J Med Assoc Thai 1997; 80 (5):319

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Relationship Between Dyspnea, Peak Expiratory Flow Rate and Wheeze in Obstructive Lung Disease
Srisawai P Mail

The relationship between dyspnea and airway obstruction is complex, and it is unclear to
what extent measures of each correlate in patients with obstructive lung disease (OLD). Thus,
the correlation between subjective assessment of dyspnea (dyspnea score using modified Borg
scale) and objective assessment of dyspnea (peak expiratory flow rate using Mini Wright Peak
Flow Meter and wheeze score using stethoscope) before and after bronchodilator (1 mg of
turbutaline sulphate) were studied in 115 patients (62 males, 53 females) with OLD attending the
chest clinic of Royal Irrigation Hospital, Nonthaburi, Thailand. The mean age of these patients
was 47.4 ± 16.4 years. Good correlations were found (r = 0.37 to 0.52; p < 0.001) but dyspnea scores
were better correlated with wheeze scores than peak expiratory flow rates. The change in dyspnea
scores after bronchodilator also correlated with the change in peak expiratory flow rates and the
change in wheeze scores (r = 0.22; p < 0.02 and r = 0.28; p < 0.005 respectively). Analyzing a
subgroup of 48 dyspneic patients (prebronchodilator dyspnea score of 2 or more) revealed the
following reponse groups : those with either a bronchodilator or dyspnea response alone, both
together, or neither. Twenty-three patients (47.92 per cent) responded both subjectively and
objectively. One (2.08 per cent) had a bronchodilator response only. Twenty (41.66 per cent) had a
dyspnea response only, while four (8.33 per cent) had neither measurable response. The present
study suggests that the assessment of dyspnea by using dyspnea score is vital and may be specially
helpful in a situation where the objective ass':!ssment cannot be performed. In some individuals
the subjective assessment of response to bronchodilator may be at least as valuable as objective
data.

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