Assessing breathlessness following pleural fluid drainage using the Visual Analogue Scale for Dyspnoea(VASD) over 1 week(7-DVQ)

Abstract

Introduction: VASD is a patient reported outcome assessing dyspnea intensity, consisting of a 100mm horizontal line anchored at 0mm with ‘Not breathless at all’ and at 100mm with ‘Worst possible breathlessness’. Although it is a validated measure of dyspnea change with pleural fluid drainage, the optimal duration of measurement following aspiration is not well established and there appears to be a significant placebo effect after 24 hours. Aim: To assess whether routine measurement of 7-DVQ post pleural aspiration is i.acceptable to patients and has a good(>70%)response rate ii. Assess relationship between volume of pleural fluid drained and mean 7-DVQ. Methods: Between Sept 2017 and Jan 2018, consecutive patients undergoing pleural aspiration in pleural clinic at NNUH were enrolled to fill up 7-DVQ. Baseline VASD was recorded before the aspiration and subsequently the patient was asked to complete it at home for 7 days. Results: Of 23 patients who underwent aspiration,17 questionnaires were returned, of which data for analysis were available from 16 patients. Demographics are summarised in Table 1. Mean VASD at baseline and at end of 7 days was 64 mm(SD 28) and 46 mm(SD 21)respectively. Mean decrease in VASD at end of 7 days was 19 mm(SD 14). Correlation between volume of fluid aspirated and decrease in 7-DVQ was 0.5(p=0.03) Conclusion: This study shows that 7-DVQ as a measure to quantify change in dyspnea post aspiration correlates well with amount of fluid aspirated and baseline dyspnea.A response rate of 73% suggests that 7-DVQ is an acceptable measure for patients.