No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Symptom burden and functional performance in patients with chronic obstructive pulmonary disease
Abstract
Background
The burden of COPD is growing, and it is one of the leading disease burdens worldwide. Studies on symptom burden as a multidimensional concept in COPD and functional performance are lacking, and little is known about the effect of multiple symptoms and symptom burden on functional performance.
Methods
A descriptive, cross-sectional correlational survey design was used. The Memorial Symptom Assessment Scale (MSAS) and the Functional Performance Inventory-Short Form (FPI-SF) were used to measure the symptom burden and functional performance. Data were analyzed using descriptive and inferential statistics. Participants (n=214) were recruited from the respiratory outpatient clinic in one of the teaching hospitals in Ireland.
Results
Patients with COPD, regardless of classification, experienced significant physical and psychological symptom burden. A total of 20 symptoms were negatively correlated with overall functional performance, indicating a high symptom burden for those symptoms was associated with low overall functional performance. A statistically significant negative correlation between physical symptom burden, psychological symptom burden, total symptom burden, and functional performance was found.
Conclusion
Patients with COPD experience a significant symptom burden and low functional performance. Decreased functional performance was not related only to a single burdensome symptom, but may also be related to the contribution of several physical/psychological burdensome symptoms, or both. Assessment and management of these symptoms are essential and imply that alleviating these symptoms’ burden may promote improved functional performance. This study supported the growing body of evidence of the need for patients with advanced COPD to receive palliative care.
... The symptoms of COPD patients gradually worsen through the years (Zwerink et al., 2014), and as in the case of functional performance, a reduction is also seen in the self-care agency of these patients (Weldam et al., 2013;Park, 2017;Melhem et al., 2021). A review of the literature in this context has shown that patients with COPD have poor self-care and symptom management skills (Bugajski et al., 2022). ...
... Lower functional performance is a predictor of COPD exacerbations and mortality. In this sense, functional performance is a clinically important indicator (Melhem et al., 2021). Moreover, lower functional performance associated with lower physical activity levels leads patients to adopt a more sedentary lifestyle and experience health problems related to this lifestyle, such as cardiovascular problems (Kapella et al., 2011). ...
... Low FEV1 values indicate higher disease severity, which is a significant factor in lower functional performance (Bozkurt et al., 2020). An increase in disease severity increases the number of symptoms experienced by patients, and experiencing more symptoms leads to a reduction in functional performance (Melhem et al., 2021). In our study, predicted FEV1 values were determined to be positively correlated with functional performance and self-care agency ( Table 4). ...
Aim:This descriptive study was conducted to determine the functional performance and self-care agency levels of Chronic obstructive pulmonary disease patients and associated factors. Subjects and Method: The sample of the study included 128 COPD patients who were being treated and followed up as outpatients at the pulmonology outpatient clinic of a research and training hospital. Results:The mean functional performance score of the patients was low (1.33±0.60), while their mean self-care agency score was moderate (92.35±22.59). Functional performance and self-care agency levels were found to be significantly lower among the patients who required help in their activities of daily living, those with comorbidities, those who presented to emergency services due to COPD in the last six months, those who were hospitalized, and those who were long-term users of oxygen treatment at home (p
... The symptoms that patients with COPD might experience have a negative impact on their health and well-being. Shortness of breath, coughing and fatigue may limit their physical mobility and abilities in performing activities of daily living, especially during exacerbations (Melhem et al., 2021). ...
Aim
The aim of this study was to investigate self‐care behaviours of patients with chronic obstructive pulmonary disease (COPD), understand their complex interconnections and identify key behaviours influencing self‐care and self‐efficacy.
Design
An observational, cross‐sectional study design.
Setting(s)
The outpatient department of two tertiary hospital.
Methods
A convenience sample of patients with a diagnosis of COPD were included (n = 222). Self‐care behaviours were assessed using the Chinese version of self‐care of chronic obstructive pulmonary disease inventory based on the Middle‐Range Theory of Self‐Care of Chronic Illness. Patient self‐care efficacy was evaluated using Chinese version of Self‐Care Self‐Efficacy Scale in Chronic Obstructive Pulmonary Disease. Employing network analysis, associations between behaviours (nodes) and their interrelationships (edges) were deciphered. The study was reported following the STROBE checklist.
Results
Among the spectrum of self‐care behaviours, patients exhibited the most pronounced deficiencies in behaviours directed to enhancing breathing, monitoring extra‐respiratory symptoms and problem‐solving. Within the network, the most central emerging behaviour was the modification of prescribed therapy at the worsening of symptoms, as suggested by healthcare providers, which drives all self‐care behaviours. The confidence in being able to do something to relieve symptoms, despite difficulties, was a bridging activator of self‐care. The network structure underscored the prominence of self‐care self‐efficacy in driving self‐care maintenance, monitoring, and management behaviours.
Conclusions
Education programs for COPD should prioritise enhancing breathing, symptom monitoring and problem‐solving skills. The crucial self‐care behaviour in COPD involves adjusting treatments in response to symptom changes. Patient confidence in symptom alleviation acts as a catalyst for self‐care engagement. Targeted assessments addressing these aspects could enhance educational interventions, ultimately improving COPD patient outcomes.
Registration
This study has been registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2200059764; registration date: 11 May 2022).
... Shortness of breath, lack of energy, difficulty sleeping, worrying, dry mouth, feeling nervous, and feeling irritable were the most severe and burdensome symptoms (8). Furthermore, high symptom burden was associated with low functional performance in this sample (9). ...
Background
Symptom burden in people with COPD is often under-recognized. In this cross-sectional analysis, we aimed to study the severity of a variety of (non-)respiratory symptoms in people with COPD and non-COPD subjects and to explore the associations between clusters based on symptom severity and other clinical characteristics.
Methods
Characteristics were assessed in 538 people with COPD from primary, secondary, tertiary care and 116 non-COPD subjects. Severity of 20 symptoms was measured using a Visual Analogue Scale (VAS), ranging from 0 (no symptom) to 100 mm (maximum severity). K-means cluster analysis was applied on symptoms’ severity in the patient sample only.
Results
Patients were comparable with non-COPD subjects in terms of gender (58% vs. 55% male, p=0.132) and age (64 [9] versus 63 [6] years, p=0.552) and had a reduced FEV 1 (57 [23]% versus 111 [17]% pred, p<0.001). Patients had higher VAS scores for most symptoms (p<0.05). Most severe symptoms in patients with COPD were dyspnea, fatigue, and muscle weakness while non-COPD subjects mainly experienced insomnia and micturition. Three clusters were identified in the patient sample. Health status and care dependency differed between all clusters, while functional mobility, exacerbation history and lung function differed between clusters 1 and the other two clusters (p<0.05).
