Comparison on the profiles of a modified Borg scale and the pediatric dyspnea scale during an induced bronchoconstriction in children with clinical asthma

You Sun Kim; Jeongmin Shin; Yun Jung Choi; Jun-Hyuk Song; Ju Kyung Lee; Hea Lin Oh; Dong In Suh; Young Yull Koh

doi:10.4168/aard.2017.5.5.262

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Kim, Shin, Choi, Song, Lee, Oh, Suh, and Koh: Comparison on the profiles of a modified Borg scale and the pediatric dyspnea scale during an induced bronchoconstriction in children with clinical asthma

Original Article

Allergy Asthma Respir Dis 2017;5(5):262-268.

Published online: 5 September 2017

DOI: https://doi.org/10.4168/aard.2017.5.5.262

Comparison on the profiles of a modified Borg scale and the pediatric dyspnea scale during an induced bronchoconstriction in children with clinical asthma

You Sun Kim¹, Jeongmin Shin¹, Yun Jung Choi¹, Jun-Hyuk Song², Ju Kyung Lee¹, Hea Lin Oh³, Dong In Suh¹, Young Yull Koh¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

²Department of Pediatrics, College of Medicine, Seonam University, Gwangju, Korea

³Department of Pediatrics, Korean Cancer Center Hospital, Seoul, Korea

Correspondence to: Yun Jung Choi https://orcid.org/0000-0002-0078-8374 Department of Pediatrics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-3625, Fax: +82-2-743-3455, E-mail: flubber224@gmail.com

Received 7 March 201728 April 2017 Accepted 17 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Dyspnea is the cardinal symptom of asthma, but it is difficult to quantify clinically. Although modified Borg (mBorg) scale has been successfully used in adult, but there has been some difficulties to apply in children. Recently, Pediatric Dyspnea Scale (PDS) was adequately designed and has been widely used. The aim of this study is to compare 2 evaluating scales of dyspnea provoked by induced-bronchoconstriction in childhood asthma.

Methods

Seventy-three clinically suspected children with asthma were enrolled in this study. Each ‘fractional exhaled nitric oxide (FeNO)’ was documented. Forced expiratory volume in 1 second (FEV1), mBorg score and PDS score were recorded during methacholine provocation test.

Results

Mapping using canonical plot demonstrated global similarity between 2 scales with some distinctive features. Whereas mBorg score showed more diverse categories in low level of dyspnea, PDS score did in medium level of it. A distribution of dyspnea perception score at a 20% decrease in FEV₁ relative to baseline (PS₂₀), a perception score of dyspnea at 20% fall in FEV₁ of 2 scales represented similar wide, biphasic feature. Statistical relevance was verified with spearman correlation (R s =0.903, P<0.001) and Bland-Altman analysis. PS₂₀ of both scores and FeNO had no statistical relationship. While relationship between PS₂₀ by mBorg score and the concentration of methacholine at 20% fall in FEV₁ (PC₂₀) was not significant (R _s =0.224, P=0.154), that between PS₂₀ by PDS and PC20 was weak positive (R s =0.29, P=0.063).

Conclusion

PDS had similar pattern to assess the dyspnea with the mBorg scale suggesting adequacy of PDS in evaluating pediatric clinical asthma. We expect these scales to help clinical practice in complementary ways.

Keywords: Asthma, Borg, Bronchial provocation tests, Dyspnea, Pediatric dyspnea scale

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Fig. 1.

Pediatric dyspnea scale which was translated into Korean was used to evaluate the severity of dyspnea.

Fig. 2.

Canonical plots of scores from one scale versus mean score of the other scale. For example, when the modified Borg (mBorg) score was 5, modified Pediatric Dyspnea Scale (mPDS) rating averaged 4.67 (solid line), Alternately, when subject rated a PDS score of 3 the Borg score averaged 2.59 (dashed line).

Fig. 3.

The dyspnea perception score at a 20% decrease in forced expiratory volume in 1 second relative to baseline (PS20) was measured by interpolation. mBorg, modified Borg; mPDS, modified Pediatric Dyspnea Scale.

Fig. 4.

Distribution of individual difference in dyspnea perception score at a 20% decrease in forced expiratory volume in 1 second relative to baseline (PS₂₀) between modified Borg scale and modified Pediatric Dyspnea Scale.

Fig. 5.

Correlation between dyspnea perception score at a 20% decrease in forced expiratory volume in 1 second (FEV1) relative to baseline (PS20) and the concentration of methacholine at 20% fall in FEV₁ (PC₂₀). mBorg, modified Borg; mPDS, modified Pediatric Dyspnea Scale.

Appendix. 1.

Modified Borg scale used in the current study.

Table 1.

General characteristics of subjects (n=73)

Characteristic	Value
Sex, male:femal	41:32
Age (mo), mean (95% CI)	129.1 (119.9–138.3)
Height (cm), mean (95% CI)	142.1 (138.2–145.9)
Atopy, n (%)	53 (72.6)
Controller, n
None	51
Use	22
LTRA	10
ICS	9
ICS/LABA combination	3
Duration of controller use (yr), n	22
<1	8
≥1, <3	4
≥3	7
Unknown	3
Last dose-step, n
1st (0.625 mg/mL)	6
2nd (2.5 mg/mL)	4
3rd (5.0 mg/mL)	5
4th (25 mg/mL)	18
5th (100 mg/mL)	40
Baseline FEV₁% (%), mean (95% CI)	97.6 (94.5–100.6)
FEV1%fall, n
<20	31
≥20	42
PC₂₀ (mg/mL), geometric mean (95% CI)	6.26 (3.47–11.30)

LTRA, leukotriene receptor antagonist; ICS, inhaled corticosteroid; LABA, long acting beta agonist; FEV₁, forced expiratory volume in 1 second; CI, confidence interval; PC₂₀, provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second.

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