Dyspnea symptom assessment tool for patients with chronic obstructive pulmonary disease: a systematic review based on COSMIN guidelines_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHEN Liuhan ¹ , GAN Jianing ² ,  ZHU Yi ²

1. Shanghai University of Sport, Shanghai, 200438, P. R. China;
2. The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China;

Corresponding?author：

ZHU Yi, Email: zhuyi1010@163.com

Keywords：

Chronic obstructive pulmonary disease; dyspnea; pulmonary function; assessment tools; COSMIN Guidelines; systematic review

DOI：

10.7507/1671-6205.202507081

Video：

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Objective To systematically review the methodological quality and measurement properties of dyspnea assessment tools for chronic obstructive pulmonary disease (COPD) patients based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines, and provide evidence for clinicians in selecting the optimal assessment tool. Methods Computerized searches were conducted in PubMed, Web of Science, Embase, CNKI, VIP, and Wanfang databases for studies related to dyspnea assessment tools in COPD patients, from the establishment of each database until April 2024. Two researchers independently screened and extracted data according to the inclusion and exclusion criteria. The included assessment tools were evaluated based on the COSMIN guidelines, and final recommendations for the tools were formulated. Results A total of 18 studies were included, involving 14 dyspnea assessment tools for COPD patients. The following tools were recommended as Grade A: SOBDA, PFSDQ-M, Chinese version of Dyspnoea-12, Norwegian version of Dyspnoea-12, and RSQ. Grade B recommendations included the Chinese version of the revised PFSDQ, SOBQ-UCSD version, S-CRQ, CRQ-SR, C-MRADLQ, and BCSS. Grade C recommendations included the Arabic version of Dyspnoea-12, Chinese version of COPD-MSD, and C-SOBQ. Conclusion The scales SOBDA, PFSDQ-M, Chinese version of Dyspnoea-12, Norwegian version of Dyspnoea-12, and RSQ have been comprehensively evaluated across various measurement properties and demonstrate good reliability and validity. Considering the national context in China, the Chinese version of Dyspnoea-12 is tentatively recommended, though other measurement properties still require further validation.

