Validation and Application of the Simplified Chinese Version of the Dyspnea-12 Questionnaire: An Independent Predictor for Hospitalization Risk in Chronic Obstructive Pulmonary Disease

Xugui Chen,1,2 Longyi Du,1 Wei Xiao,1 Meilu Liu,1 Tiwei Miao,1 Chan Xiong,2 Li Liao,2 Yu Li,2 Yonggang Hu,3 Juanjuan Fu1 1Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Department of Respiratory Medicine, No. 3 Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (West District)/Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China; 3Chengdu Xinjin District Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Juanjuan Fu, Email [email protected]: The Dyspnea-12 is a brief patient reported tool assessing physical and emotional components of breathlessness. However, the reliability and effectiveness of the Chinese version of Dyspnea-12 (D-12-C) needs to be verified.Purpose: This study aimed to assess the reliability and validity of D-12-C in patients with chronic obstructive pulmonary disease (COPD) and investigate its associations with clinical outcomes of COPD.Patients and Methods: Patients from three centers completed baseline assessments (pulmonary function test, the COPD Assessment Test (CAT), the Modified Medical Research Council Dyspnea Scale (mMRC), the Hospital Anxiety and Depression Scale (HADS), St George’s Respiratory Questionnaire (SGRQ), Borg dyspnea scale, 6-minute walking distance (6MWD) and the history of exacerbations. The internal consistency, construct validity, convergent validity and reliability of the D-12-C were evaluated. The binary multivariate logistic regression analysis was performed to explore the influencing factors for hospitalization during follow-up.Results: A total of 279 patients were recruited. Exploratory factor analysis divided the D-12-C into physical and affective dimensions. A high level of internal consistency was manifested by the Cronbach’s alpha values of the D-12-C with total scores, physical, and affective dimensions of 0.94, 0.96, and 0.92, respectively. The score of D-12-C increased as the GOLD or mMRC grade rose, and patients suffering from anxiety or depression had more severe dyspnea. The score of D-12-C was significantly correlated with CAT, mMRC, HADS, SGRQ and hospitalization during follow-up. Additionally, baseline D-12-C was an independent predictor of hospitalization during the one year follow-up (OR=1.086, 95% CI: 1.035– 1.139, p < 0.001).Conclusion: The D-12-C demonstrated good internal consistency and validity in COPD. The score of D-12-C correlates with the clinical parameters of disease severity and predicts severe exacerbations of hospitalization, supporting its use in risk stratification and management planning to prevent adverse outcomes.Keywords: dyspnea-12 questionnaire, dyspnea, chronic obstructive pulmonary disease, exacerbation