Use of the Breathlessness, Cough, and Sputum Scale (BCSS©) in Pulmonary Rehabilitation§

Michele L McCarroll*, 1, Rachael J Pohle-Krauza 2, Teresa A Volsko 3, Jennifer L Martin 4, Matthew L Krauza 5, 6
1 Summa Center for Women’s Health Research, Summa Health System Akron, Ohio, USA
2 Department of Human Ecology, Youngstown State University Youngstown, Ohio, USA
3 Department of Respiratory Therapy, Akron Children’s Hospital Akron, Ohio, USA
4 Department of Rehabilitation, Summa Health System Akron, Ohio, USA
5 Department of Internal Medicine, Summa Health System Akron, Ohio, USA
6 Northeast Ohio Medical University Rootstown, Ohio, USA

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© McCarroll et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Summa Center for Women’s Health Research, Summa Health System Akron, Ohio, USA; Tel: 330-375-4880; Fax: 330-375-7831; E-mail:



In pulmonary rehabilitation (PR) effective measures have been taken while in analyzing a patient’s intervention with the help of entry to exit evaluations. The absence of an objective and quantifiable scale are limitations of PR that allow analyzing of a patient’s self reported symptoms throughout PR. The Breathlessness, Cough and Sputum Scale (BCSS©) is used to predict patient exacerbations by evaluating common symptoms identified in the COPD population. This study used the BCSS© survey to track complex symptom changes throughout the course of PR intervention. The BCSS© tool measured the patient’s self reported symptoms in real time for each visit when patient enrolled in PR.


Thirty-five patients with COPD from three outpatient PR centers were asked to report the severity of breathlessness, cough, and sputum prior to each PR session using the BCSS© survey.


There was a significant decrease in self reported symptoms of the mean BCSS© score from entry 4.6(± 2.9) to exit 2.3 (± 2.5), p < 0.001. The results showed variable decrease in the self reported symptoms with more PR visits. The secondary outcome showed high correlations with quality of life measures using the Pulmonary Function Status Scale (PFSS) on entry and exit to PR.


The BCSS© tool is an effective means for measuring the impact of PR on improving patient tolerance and self-reported symptoms as a result of COPD. More research is needed to better assess the complex symptoms of COPD patients in PR to enhance programmatic outcomes.

Keywords: Rehabilitation, quality of life, dyspnea, cough, sputum..