CHEST Guidelines-Identifying-Abnormal-Exertional-Breathlessness-in-

Identifying-Abnormal-Exertional-Breathlessness-in-

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The study "Identifying Abnormal Exertional Breathlessness in COPD" examines the effectiveness of the modified Medical Research Council (mMRC) scale and the COPD Assessment Test (CAT) in identifying abnormal breathlessness during exercise among COPD patients, compared to cardiopulmonary exercise testing (CPET). Conducted on a cohort of 318 individuals from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study, the study measured breathlessness using the Borg scale during CPET, defining abnormal breathlessness as exceeding the upper limit of normal.<br /><br />Results indicated that while an mMRC score of 2 and a CAT score of 10 were specific in identifying abnormal breathlessness, they had low sensitivity, detecting only 12% of cases. Approximately 24% of participants experienced high exertional breathlessness, yet many had low mMRC and CAT scores, highlighting a significant discrepancy between these questionnaires and CPET results.<br /><br />The findings reveal that mMRC and CAT assessments often fail to identify severe breathlessness, potentially leading to inadequate management of COPD. Patients with hidden breathlessness according to CPET performed worse in self-reported and physiological outcomes but were not significantly more likely to be receiving respiratory medication.<br /><br />This discrepancy underscores the necessity for standardized exercise testing, like CPET, in evaluating COPD patients to ensure accurate assessment and management, particularly since many individuals self-adjust their activities to avoid symptoms, masking real breathlessness severity. Despite the broad utility of mMRC and CAT, neither alone nor together did they adequately reflect true physical challenges faced by patients, suggesting the limitations of these self-reported measures for comprehensive COPD evaluation. Future research should further explore similar evaluations across more diverse and severe COPD populations and other related diseases.

Keywords

COPD

breathlessness

mMRC scale

COPD Assessment Test

CPET

CanCOLD study

Borg scale

exercise testing

self-reported measures

respiratory management