ABSTRACT
A patient comes to see his doctor with a complaint of shortness of breath.
The probability is quite high that as the doctor begins to take her history, the focus of the questions will be on the intensity of the discomfort and
the factors that precipitate the breathlessness. The quality of the breathing
discomfort, what the patient actually feels, will be ignored. Contrast this
with the experience of the same patient presenting to his physician with a
complaint of abdominal or chest pain. Quickly, the doctor will ask about
the quality of the pain-is it sharp, aching, cramping, or burning? What accounts for this difference in the approach to the assessment of two related
symptoms? If a physician has a normal cardiopulmonary system, she likely experi-
ences dyspnea only with exercise. If it is true that dyspnea, like pain, is a
‘‘private experience, and only through such experience’’ can it be defined
(1), then the presumption may be that all dyspnea is characterized by this
sensation and thus, there is little utility in probing for qualitative distinc-
tions. Traditional texts used to instruct medical students on the art of
patient interviewing do not discuss qualitative aspects of dyspnea (2,3) despite the fact that, as early as 1966, Comroe (4) summarized the prevail-
ing work on dyspnea as showing six grades or types of dyspnea, and over 20
years ago, Campbell and Guz (5) enumerated four ‘‘elemental sensations’’
that ‘‘singly or in combination underlie breathlessness.’’