Conclusions
People with COPD report a high burden of respiratory as well as non-respiratory symptoms. Cluster analysis demonstrated a co-occurrence of different levels of symptom severity highlighting the heterogeneity of symptoms experience. Identifying clusters of patients with shared symptom experiences can help to understand the impact of the disease and define integrated, multidimensional treatment strategies.
... COPD patients are characterized by high symptom burden and low physical function, and reducing their symptom burden can effectively improve their functional status. 57 Reportedly, symptom burden in COPD patients is significantly correlated with scores related to self-management, 58 and self-management interventions can help COPD patients cope with changing symptoms and effectively reduce symptom burden. 59 More researchers are speculated to be involved in the development of models to help patients achieve self-symptom management in the future. ...
Background and Aim
COPD nursing plays a crucial role in alleviating disease symptoms, prolonging patient survival, and is therefore of paramount importance. However, authoritative research findings, research hotspots, and development trends in the field of COPD are still unclear. This study aimed to examine authoritative research findings, research hotspots, and trends in the field of COPD nursing. Descriptive statistics and bibliometric and visual analyses of the literature were conducted.
Methods
Bibliometric data were obtained from the Web of Science database. Citespace was used to explore publication trends, countries, institutions, journals, authors, keywords, and co-citation characteristics of the included literature in order to summarize the key research in the field of COPD nursing.
Results
In total, 693 articles on COPD nursing were published. 1998–2014 showed a rapid growth period in this research field, which stabilized in 2015–2022. The research content could mostly be summarized into five categories: acute exacerbation, quality of life, risk, evidence-based nursing, and pulmonary rehabilitation. The research hotspots in 1998–2014 included randomized controlled trials, education, elderly patients, nursing home residents, nursing homes, rehabilitation, and prevalence. Research in 2015–2022 focused on impact, palliative care, needs, and predictors. In recent years, research mainly concentrated on symptom management models, cost-effectiveness, and cumulative meta-analysis.
Conclusion
Bibliometric analysis of COPD nursing articles indicates that the focus of COPD nursing research is shifting from tertiary prevention to primary and secondary prevention. Helping patients achieve self-management of symptoms, reducing the financial burden of COPD on healthcare, and summarizing research evidence by meta-analyses will likely remain the focus of future research.
... Although other studies have looked at symptom burden in patients with COPD using a multi-dimensional symptom burden assessment tool, [2][3][4][19][20][21] to our knowledge our study is the first to look at independent predictors of overall symptom burden including the influence of anxiety, depression, and sex. We have demonstrated the high prevalence of multiple physical and psychological symptoms that contribute to overall symptom burden in a group of stable breathless outpatients with COPD. ...
Purpose
Chronic obstructive pulmonary disease (COPD) is a progressive disease resulting in a range of symptoms including breathlessness. “Symptom burden” describes the severity and impact of multiple symptoms in an individual and is best quantified using validated symptom instruments but is not routinely measured in clinical practice. Therefore, we wanted to assess overall symptom burden in patients with moderate-to-severe COPD and find associated independent predictors.
Patients and methods
A single-centre cross-sectional study of patients with COPD who attended the Westmead Breathlessness Service between March 2017 and May 2022 was conducted. We obtained baseline demographic data, lung function, assessed quality of life (CAT), anxiety/depression (HADS), and measured symptom burden (CMSAS). We compared variables between men and women using unpaired t tests or Mann–Whitney tests for continuous variables, and Fisher’s exact tests for categorical variables. We used multiple regression to look for independent predictors of overall symptom burden. Data were analysed using Stata/IC 15.1.
Results
Eighty-nine patients with COPD, mean age 72.6 years, 55% male, mean FEV1 32% predicted, reported an average of 8.9 symptoms including 6.9 physical and 1.6 psychological symptoms. The most common physical symptoms were shortness of breath (100%) and lack of energy (80%), and the most common psychological symptoms were worrying (65%) and feeling anxious (61%). Median CMSAS total score was higher in women than men (1.34 versus 1.04, respectively; p=0.03) with more women experiencing nervousness (p=0.011) and anxiety (p=0.005). Female sex (p=0.003), HADS-Anxiety (p=0.0001), and HADS-Depression (p=0.0001) were independently associated with total CMSAS score in a multiple linear regression model and explained 63% of total CMSAS variability.
Conclusion
Very high physical and psychological symptom burden exists among patients with severe COPD. Anxiety, depression, and female sex were independently associated with increasing symptom burden. Identifying and understanding sex differences for COPD symptoms, and interventions targeting anxiety and depression may help to reduce overall symptom burden within this population.
... This psychological burden leads to low functional performance and health-related quality of life, 44,45 and is often neglected. 14,46 To deal with AECOPDs, people usually reduce their daily activities and/or perform them slower or after some breaks, planning and adjusting based on how they feel. ...
Background:
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on health status and disease progression, but their clinical presentation is heterogenous. A comprehensive understanding of people's experience during AECOPD is needed to develop person-centred interventions, such as pulmonary rehabilitation (PR). This study aimed to explore people's experience during mild to moderate AECOPD, and their thoughts on PR during this period.
Methods:
Short, semi-structured interviews were conducted with people with mild to moderate AECOPD treated in the community, within 48h of the diagnosis. Interviews were audio recorded, transcribed and analysed by deductive thematic analysis using the Web Qualitative Data Analysis software.
Results:
Eleven people with AECOPD (9 male, 67±10 years, FEV1 41±16%predicted) participated. Four themes and seventeen subthemes were identified: impact of AECOPD (symptoms, physiological changes, limitations in activities of daily living, social constrains, psychological and emotional challenges, family disturbances); dealing with AECOPD ([not] depending on others, planning and compensation strategies); main needs during AECOPD (breath better, feel less tired, get rid of sputum, be able to walk); and (un)certainty about PR (lack of knowledge, get better, exercises, design and timing, trust in health professionals).
Conclusion:
AECOPD, even when not requiring hospital admission, have a huge negative impact on people's lives. People's thoughts about PR reflect the need to raise awareness for this intervention during AECOPD. This study provides a foundation for the development of meaningful person-centred interventions during AECOPD.
