The Breathlessness, Cough, and Sputum Scale

Background A patient report of respiratory symptoms in COPD is essential to successfully monitoring disease, adjusting treatment, and evaluating outcomes. Objective To develop empirically based guidelines for interpreting mean changes in symptom scores using the Breathlessness, Cough, and Sputum Scale (BCSS). Methods Analyses were performed on data from three multinational trials (n = 2,971). Mean changes in BCSS score with treatment were examined by physician and patient ratings of treatment efficacy, juxtaposed with percentage change in symptoms, statistical effect size (ES), ΔFEV1, and change in St. George Respiratory Questionnaire (SGRQ) score. BCSS scores during an exacerbation were examined relative to changes in peak expiratory flow and rescue medication use. Results Mean baseline BCSS total score was 5.2 ± 2 (± SD); 90% of scores were between 2 and 9. Highly efficacious treatment (n = 257; physician rating) was associated with a ΔBCSS total score of − 1.3 ± 1.8, representing a 24% improvement (ES = 0.7), and corresponding to a 10% improvement in FEV1 and ΔSGRQ score total of − 10.3 ± 13.8. Similar changes in BCSS score were observed during recovery from an exacerbation (n = 713; − 1.3 ± 1.8). Mean change with moderately efficacious treatment (n = 965) was − 0.7 ± 1.8, a 13% improvement (ES = 0.3) corresponding to ΔSGRQ total score of − 6.8 ± 12.6. Mildly efficacious treatment (n = 891) was associated with a change of − 0.35, a 7% improvement (ES = 0.18), with a ΔFEV1 Conclusions Patient-reported daily symptom data are sensitive to change and useful for both observational studies and controlled clinical trials of patients with COPD. A mean ΔBCSS total score > 1.0 represents substantial symptomatic improvement, changes of approximately 0.6 can be interpreted as moderate, and changes of 0.3 can be considered small.