Dyspnea is the sensation of difficult or labored breathing and can occur at rest or with activity. It is a subjective measure reported by the individual experiencing dyspnea and takes into account the personal sensation of effort, tightness, and air hunger (Parshall et al., 2012). Objective measures are available to aid clinicians in quantifying the severity and impact of dyspnea on an individual's function. As dyspnea is the most prevalent symptom among individuals with cardiac and respiratory disease, it is an essential assessment when evaluating a patient and when monitoring the impact of a treatment dosage. There is evidence that dyspnea is an independent predictor of mortality among older adults and those with a heart disease or chronic obstructive pulmonary disease (COPD), further supporting its assessment (Pesola & Ahsan, 2016).

It is common in the home care setting to utilize the Outcome and Assessment Information Set (OASIS)-D Guidance Manual to assess shortness of breath and dyspnea (Centers for Medicare and Medicaid Services, 2019). Within OASIS, M1400 asks healthcare providers to report "When is the patient dyspneic or noticeably short of breath?" and score the findings on a 0-4 scale (Table 1). Although OASIS does provide scoring details, there are other valid and reliable tools available to aid in a comprehensive assessment of dyspnea.

Table 1. (M1400) When Is the Patient Dyspneic or Noticeably Short of Breath?

Shortness of breath can be assessed using tools aimed at garnering insight into common domains useful to understanding the dyspnea experience: sensory (intensity and quality of the dyspnea), affective (distress brought about by the dyspnea), and symptom burden (impact of dyspnea on daily activities (Parshall et al., 2012). The Visual Analogue Scale (VAS) and the Rating of Perceived Exertion/Dyspnea (RPE/RPD) Scale are useful to gain insight into how breathing "feels" (sensory) or how "distressing or unpleasant" (affective) dyspnea is to an individual. The VAS asks a person to mark a point on a premeasured line with the extreme highest and lowest points of dyspnea at either end (Aitken, 1969). The Borg RPE/RPD scale requests a number be provided that best represents the person's level of dyspnea on either a 0-10 category ratio scale (CR10) or the traditional 6-20 scale (Borg, 1998).

The Modified Medical Research Council Questionnaire of Dyspnoea Scale for COPD (MMRC) is a 0-4 scale used to quantify shortness of breath (Munari et al., 2018). The MMRC is a component of the BODE index calculation which is a good predictor of decline in health-related quality of life among individuals with COPD (Medinas-Amoros et al., 2008) and can be useful to assess symptom impact or burden of the dyspnea on function. Furthermore, the St. George's Respiratory Questionnaire (Barr et al., 2000), University of California, San Diego Shortness of Breath Questionnaire (Kupferberg et al., 2005), and the Chronic Respiratory Disease Questionnaire (Reda et al., 2010) have strong psychometric properties supporting their use; however, copyright and licensing agreements should be explored prior to implementing use in practice.

The Talk Test is a useful approach to measuring the intensity of an activity (Woltmann et al., 2015) and aligns with the M1400 scoring system. High levels of ventilatory control are required for comfortable talking, so if an individual is unable to talk comfortably during an activity or exercise, the intensity may be above the ventilatory threshold. Although the talk test is generally a subjective measure, an objective element could be introduced into this tool in an effort to promote reproducible documentation able to demonstrate change over time. For example, the clinician could ask a patient to count out loud to 10 during an activity and then record/document the number of breaths taken during this maneuver. This may prove to be a useful option when objectifying dyspnea common to functional activities (i.e., walking up five stairs, putting on both shoes).

Although M1400 may be the obligatory OASIS assessment commonly associated with home care, other tools can be used to complement M1400 or add value to the various constructs brought about by dyspnea and should be considered when completing a patient assessment. Not only can these dyspnea measures be useful in providing support for the M1400 score, they can justify the need for skilled therapy interventions for compromised individuals who may demonstrate gains not reflected in the OASIS M1400 point scoring system.

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