Background:
There is considerable heterogeneity in symptom burden among lung transplant candidates that may not be explained by objective measures of illness severity.
Objectives:
This study aimed to characterize symptom burden, identify distinct profiles based on symptom burden and illness severity, and determine whether observed profiles are defined by differences in social determinates of health (SDOH).
Methods:
This was a prospective study of adult lung transplant candidates. Symptoms were assessed within 3 months of transplant with the Memorial Symptom Assessment Scale (MSAS). MSAS subscale (physical and psychological) scores range 0-4 (higher=more symptom burden). The lung allocation score (LAS) (range 0-100) was our proxy measure of illness severity. The MSAS subscales and LAS were used as continuous indicators in a latent profile analysis to identify distinct symptom-illness severity profiles. Comparative statistics were used to identify SDOH differences among observed profiles.
Results:
Among 93 candidates, 3 distinct symptom-illness severity profiles were identified: 71% had a mild profile in which mild symptoms (MSAS physical 0.49; MSAS psychological 0.57) paired with mild illness severity (LAS 38.59). Of the 29% mismatched participants, 9% had moderate symptoms (MSAS physical 0.88; MSAS psychological 1.47) but severe illness severity (LAS 88.02) and 20% had severe symptoms (MSAS physical 1.30; MSAS psychological 1.94) but mild illness severity (LAS 42.13). The two mismatch profiles were younger, more racially diverse, and had higher psychosocial risk scores.
Conclusion:
Symptom burden is heterogenous, does not always reflect objective measures of illness severity, and may be linked to SDOH.
Background:
COPD is a high prevalence chronic disease that involves large reductions of health-related quality of life (HRQL) of patients. This study aims to describe the HRQL of patients with COPD in Extremadura (Spain).
Methods:
This is a cross-sectional observational study carried out using a representative sample of patients diagnosed with COPD in Extremadura. The inclusion criteria were patients of legal age, diagnosed with COPD at least 12 months prior to the visit, residing in Extremadura, with electronic medical records available for the 12 months prior to the visit and providing informed consent. The intervention aimed to elicit HRQL indicators obtained from two validated questionnaires: EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L), and St. George's Respiratory Questionnaire-COPD (SGRQ-C). The main outcome measures were general HRQL (utility and visual analogue scale) and specific quality of life of COPD patients (total score and three component scores: Symptoms, Activity, and Impacts). Stepwise multiple regression analysis was applied to evaluate the association of EQ-5D-5L and SGRQ-C with respect to clinical and sociodemographic characteristics of the patients.
Results:
We recruited 386 patients (mean age 71.8 ± 10.3 years, 76.2% males). In the EQ-5D-5L, participants reported greater problems with respect to mobility (56.5%) and pain/discomfort (48.2%). The mean utility was 0.72 ± 0.31, and the SGRQ-C total score was 40.9 ± 25.0. The results of both questionnaires were associated with number of exacerbations in the last 12 months, level of COPD severity, gender, and education level of the patient (p < 0.05).
Conclusions:
The results for both utility and total SGRQ-C score indicate that having suffered exacerbations in the last year, presenting a higher level of severity, being a woman, and having a low education level are related to worse HRQL in patients with COPD.
Background: COPD is a common cause of morbidity and mortality. The aim of this study was to explore patients’ experiences, self-reported needs, and needs-driven strategies to cope with self-management of COPD.
Patients and methods: In this phenomenological study, 10 participants with mild to severe COPD were interviewed 1–2 times, until data saturation was reached. In total, 15 in-depth interviews were conducted, recorded, transcribed, and analyzed.
Results: COPD negatively affected participants’ physical and psychosocial well-being, their family relationships, and social life. They described their experiences of COPD like fighting a war without weapons in an ever-shrinking world with a loss of freedom at most levels, always fearing possible breathlessness. Fourteen needs were identified and eight clusters of needs-driven strategies that participants used to cope with self-management of COPD. Coping with the reality of COPD, a life-threatening disease, meant coping with dyspnea, feelings of suffocation, indescribable smoking addiction, anxiety, and lack of knowledge about the disease. Reduced participation in family and social life meant loss of ability to perform usual and treasured activities. Having a positive mindset, accepting help and assuming healthy lifestyle was important, as well as receiving continuous professional health care services. The participants’ needs-driven strategies comprised conducting financial arrangements, maintaining hope, and fighting their smoking addiction, seeking knowledge about COPD, thinking differently, facing the broken chain of health care, and struggling with accepting support. Procrastination and avoidance were also evident. Finally, the study also found that participants experienced a perpetuating cycle of dyspnea, anxiety, and fear of breathlessness due to COPD which could lead to more severe dyspnea and even panic attacks.
Conclusion: COPD negatively affects patients’ physical and psychosocial well-being, family relationships and, social life. Identifying patients’ self-reported needs and needs-driven strategies can enable clinicians to empower patients by educating them to improve their self-management.
Background
Chronic obstructive pulmonary disease (COPD) is a prevalent illness that, due to its symptoms and treatment, entails a significant burden for the affected person, and his/her family, health care and private finances. Today, knowledge and understanding are sparse regarding COPD-affected persons’ own lived experiences and about the symptom burden and its effect on their daily life. Due to this knowledge gap the aim of this study was to identify and describe the symptom burden and its effect on daily life in people with COPD, based on their own lived experiences.
Subject and method
Eleven males and 14 females in GOLD stages III and IV, in an age range of 58–82 years, were interviewed. An interview guide was used to direct the face-to-face interviews. Data was analyzed with thematic analysis following the six steps according to Braun and Clarke.
Results
The results highlighted one theme: an altered everyday life. The altered everyday life leads to a need for support to handle everyday life and for different strategies to live as desired. Persons with COPD need to take each day as it comes and their life is not easy to plan since it depends on how they feel from day to day. Life is handled with several strategies such as breathing techniques, and ways to take care of the home and garden as well as the emotions. Support from the next of kin, society and the health care service is important.
Conclusion
This study provides the insight that persons with COPD in stages III and IV have an altered life caused by the symptom burden. They must struggle with strategies to handle everyday life. There is a need of support from the next of kin and society to facilitate daily living, but this support needs to be well-balanced.
Background:
Activities of daily living (ADL) are important for an independent life. As COPD progresses, the ability to complete ADL is usually reduced. Knowing the possible factors that influence the ability to perform ADL may allow better targeting of appropriate rehabilitation programs to increase the independence levels and/or to prevent further decreases in patients with COPD. Therefore, the aim of this study was to investigate ADL performance as measured by the London Chest Activity of Daily Living scale, which is a commonly used measure in patients with COPD.
