Dyspnea Index

Dyspnea Index

Waring Wellness / Kristina Waring MA CCC-SLP
Dyspnea Index (DI) the only available instrument developed exclusively for the assessment of upper airway dyspnea. Dyspnea is shortness of breath. The DI is an instrument developed by Gartner-Schmidt et al, and was designed and validated to provide clinicians and patients with a reliable and valid clinical assessment tool to evaluate overall symptom severity of dyspnea in patients with upper airway pathologies.
Name*

First NameLast Name
Date of birth

MonthDayYear
Date
Today's Date*

MonthDayYear
Date
Reporting cycle before treatmentReporting cycle during treatmentReporting cycle after 5 treatmentsOther
Instructions for Patients:

These may be symptoms that you are experiencing.

Please select the response that indicates how frequently you experience the same symptoms:

0 = never, 1 = almost never, 2 = sometimes, 3 = almost always, 4 = always
I have trouble getting air in

NeverAlmost NeverSometimesAlmost AlwaysAlways
I feel tightness in my throat when my breathing is difficult

NeverAlmost NeverSometimesAlmost AlwaysAlways
It takes great effort to breathe

NeverAlmost NeverSometimesAlmost AlwaysAlways
Changes in weather or temperature affect my breathing

NeverAlmost NeverSometimesAlmost AlwaysAlways
My breathing gets worse with stress, when I feeling anxious or have strong emotion

NeverAlmost NeverSometimesAlmost AlwaysAlways
My breathing is noisy when I breathe IN

NeverAlmost NeverSometimesAlmost AlwaysAlways
I physically strain myself to breathe

NeverAlmost NeverSometimesAlmost AlwaysAlways
My breathing gets worse with exercise or any type of physical activity

NeverAlmost NeverSometimesAlmost AlwaysAlways
My breathing problem is a source of stress or anxiety for me

NeverAlmost NeverSometimesAlmost AlwaysAlways
My breathing problem restricts or limits my personal interests/hobbies, social life, or ability to be active

NeverAlmost NeverSometimesAlmost AlwaysAlways

Rows	0	1	2	3	4
I have trouble getting air in
I feel tightness in my throat when I am having my breathing problem
It takes more effort to breathe than it used toResponsiveness
Changes in weather affect my breathing problem
My breathing gets worse with stress
I make sound/noise when I breath in
I have to strain to breathe
My shortness of breath gets worse with exercise or physical activity
My breathing problem makes me feel stressed
My breathing problem causes me to restrict my personal and social life

DI Score this week
I would describe the severity of my breathing difficulties as:

MarginalMildModerateSevere
Should be Empty: