The Breathlessness, Cough, and Sputum Scale: The Development of Empirically Based Guidelines for Interpretation

Nancy Kline Leidy, Stephen I. Rennard, Jordana Schmier, M. Kathryn C. Jones, Mitch Goldman

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


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 <1% and ΔSGRQ total score of - 2.6 ± 11.7. 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.

Original languageEnglish (US)
Pages (from-to)2182-2191
Number of pages10
Issue number6
StatePublished - Dec 2003


  • Bronchitis
  • COPD
  • Clinical trials
  • Cough
  • Dyspnea
  • Emphysema
  • Exacerbation
  • Health-related quality of life
  • Instrument
  • Patient-reported outcome
  • Sputum
  • St. George Respiratory Questionnaire
  • Symptoms

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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