Methods:
This cross-sectional study included 44 clinically stable subjects who were not taking antibiotics and had not made any changes in their medications for at least three weeks with a COPD diagnosis based on Global Initiative for Chronic Obstructive Lung Disease. Demographic characteristics, pulmonary function, ADL measured by the London Chest Activity of Daily Living scale, functional exercise capacity via the 6-min walk distance, disease-related symptoms measured by the COPD Assessment Test, and peripheral and respiratory muscle strength were evaluated. A multiple linear regression (stepwise) analysis was used to determine the variables that have the greatest influence on ADL (ie, the London Chest Activity of Daily Living scale score).
Results:
The London Chest Activity of Daily Living scale score had moderate correlations with the COPD Assessment Test score (r = 0.31, P = .041), maximum expiratory pressure value (r = -0.37, P = .01), 6-min walk distance (r = -0.48, P = .001), knee extensor muscle strength (r = -0.47, P = .001), handgrip strength (r = -0.44, P = .003). The 6-min walk distance, COPD Assessment Test score and maximal expiratory pressure values were significant and independent determinants of the London Chest Activity of Daily Living scale, with 40.1% of the variance in subjects with COPD.
Conclusions:
Functional exercise capacity, disease-related symptoms, and expiratory muscle strength have the greatest influence on ADL in the subjects with COPD. The level of independence to perform ADL can be increased by improving functional exercise capacity, reducing symptoms, and increasing expiratory muscle strength in subjects with COPD.
Abstract Background Many studies have reported the prevalence of chronic obstructive pulmonary disease (COPD) and its effects and prognosis in patients with lung cancer, but few have considered quality of life and survival of patients with lung cancer according to severity of airway obstruction. This study investigated the presence of COPD and the severity of airway obstruction in patients with non-small cell lung cancer (NSCLC), and analyzed how these factors affected symptoms, quality of life, and prognosis. Methods We retrospectively reviewed the prospective lung cancer database of the Catholic Medical Centers at the Catholic University of Korea from 2014 to 2017. We enrolled patients with advanced NSCLC and evaluated quality of life using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. We also estimated pulmonary function and analyzed survival data. Results Of the 337 patients with advanced NSCLC, 170 (50.5%) had COPD and 167 (49.5%) did not. Significant differences were observed in symptoms between the two groups. The COPD group complained of more symptoms, such as cough, sputum, and dyspnea, than those in the non-COPD group. The distribution according to the severity of obstruction in the COPD group was as follows: Grade 1 (FEV1 ≥ 80%) 35 patients (20.6%), Grade 2 (50% ≤ FEV1
Background
Data suggesting that low physical activity levels are associated with increased mortality and exacerbations in patients with COPD have led to increasing interest in the role of physical activity in COPD. This study evaluated self-reported functional performance, a measure of physical activity impairment, according to current treatment regimen, lung function, symptoms, and Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 groups in a large sample of patients with COPD.
Methods
This multicenter, cross-sectional, observational study (study identifier: D5970R00003) included patients with COPD (≥40 years) in the USA. A self-completion questionnaire captured demographics and patient-reported outcomes, including the Functional Performance Inventory-Short Form (FPI-SF). Diagnosis and treatment history (including spirometry results) were extracted from medical charts. Multiple linear regression was used to determine the relationship between FPI-SF and FEV1 % predicted, and FPI-SF and COPD assessment test (CAT) score.
Results
Overall, 1,775 patients participated (classified as GOLD 2017 group A, 14.8%; B, 46.6%; C, 2.6%; D, 36.0%). Physical activity impairment affected patients across all treatment regimens and GOLD groups (mean FPI-SF total score: 2.1), with the greatest impairment within FPI-SF observed for domains requiring most physical exertion, “physical exercise” and “maintaining the household” (mean FPI-SF scores: 1.7 and 1.8, respectively). Patients receiving loose triple therapy and those in GOLD group D had the highest impairment (mean FPI-SF total scores: both 1.9), and the lowest FEV1 % predicted (55.5% and 54.7%, respectively). FPI-SF total score correlated with FEV1 % predicted and more strongly with CAT score (all P<0.05).
Conclusion
The stronger correlation between FPI-SF and CAT scores compared to FPI-SF and FEV1 % predicted suggests that symptoms may have a greater impact on patients’ functional performance than lung function. Further longitudinal studies are required to establish a correlation between the effect of treatment on symptoms, lung function, and physical activity.
Background
COPD is associated with a large disease burden. The use of dual (two maintenance treatments) and triple (combination of any three treatments) therapy has shown efficacy for symptom relief; however, some patients with COPD remain symptomatic despite these therapies. This study assessed the scope and magnitude of the symptomatic burden for patients with COPD receiving dual or triple therapy.
Patients and methods
Cross-sectional data from three Adelphi COPD surveys (2013–2016) conducted in the USA, Europe, Japan, and China were analyzed for patients with COPD and forced expiratory volume in 1 second ≤65% receiving dual or triple therapy for ≥3 months. Physicians completed clinical and disease characteristic forms for identified patients. Corresponding patients completed questionnaires that included validated survey instruments to assess adherence and symptom impact. Descriptive statistics are reported.
Results
Our analysis included 690 patients (mean age 68.2 years; 73.3% male); 41.4% and 58.6% were receiving dual and triple therapy, respectively. Most patients had dyspnea with substantial disability (modified Medical Research Council dyspnea scale rating ≥2, 56.3%; large health status impairment from symptoms, COPD Assessment Test score >20, 64.4%). A large symptom burden was observed, even for patients highly adherent to treatment (Morisky Medication Adherence Scale 8, 30.3% [185/612]), of whom 62.1% still had a COPD Assessment Test score >20. Sensitivity analyses of patients regardless of their forced expiratory volume in 1 second status and of those receiving treatment for >6 months both reported similar results.
Conclusion
Although patients who consult their physicians more frequently than average may be overrepresented because of the observational design of this study, we report that unmet needs remain for patients with COPD, despite the use of dual or triple therapy. A percentage of patients with COPD reported major symptom burden affecting their daily living and causing a large impairment in the health status, regardless of treatment adherence.
Background
Although evidence shows that patients with end stage renal disease (ESRD) experience a high symptom burden which impacts on quality of life (QoL), less is known about patients with earlier stages of chronic kidney disease (CKD). This study aimed to explore symptom burden and potential contributing factors in patients with CKD Stage 1-5 not requiring renal replacement therapy (RRT).
