Dyspnea Management Questionnaire (DMQ-56)

Dyspnea, also known as shortness of breath, is one of the most common global symptoms and can significantly affect both physical and psychological health. It is often described as a sensation of air hunger or difficulty breathing normally. The Dyspnea Management Questionnaire (DMQ) was developed in the United States to measure the effects of pulmonary rehabilitation and changes over time in patients with Chronic Obstructive Pulmonary Disease (COPD). This tool is widely used in both clinical practice and research to evaluate treatment outcomes in COPD patients【1】

Advantages and limitations

One of the strengths of the DMQ is its multidimensional approach, which includes sensory, psychological, and behavioral aspects of dyspnea. The questionnaire provides a comprehensive assessment of how dyspnea impacts daily life and treatment outcomes, particularly in patients with high anxiety related to breathing difficulties.

Limitations include the lack of full standardization of certain sections of the questionnaire and potential subjective variation in patient responses, which may affect reliability.

Method of use

The DMQ is structured around five theoretical dimensions of dyspnea:

• Intensity of dyspnea

• Anxiety related to dyspnea

• Avoidance of activities

• Confidence in performing activities

• Satisfaction with strategy use

Responses are given on a 7-point Likert scale, where higher scores indicate better dyspnea-related functioning. For each subscale, raw values are summed and an average score is calculated【2】.

Specific versions of the DMQ

• DMQ-30Contains 30 items covering the five theoretical dimensions. It is designed for patients with high levels of anxiety and avoidance behavior. The DMQ-30 has demonstrated high internal consistency (α = 0.87–0.96) and strong test–retest reliability (ICC = 0.71–0.95) over 2.5 weeks. It is often used clinically to evaluate the effects of multidisciplinary interventions【3】.

• DMQ-56The extended version, offering a more comprehensive assessment of dyspnea. Studies show high reliability (α = 0.85–0.96) and strong test–retest reliability over three weeks (ICC = 0.69–0.92). The DMQ-56 is recommended in complex cases where detailed evaluation is required【4】.

• DMQ-CAT (Computer Adaptive Test)Utilizes an adaptive testing method, tailoring questions to each patient based on previous responses. This reduces respondent burden and ensures only relevant items are presented. DMQ-CAT has been shown to be reliable, valid, and efficient for evaluating multidimensional aspects of dyspnea【5】.

Clinical use and implications

The DMQ improves understanding of how dyspnea affects patients’ quality of life. It provides valuable insights that can be used to:

• Tailor pulmonary rehabilitation programs

• Measure treatment effectiveness

• Promote coping strategies to reduce anxiety and functional impairment

By integrating the patient’s perspective, the DMQ offers a holistic approach to dyspnea management and supports evidence-based interventions.

Sources

1. Norweg A, Jette AM, Ni P, Whiteson J, Kim M. Outcome measurement for COPD: reliability and validity of the Dyspnea Management Questionnaire. Respiratory medicine. 2011 Mar;105(3):442-53.

2. Norweg A, Whiteson J, Demetis S, Rey M. A new functional status outcome measure of dyspnea and anxiety for adults with lung disease: the dyspnea management questionnaire. J Cardiopulm Rehabil Prev. 2006 Nov;26(6):395-404.

3. Norweg A, Steffen A, Jette A, Moy ML, Grady S, Garshick E. DMQ-CAT Multidimensional Dyspnea Severity Predicts Risk of Acute Respiratory Events in COPD. Am Thorac Soc. 2017 May; A5455.

4. Norweg A, Ni P, Garshick E, O'Connor G, Wilke K, Jette AM. A multidimensional computer adaptive test approach to dyspnea assessment. Arch Phys Med Rehabil. 2011 Oct;92(10):1561-9.