1.	Celli B, Fabbri L, Criner G, et al. Definition and nomenclature of chronic 0bstructive pulmonary disease: time for its revision. Am J Respir Crit Care Med, 2022, 206(11): 1317-1325.
2.	Zhai Y, Zhu C, Zhu T, et al. Global, regional, and national burden of chronic respiratory diseases, 1990-2021 and predictions to 2035: analysis of data from the global burden of disease study 2021. Ann Med, 2025, 57(1): 2530225.
3.	Dong F, Su R, Ren Y, et al. Burden of chronic obstructive pulmonary disease and risk factors in China from 1990 to 2021: analysis of global burden of disease 2021. Chi Med J Pulm Crit Care Med, 2025, 3(2): 132-140.
4.	Parshall MB, Schwartzstein RM, Adams L, 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(4): 435-452.
5.	Agustí A, Celli BR, Criner GJ, et al. Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary. Eur Respir J, 2023, 61(4): 2300239.
6.	O’donnell DE, milne KM, james MD, et al. Dyspnea in COPD: new mechanistic insights and management implications. Adv Ther, 2020, 37(1): 41-60.
7.	陳祎婷, 彭健, 沈藍君, 等. COSMIN方法介紹: 制作患者報告結局測量工具的系統評價. 護士進修雜志, 2021, 36(8): 699-703.
8.	Terwee CB, Prinsen CAC, Chiarotto A, et al. COSMIN methodology for evaluating the content validity of Patient-Reported Outcome Measures: a Delphi study. Qual Life Res, 2018, 27(5): 1159-1170.
9.	Mokkink LB, Devet HCW, Prinsen CAC, et al. COSMIN risk of bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual Life Res, 2018, 27(5): 1171-1179.
10.	陳祎婷, 沈藍君, 彭健, 等. 改良版定量系統評價證據分級方法對患者報告結局測量工具的評價. 解放軍護理雜志, 2020, 37(10): 57-60.
11.	楊國莉, 龍露, 龍檢. Dyspnoea-12量表的漢化與信效度檢驗. 護理學雜志, 2020, 35(19): 35-37,51.
12.	朱燕, 徐明霞, 顏明亞. 漢化慢性阻塞性肺疾病患者晨間癥狀量表的應用信度與效度驗證. 齊魯護理雜志, 2020, 26(23): 56-58.
13.	王明航, 李建生, 余學慶, 等. 肺功能狀態與呼吸困難問卷在慢性阻塞性肺疾病穩定期信度、效度和反應度評價. 中華中醫藥雜志, 2011, 26(10): 2384-2387.
14.	郭愛敏, 韓江娜, 王萍, 等. 肺功能狀態和呼吸困難問卷用于慢性阻塞性肺疾病患者的信度與效度研究. 中華結核和呼吸雜志, 2010, 33(4): 251-255.
15.	李曉云, 成瑋, 段佳熙, 等. 慢性阻塞性肺疾病晨間癥狀量表中文版研制及信效度驗證. 中華結核和呼吸雜志, 2019, 42(6): 444-450.
16.	Wilcox TK, Chen WH, Howard KA, et al. Item selection, reliability and validity of the Shortness of Breath with Daily Activities (SOBDA) questionnaire: a new outcome measure for evaluating dyspnea in chronic obstructive pulmonary disease. Health Qual Life Outcomes, 2013, 11: 196.
17.	Güell R, Casan P, Sangenís M, et al. Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ). Eur Respir J, 1998, 11(1): 55-60.
18.	Karlsson N, Atkinson MJ, Müllerová H, et al. Validation of a diagnosis-agnostic symptom questionnaire for asthma and/or COPD. ERJ Open Res, 2021, 7: 00828-2020.
19.	Watkins ML, Wilcox TK, Tabberer M, et al. Shortness of breath with daily activities questionnaire: validation and responder thresholds in patients with chronic obstructive pulmonary disease. BMJ Open, 2013, 3(10): e003048.
20.	Siu DCH, So CT, Lau CWL, et al. The manchester respiratory activities of daily living questionnaire: reliability and validity of the chinese version with pictorial enhancement. Int J Chron Obstruct Pulmon Dis, 2021, 16: 91-100.
21.	Howard K, Berry P, Petrillo J, et al. Development of the Shortness of Breath with Daily Activities questionnaire (SOBDA). Value Health, 2012, 15(8): 1042-1050.
22.	Leidy NK, Schmier JK, Jones MKC, et al. Evaluating symptoms in chronic obstructive pulmonary disease: validation of the Breathlessness, Cough and Sputum Scale?. Respir Med, 2003, 97(SUPPL.A): S59-S70.
23.	Fung A, Chan LLC, So CT, et al. Reliability and validity of the self-administered Chinese version of the shortness of breath questionnaire (C-SOBQ) in patients with chronic obstructive pulmonary disease. Hong Kong J Occup Ther, 2012, 22(2): 75-83.
24.	Lareau SC, Meek PM, Roos PJ. Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M). Heart Lung, 1998, 27(3): 159-168.
25.	Williams J, Singh S, Sewell L, et al. Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR). Thorax, 2001, 56(12): 954-959.
26.	Garratt AM, Nerheim EM, Einvik G, et al. Evaluation of the Norwegian version of the Dyspnoea-12 questionnaire in patients with COPD. BMJ Open Respir Res, 2022, 9(1): e001262.
27.	Alyami M, Jenkins S, Lababidi H, et al. Reliability and validity of an arabic version of the dyspnea-12 questionnaire for Saudi nationals with chronic obstructive pulmonary disease. Ann Thorac Med, 2015, 10(2): 112.
28.	Eakin EG, Resnikoff PM, Prewitt LM, et al. Validation of a new dyspnea measure: The UCSD Shortness of Breath Questionnaire. Chest, 1998, 113(3): 619-624.
29.	Victorson DE, Anton S, Hamilton A, et al. A conceptual model of the experience of dyspnea and functional limitations in chronic obstructive pulmonary disease. Value Health, 2009, 12(6): 1018-1025.
30.	Yorke J, Moosavi SH, Shuldham C, et al. Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12. Thorax, 2010, 65(1): 21-26.