Methods
Patients with CKD Stage 1-5 and not on RRT were asked to report their symptoms using the Leicester Uraemic Symptom Score (LUSS), a questionnaire which assesses the frequency and intrusiveness of 11 symptoms commonly reported by kidney patients.
Results
Symptoms were assessed in 283 CKD Stage 1-5 patients: 54% male, mean age 60.5 standard error± 1.0, mean eGFR 38ml/min/1.73m². Some 96% (95% confidence interval 93.2–98.0) of participants reported experiencing at least one symptom, the median reported being six. Excessive tiredness (81%;76.0–85.6), sleep disturbance (70%;64.3–75.3) and pain in bones/joints (69%;63.4–74.6) were reported most commonly. Overall, few significant associations were found between biochemical markers of disease severity and symptom burden. Men tended to report fewer symptoms than women and South Asian patients often described experiencing symptoms with a greater severity. Older patients found musculoskeletal symptoms more intrusive whereas younger patients found reduced concentration more intrusive.
Conclusions
Our findings suggest that patients with CKD stages 1–5 experience a multitude of symptoms that could potentially impact QoL. Using multidimensional tools like the LUSS, more exploration and focus could provide a greater opportunity for patient focussed symptom control from the earliest stages of CKD.
Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.
Background
Chronic obstructive pulmonary disease (COPD) can greatly impact the quality of life by limiting patients’ activities. However, data on impact of symptomatic burden on the health care resource utilization (HCRU) and employment in COPD are lacking. We examined the association between COPD Assessment Test (CAT) score and direct/indirect costs associated with HCRU and work productivity.
Methods
Data from >2,100 patients with COPD consulting for routine care were derived from respiratory disease-specific programs in Europe, the USA and China. Questionnaires, including CAT and Work Productivity and Activity Impairment (WPAI), were used to collect the past and current disease status data and HCRU characteristics from physicians (general practitioners/specialists) and patients. A regression approach was used to quantify the association of CAT with HCRU and WPAI variables. CAT score was modeled as a continuous independent variable (range: 0–40).
Results
Ninety percent of patients with COPD had a CAT score ≥10. Short-acting therapy and maintenance bronchodilator monotherapy, respectively, were currently prescribed to patients with CAT scores of 10–19 (5.8% and 27.6%), 20–29 (5.1% and 13.1%) and 30–40 (2.8% and 6.6%). Prescribing of maintenance bronchodilator dual therapy was low across the CAT score groups (0–9, 7.8%; 10–19, 6.4%; 20–29, 5.9%; 30–40, 4.4%), whereas maintenance triple combination therapy was prescribed more commonly in patients with higher CAT scores (0–9, 16.1%; 10–19, 23.2%; 20–29, 25.9%; 30–40, 35.5%). Increasing CAT scores were significantly associated with a higher frequency of primary care physician visits (P<0.001), pulmonologist visits (P=0.007), exacerbations requiring hospitalization (P<0.001) and WPAI scores (P<0.001).
Conclusion
Most patients with COPD presented with high symptom levels, despite being treated for COPD. Increasing symptom burden was associated with increasing HCRU and had a detrimental impact on work productivity.
Morning symptoms are common in chronic obstructive pulmonary disease (COPD). Many COPD patients consider the morning as the most troublesome part of the day, in which they experience more symptoms and physical activity limitations.
To systematically report evidence of the association between morning symptoms and physical activity in COPD patients, a literature search was conducted using relevant MESH terms and text words in PubMed, Embase, Web of Science, COCHRANE, CINAHL and PsycINFO. Quality of the articles was assessed with validated checklists.
Eight studies were included. Morning symptoms were present in 39.8–94.4%. In 37.0–90.6% of all COPD patients, there was an association between physical activity and morning symptoms. However, causality could not be proved. Morning symptoms were associated with a sedentary lifestyle (p<0.05). Treatment in line with the guidelines improved the degree of activity limitations due to morning symptoms (p<0.0001).
Across all disease stages, COPD patients experience morning symptoms which are negatively associated with physical activity. Physicians should consider morning symptoms as a treatment goal. Pharmacotherapy may improve the degree of activity limitations due to morning symptoms. More objective research should focus on symptoms, activity limitations and physical inactivity of COPD patients, especially in the morning.
Background:
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. It is an incurable disease with improvement in quality of life (QOL) as a major focus area for management. This study assesses the QOL of COPD patients and the factors affecting it.
Materials and methods:
All 124 patients diagnosed with COPD in a larger cross-sectional study to determine the prevalence of COPD were assessed for their QOL using St. George's respiratory questionnaire for COPD patients (SGRQ-C). Spirometry was performed to assess lung function and diagnose COPD. Chronic lung disease (CLD) severity index was used to assess the severity of symptoms and the Medical Research Council questionnaire was used to assess the severity of dyspnea. Sociodemographic data regarding the patients were also recorded.
Results:
Patients with COPD showed significantly reduced health-related quality of life (HRQOL). CLD estimate for severity of lung disease and the Medical Research Council assessment for dyspnea and the duration of illness showed a highly significant positive correlation with HRQOL. There was a statistically significant negative correlation between lung function and SGRQ-C score. Increasing age, increased quantum of smoking, and lower socioeconomic status were correlated with poorer HRQOL. No association between QOL and education, body mass index (BMI), and gender was observed.
Conclusion:
This study showed that Indian patients with COPD had reduced HRQOL. Poor lung function, increased disease duration and smoking, and worsening symptoms impacted HRQOL negatively.
Online self-management diaries are used to support patients' self-management skills and facilitate associated behavioral changes. Although web-based diaries are well-known as a potential self-management tool, reasons that patients use (or do not use) self-management diaries, as well as perceptions and behaviors related to diary use, remain largely unknown.
Semistructured interviews (n = 30) were conducted with health-care professionals and subjects to understand perceptions and behaviors related to self-management diary use for asthma and COPD in 2 hospitals in Rotterdam, The Netherlands.
Subjects in this study used self-management diaries to improve their knowledge of the disease, cope more consciously with their disease, feel in control, and discuss outcomes from the self-management diaries with their health-care professionals. Two subjects reported that they used the self-management diary to cope more effectively with their disease and recognized an exacerbation and acted by adjusting their medications. Both health-care professionals and subjects experienced practical barriers in integrating self-management diaries into their regular practices. Subjects' reasons for nonuse were related to the intervention, the disease, and subject-provider contact.
