK UGM Tahun 1999 S 2 Ilmu Kedokteran Klinis Minat Epidemiologi Klinis Tahun 2004 PPDS 1 Tahun 2007 PPDS 2 Tahun 2014 Bandung Integrated Respiratory Care IV | 16– 18 September 2016

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

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)

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

Neurophysiology of Dyspnea (Laviolette dan Laveneziana, 2014)

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

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

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)

Clinical assessment of dyspnoea Laboratory evaluation • • SPo 2 Blood gas analysis Hemoglobin level Electrolyte Radiological examination Lung function test Cardiopulmonary exercise test (Bausewein dkk, 2008)

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

Valid & reliable. . .

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

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.

Unidimensional instruments • Visual analog scale • Medical research council scale • Oxygen cost diagram

Visual Analog Scale • MCID 10 -20 mm

Medical Research Council Scale MCID 1 point score

The Oxygen Cost Diagram MCID 7 mm

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

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

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

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

The St George Respiratory Questionnaire Reliability test in COPD patient MCID 4, 8 -> minimal-moderate 12 point score large improvement Domain (bahasa) Item total analysis Internal consistency Test retest Symptoms 8 1 dropped 0. 76 0. 52 Activity 16 Valid 0. 93 0. 50 Impact 26 1 dropped 0. 91 0. 71 Total 50 Valid 0. 95 0. 70 (Retnowulan dkk, 2004)

The St George Respiratory Questionnaire Reliability test in asthma patients Domain (bahasa) 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 Valid 0. 905 -(Putra dkk, 2012)

Multidimensional Dyspnoea Profile

α 0. 93 α 0. 84 (Meek dkk, 2012)

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

Thank you