1. Celli B, Fabbri L, Criner G, et al. Definition and nomenclature of chronic 0bstructive pulmonary disease: time for its revision. Am J Respir Crit Care Med, 2022, 206(11): 1317-1325.
2. Zhai Y, Zhu C, Zhu T, et al. Global, regional, and national burden of chronic respiratory diseases, 1990-2021 and predictions to 2035: analysis of data from the global burden of disease study 2021. Ann Med, 2025, 57(1): 2530225.
3. Dong F, Su R, Ren Y, et al. Burden of chronic obstructive pulmonary disease and risk factors in China from 1990 to 2021: analysis of global burden of disease 2021. Chi Med J Pulm Crit Care Med, 2025, 3(2): 132-140.
4. Parshall MB, Schwartzstein RM, Adams L, 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(4): 435-452.
5. Agustí A, Celli BR, Criner GJ, et al. Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary. Eur Respir J, 2023, 61(4): 2300239.
6. O’donnell DE, milne KM, james MD, et al. Dyspnea in COPD: new mechanistic insights and management implications. Adv Ther, 2020, 37(1): 41-60.
7. 陳祎婷, 彭健, 沈藍君, 等. COSMIN方法介紹: 制作患者報告結局測量工具的系統評價. 護士進修雜志, 2021, 36(8): 699-703.
8. Terwee CB, Prinsen CAC, Chiarotto A, et al. COSMIN methodology for evaluating the content validity of Patient-Reported Outcome Measures: a Delphi study. Qual Life Res, 2018, 27(5): 1159-1170.
9. Mokkink LB, Devet HCW, Prinsen CAC, et al. COSMIN risk of bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual Life Res, 2018, 27(5): 1171-1179.
10. 陳祎婷, 沈藍君, 彭健, 等. 改良版定量系統評價證據分級方法對患者報告結局測量工具的評價. 解放軍護理雜志, 2020, 37(10): 57-60.
11. 楊國莉, 龍露, 龍檢. Dyspnoea-12量表的漢化與信效度檢驗. 護理學雜志, 2020, 35(19): 35-37,51.
12. 朱燕, 徐明霞, 顏明亞. 漢化慢性阻塞性肺疾病患者晨間癥狀量表的應用信度與效度驗證. 齊魯護理雜志, 2020, 26(23): 56-58.
13. 王明航, 李建生, 余學慶, 等. 肺功能狀態與呼吸困難問卷在慢性阻塞性肺疾病穩定期信度、效度和反應度評價. 中華中醫藥雜志, 2011, 26(10): 2384-2387.
14. 郭愛敏, 韓江娜, 王萍, 等. 肺功能狀態和呼吸困難問卷用于慢性阻塞性肺疾病患者的信度與效度研究. 中華結核和呼吸雜志, 2010, 33(4): 251-255.
15. 李曉云, 成瑋, 段佳熙, 等. 慢性阻塞性肺疾病晨間癥狀量表中文版研制及信效度驗證. 中華結核和呼吸雜志, 2019, 42(6): 444-450.
16. Wilcox TK, Chen WH, Howard KA, et al. Item selection, reliability and validity of the Shortness of Breath with Daily Activities (SOBDA) questionnaire: a new outcome measure for evaluating dyspnea in chronic obstructive pulmonary disease. Health Qual Life Outcomes, 2013, 11: 196.
17. Güell R, Casan P, Sangenís M, et al. Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ). Eur Respir J, 1998, 11(1): 55-60.
18. Karlsson N, Atkinson MJ, Müllerová H, et al. Validation of a diagnosis-agnostic symptom questionnaire for asthma and/or COPD. ERJ Open Res, 2021, 7: 00828-2020.
19. Watkins ML, Wilcox TK, Tabberer M, et al. Shortness of breath with daily activities questionnaire: validation and responder thresholds in patients with chronic obstructive pulmonary disease. BMJ Open, 2013, 3(10): e003048.
20. Siu DCH, So CT, Lau CWL, et al. The manchester respiratory activities of daily living questionnaire: reliability and validity of the chinese version with pictorial enhancement. Int J Chron Obstruct Pulmon Dis, 2021, 16: 91-100.
21. Howard K, Berry P, Petrillo J, et al. Development of the Shortness of Breath with Daily Activities questionnaire (SOBDA). Value Health, 2012, 15(8): 1042-1050.
22. Leidy NK, Schmier JK, Jones MKC, et al. Evaluating symptoms in chronic obstructive pulmonary disease: validation of the Breathlessness, Cough and Sputum Scale?. Respir Med, 2003, 97(SUPPL.A): S59-S70.
23. Fung A, Chan LLC, So CT, et al. Reliability and validity of the self-administered Chinese version of the shortness of breath questionnaire (C-SOBQ) in patients with chronic obstructive pulmonary disease. Hong Kong J Occup Ther, 2012, 22(2): 75-83.
24. Lareau SC, Meek PM, Roos PJ. Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M). Heart Lung, 1998, 27(3): 159-168.
25. Williams J, Singh S, Sewell L, et al. Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR). Thorax, 2001, 56(12): 954-959.
26. Garratt AM, Nerheim EM, Einvik G, et al. Evaluation of the Norwegian version of the Dyspnoea-12 questionnaire in patients with COPD. BMJ Open Respir Res, 2022, 9(1): e001262.
27. Alyami M, Jenkins S, Lababidi H, et al. Reliability and validity of an arabic version of the dyspnea-12 questionnaire for Saudi nationals with chronic obstructive pulmonary disease. Ann Thorac Med, 2015, 10(2): 112.
28. Eakin EG, Resnikoff PM, Prewitt LM, et al. Validation of a new dyspnea measure: The UCSD Shortness of Breath Questionnaire. Chest, 1998, 113(3): 619-624.
29. Victorson DE, Anton S, Hamilton A, et al. A conceptual model of the experience of dyspnea and functional limitations in chronic obstructive pulmonary disease. Value Health, 2009, 12(6): 1018-1025.
30. Yorke J, Moosavi SH, Shuldham C, et al. Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12. Thorax, 2010, 65(1): 21-26.

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Latest ArticlesDyspnea symptom assessment tool for patients with chronic obstructive pulmonary disease: a systematic review based on COSMIN guidelines

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