Health-care professionals should help patients use self-management diaries by collaboratively developing an individual treatment plan and by showing patients how to use the diaries to recognize and act on an exacerbation. Together with the suggestions made for improving the self-management diaries, this will aid in the integration of self-management diaries into regular health-care practice and enhance patients' self-management of their disease.
Copyright © 2015 by Daedalus Enterprises.
Background
Effective self-management in chronic obstructive pulmonary disease (COPD) is crucial to reduce hospital admissions and improve outcomes for patients. This includes early detection and treatment of exacerbations by patients themselves.
Aims
To explore patients’ current understanding and experience of managing and identifying COPD exacerbations at home.
Methods
A qualitative, interview-based study was carried out in patients’ homes. Interviews were audio-recorded, transcribed and analysed using a grounded theory approach. Forty-four patients (17 women, 27 men; age range 55–85 years), with moderate-to-very-severe COPD, were recruited to the interview study from primary and secondary care settings in Oxford, UK, during 2012–2013.
Results
Patients identified exacerbations on the basis of measurable, ‘visible’ symptoms, such as cough and sputum and ‘invisible’ symptoms, such as chest sensations and bodily knowledge. Most patients seemed to use a combination of these approaches when identifying exacerbations, according to the symptoms that had the most impact on their well-being. Patients used additional self-management strategies during an exacerbation, such as self-medication (antibiotics and steroids) and monitored their recovery. Contact with health-care professionals usually occurred when patients felt no longer able to manage themselves.
Conclusions
Patients use both assessment of objective biomarkers, which are aligned with medical knowledge, and subjective symptoms based on their experience, to identify and manage exacerbations of COPD. Health-care professionals and clinicians should acknowledge this ‘expert patient’ knowledge and integrate this into patients’ care plans to facilitate early recognition and treatment of exacerbations.
The relationship between physical activity, disease severity, health status and prognosis in patients with COPD has not been systematically assessed. Our aim was to identify and summarise studies assessing associations between physical activity and its determinants and/or outcomes in patients with COPD and to develop a conceptual model for physical activity in COPD.
We conducted a systematic search of four databases (Medline, Embase, CINAHL and Psychinfo) prior to November 2012. Teams of two reviewers independently selected articles, extracted data and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess quality of evidence.
86 studies were included: 59 were focused on determinants, 23 on outcomes and 4 on both. Hyperinflation, exercise capacity, dyspnoea, previous exacerbations, gas exchange, systemic inflammation, quality of life and self-efficacy were consistently related to physical activity, but often based on cross-sectional studies and low-quality evidence. Results from studies of pharmacological and non-pharmacological treatments were inconsistent and the quality of evidence was low to very low. As outcomes, COPD exacerbations and mortality were consistently associated with low levels of physical activity based on moderate quality evidence. Physical activity was associated with other outcomes such as dyspnoea, health-related quality of life, exercise capacity and FEV1 but based on cross-sectional studies and low to very low quality evidence.
Physical activity level in COPD is consistently associated with mortality and exacerbations, but there is poor evidence about determinants of physical activity, including the impact of treatment.
This study aimed to examine the importance of fatigue as a clinical indicator in chronic obstructive pulmonary disease (COPD), by analysing its relationship with COPD severity and ability to predict risk of hospitalisation, and by comparing the intensity of fatigue in stable COPD patients with levels of fatigue reported by patients with other chronic conditions.
We studied 100 consecutive patients attending assessment clinics before pulmonary rehabilitation. Both questionnaire and physiological data were collected. Partial correlations, multiple linear regressions and Cox proportional hazard models/negative binomial regressions were used to address the research questions.
A significant relationship existed between fatigue and COPD severity. Fatigue reports predicted future hospitalisation risk. Compared to the lowest third of patients, the third of patients reporting the most intense fatigue showed a 10-fold increase in risk of hospitalisation (fatigue experiences hazard ratio (HR) 10.2, 95% CI 2.66–38.86; fatigue impacts HR 10.7, 95% CI 2.76–41.65). Our COPD sample reported fatigue scores of similar intensity to colorectal cancer patients and HIV-positive patients.
While fatigue is significantly related to COPD functional severity, fatigue data also capture independent information. Fatigue reports can contribute to predictions of hospitalisation risk.
the 65-item Functional Performance Inventory (FPI), developed to quantify functional performance in patients with chronic obstructive pulmonary disease (COPD), has been shown to be reliable and valid. The purpose of this study was to create a shorter version of the FPI while preserving the integrity and psychometric properties of the original.
secondary analyses were performed on qualitative and quantitative data used to develop and validate the FPI long form. Seventeen men and women with COPD participated in the qualitative work, while 154 took part in the mail survey; 54 completed 2-week reproducibility assessment, and 40 relatives contributed validation data. Following a systematic process of item reduction, performance properties of the 32-item short form (FPI-SF) were examined.
the FPI-SF was internally consistent (total scale α = 0.93; subscales: 0.76-0.89) and reproducible (r = 0.88; subscales: 0.69-0.86). Validity was maintained, with significant (P < 0.001) correlations between the FPI-SF and the Functional Status Questionnaire (activities of daily living, r = 0.71; instrumental activities of daily living, r = 0.73), Duke Activity Status Index (r = 0.65), Bronchitis-Emphysema Symptom Checklist (r = -0.61), Basic Need Satisfaction Inventory (r = 0.61) and Cantril's Ladder of Life Satisfaction (r = 0.63), and Katz Adjustment Scale for Relatives (socially expected activities, r = 0.51; free-time activities, r = -0.49, P < 0.01). The FPI-SF differentiated patients with an FEV(l)% predicted greater than and less than 50% (t = 4.26, P < 0.001), and those with severe and moderate levels of perceived severity and activity limitation (t = 9.91, P < 0.001).
results suggest the FPI-SF is a viable alternative to the FPI for situations in which a shorter instrument is desired. Further assessment of the instrument's performance properties in new samples of patients with COPD is warranted.
The primary purpose of this secondary data analysis was to evaluate the efficacy and suitability of the Memorial Symptom Assessment Scale (MSAS) for use with patients with severe chronic obstructive pulmonary disease (COPD). Symptoms experienced by patients with severe COPD were assessed in the original investigation using the 32-item MSAS. The sample consisted of 72 individuals with COPD ranging in age from 36 to 79 years. To increase its efficiency for use with severely ill COPD patients, the original MSAS was shortened to include the 19 most frequently reported symptoms. Reliability of the revised tool remained high (Cronbach's alpha = .86). Content and convergent validity of the revised tool were also established. The revised MSAS appears to be an appropriate measure of the multidimensional, multisymptom experience of patients with severe COPD.
Background:
Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance.
Objectives:
The purpose of this study was to examine interrelationships among dyspnea, anxiety, depressive symptoms, and fatigue as contributing factors to physical performance in COPD.
Methods:
This study used baseline data of 282 COPD patients from a longitudinal observational study to explore the relationship between depression, inflammation, and functional status. Data analyses included confirmatory factor analyses and structural equation modeling.
Results:
Dyspnea, anxiety and depression had direct effects on fatigue, and both dyspnea and anxiety had direct effects on physical performance. Higher levels of dyspnea were significantly associated with impaired physical performance whereas higher levels of anxiety were significantly associated with enhanced physical performance.
Conclusion:
Dyspnea was the strongest predictor of impaired physical performance in patients with COPD.
Background and Aims: Individuals with inflammatory bowel disease experience debilitating symptoms on a daily basis, but little is known about symptom burden in IBD. The objectives were to (i) identify the most prevalent symptoms and the average number of symptoms experienced; (ii) assess symptom frequency, severity and distress; and (iii) determine the most burdensome symptoms experienced by individuals with inflammatory bowel disease. Methods: A cross-sectional descriptive design was used to collect data in a single regional treatment centre in Ireland. A consecutive and unique sample of 247 individuals diagnosed with Crohn's disease and ulcerative colitis completed a modified disease-specific version of the Memorial Symptom Assessment Scale. Results: Participants reported experiencing a median of 10 symptoms during the last week, but as many as 16 symptoms were experienced by those with active disease. Of the symptoms experienced, lack of energy was identified as the most burdensome symptom. Bowel symptoms of urgency and diarrhoea and irritable bowel syndrome-type symptoms such as feeling bloated and flatulence were also problematic. Worry was ranked the most burdensome psychological symptom experienced. Symptom burden scores varied according to disease type and disease status, with significant differences found between those with active and inactive disease. Conclusions: Individuals with inflammatory bowel disease experience a considerable number of symptoms and are burdened by both physical and psychological symptoms, particularly during active disease. Healthcare professionals' focus of assessment needs to be broadened to encompass multiple symptoms. Greater attention needs to be given to fatigue and psychological symptoms.
Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition that leads to significant burden, both medically and financially. It affects millions of people worldwide and causes significant morbidity and mortality. Most detailed information related
to its prevalence, morbidity, and mortality comes from high-income countries, but 90% of COPD-related deaths occur in low- and middle-income countries. Cigarette smoking is the main risk factor for developing COPD, but other risk factors do exist and need to be recognized. A majority of morbidity
and mortality as well as health care costs occur from acute exacerbations of COPD with a known phenotype of patients being “frequent exacerbators.” Health care costs for COPD are not only from treatment of exacerbations, such as hospitalization, but also medication costs for maintenance
therapy and outpatient treatment. COPD has been linked with many comorbidities leading to significant burden of disease. The goal of this review is to evaluate the overall burden of disease including prevalence, morbidity, mortality, health care costs, and economic costs.
Objectives:
To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.
Background:
Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.
Methods:
A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.
Results:
The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.
Conclusions:
Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.
Inflammatory bowel disease collectively known as Crohn’s disease and ulcerative colitis are chronic inflammatory diseases of the digestive tract. Periods of active and inactive disease are common along the trajectory of this illness. A range of symptoms such as fatigue, diarrhoea and abdominal pain are experienced and are often very debilitating in nature resulting in significance interference in daily life. Despite this, to date research in the area of symptoms remains an underexplored topic. This paper aims to discuss current approaches to symptom assessment in IBD and the potential to measure symptom burden in further research, in order to gain a greater understanding into the experiences of individuals with IBD.
People with chronic obstructive lung diseases often experience a variety of symptoms. Few studies, however, have described these symptoms in detail. This study sought to examine concurrent symptoms, symptom clusters, and the effects of symptoms on functioning in Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD).
Outpatients with asthma or COPD participated in this cross-sectional, correlational study. Symptoms, dyspnea, mood, and functional performance were assessed with questionnaires. Descriptive and inferential statistics were used to analyze the data.
The most frequently reported symptom was shortness of breath. Three factors emerged from 16 symptoms. Age, mean severity score of 7 symptoms, working status, level of acculturation, and level of education explained significant variance in functional performance.
The symptom cluster, consisting of 7 symptoms, showed the greatest effect on levels of functioning, which emphasizes the importance of assessment for coexisting symptoms in populations with these diseases.
Little is known about symptom burden and palliative care needs of breathless patients with advanced cancer and chronic obstructive pulmonary disease (COPD).
We aimed to describe and compare symptoms and needs in these two groups in relation to survival.
Cross-sectional study of breathless patients with COPD III/IV or advanced cancer. Data were collected in an interview using the Memorial Symptom Assessment Scale short form (MSAS-SF), the modified Borg Scale, the Hospital Anxiety and Depression Scale, and the Palliative Care Outcome Scale (POS). Follow-up information was collected on survival.
Forty-nine patients with cancer and 60 patients with COPD were recruited. Both groups had similar demographics and a similar high symptom burden: median number of 14 symptoms; most prevalent symptoms in both groups besides breathlessness were drowsiness, lack of energy, cough; median global symptom distress on MSAS-Global Distress Index MSAS-GDI 1.6 in cancer and 1.4 in COPD. HADS depression scores were higher than HADS anxiety scores. Palliative care needs were also similar in both groups. Median survival was 107 days in patients with cancer and 589 days in patients with COPD.
Symptom burden and palliative care needs of breathless patients with severe COPD are considerable and as high as among patients with advanced primary and secondary lung cancer although patients with COPD have a longer survival.
Historically, palliative care has been developed for cancer patients and is not yet generally available for patients suffering from chronic life-limiting illnesses, such as chronic obstructive pulmonary disease (COPD). To examine whether COPD patients experience similar or worse disease burden in comparison with non-small cell lung cancer (NSCLC) patients, we compared the health-related quality of life (HRQOL) scores of severe COPD patients with those of advanced NSCLC patients. We also formally updated previous evidence in this area provided by a landmark study published by Gore et al. in 2000. In updating this previous evidence, we addressed the methodological limitations of this study and a number of confounding variables. Eighty-two GOLD IV COPD patients and 19 Stage IIIb or IV NSCLC patients completed generic and disease-specific HRQOL questionnaires. We used an individual patient data meta-analysis to integrate the new and existing evidence (total n=201). Finally, to enhance between-group comparability, we performed a sensitivity analysis using a subgroup of patients with a similar degree of "terminality," namely those who had died within one year after study entry. Considerable differences in HRQOL were found for physical functioning, social functioning, mental health, general health perceptions, dyspnea, activities of daily living, and depression. All differences favored the NSCLC patients. The sensitivity analysis, using only terminal NSCLC and COPD patients, confirmed these findings. In conclusion, end-stage COPD patients experience poor HRQOL comparable to or worse than that of advanced NSCLC patients. We discuss these findings in the light of the notion that these COPD patients may have a similar need for palliative care.
Although chronic obstructive pulmonary disease (COPD) is a highly prevalent and disabling illness, few empirical studies have evaluated the impact of the disease on symptom distress, functional status, and quality of life. These outcomes were explored in a prospective survey of 100 patients with advanced COPD. Patients were recruited from two academic centers. The mean forced expiratory volume in 1 second (FEV1) was 24.4% (standard deviation=3.9). Validated instruments were used to assess symptom distress (Memorial Symptom Assessment Scale [MSAS]), mental health (Mental Health Inventory [MHI]-5), functional status (Sickness Impact Profile [SIP]), quality of life (Multidimensional Index of Life Quality [MILQ]), spirituality (Functional Assessment of Chronic Illness Therapy [FACIT] Spirituality Scale), and comorbid conditions (Charlson Comorbidity Index). The most prevalent symptoms were dyspnea (94%), fatigue (71%), xerostomia (60%), coughing (56%), and anxiety (51%). Other symptoms with high prevalence were drowsiness (47%), irritability (42%), feeling nervous (40%), and wheezing (40%). Significant pain was reported in about one-third of patients. Patients reported relatively high levels of overall functional impairment (SIP median=24.0) and modest impairment in overall quality of life (MILQ median=52). Overall, psychological well-being was relatively unimpaired (median=24.5), and the comfort derived from faith was intact (FACIT median=2.5). Impairment in quality of life was strongly associated with symptom distress (MSAS-GDI; r=-0.74, P<0.001), functional impairment (SIP total; r=-0.59, P<0.001), female sex (r=-0.26, P=0.01), and poor psychological well-being (MHI-5; r=0.68, P<0.001). In multivariate analyses, poor quality of life was strongly correlated with higher total symptom distress, sickness-related dysfunction, and lower levels of psychological well-being (R(2)=0.66). In addition, two specific psychological symptoms-worrying and feeling irritable-were independently predictive of poor quality of life. Patients with advanced COPD have multiple distressing symptoms and a high prevalence of disturbances in mood, functional status, and quality of life. A focus on ameliorating prevalent physical symptoms and psychological distress may lead to an improvement in the overall quality of life in this patient population.
Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and outpatients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 evaluable patients was 55.5 years (range 23-86 years); over 60% were women and almost two-thirds had metastatic disease. The Karnofsky Performance Status (KPS) score was < or = 80 in 49.8% and 123 were inpatients at the time of assessment. Across tumour types, 40-80% experienced lack of energy, pain, feeling drowsy, dry mouth, insomnia, or symptoms indicative of psychological distress. Although symptom characteristics were variable, the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing. The mean (+/- SD range) number of symptoms per patient was 11.5 +/- 6.0 (0-25); inpatients had more symptoms than outpatients (13.5 +/- 5.4 vs. 9.7 +/- 6.0, p < 0.002) and those with KPS < or = 80 had more symptoms than those with KPS > 80 (14.8 +/- 5.5 vs. 9.2 +/- 4.9, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Functional status is frequently discussed as a key element of nursing practice and a critical outcome criterion, and yet this phenomenon is poorly understood. Many important questions have not been addressed, in part because terms such as functional status, functional ability, health status, and quality of life have been used interchangeably. Failure to clearly outline the terminology and refine the definitions has placed us on a functional status merry-go-round that inhibits scientific progress in this area. The purpose of this article is to introduce an analytical framework for the study of functional status. Four dimensions of functional status are proposed: functional capacity, performance, reserve, and capacity utilization. These terms are defined and clarified through a discussion emphasizing the consequences for measurement, intervention, and clinical trials. The article concludes by illustrating the utility of the framework in recognizing and appreciating functional status trajectory patterns in aging and chronic illness.
Little is known about the frequency and range of symptoms experienced by community-dwelling older persons with advanced chronic disease who are not enrolled in hospice. The objectives of our study were to determine (1) the prevalence of a range of symptoms among older persons with advanced chronic disease and (2) whether the prevalence of symptoms is similar across diagnoses.
This was a cross-sectional study of the symptoms reported by 226 community-dwelling persons 60 years or older with advanced chronic obstructive pulmonary disease (COPD), cancer, or congestive heart failure (CHF). Symptoms were assessed using the Edmonton Symptom Assessment System.
Virtually all participants (86%) experienced at least 1 symptom that rated moderate or severe, and most (69%) experienced 2 or more symptoms. The symptoms reported by the greatest proportion of participants were limited activity (61%), fatigue (47%), and physical discomfort (38%). Participants with COPD had a higher unadjusted mean +/- SD number of moderate or severe symptoms (3.3 +/- 2.1) than did participants with cancer (2.6 +/- 1.8; P = .03) or CHF (2.0 +/- 1.7; P<.001). After we adjusted for sociodemographic factors, compared with participants with CHF, participants with cancer experienced 38% (95% confidence interval, 9%-75%) more moderate or severe symptoms and participants with COPD experienced 71% (95% confidence interval, 37%-114%) more moderate or severe symptoms.
Most community-dwelling older persons with advanced COPD, cancer, or CHF experienced multiple moderate or severe symptoms. The clinical care of community-dwelling older persons with advanced chronic illnesses would be enhanced by the identification and alleviation of the range of symptoms they experience.
To analyze the concept of symptom burden and discuss implications for symptom research and symptom management.
MEDLINE, CINAHL, PsycINFO, Cochrane Reviews, and published literature.
Through Rodgers's evolutionary method of concept analysis, attributes of symptom burden were identified as dynamic, multidimensional, quantifiable, subjective, and physiologic. The major antecedent was multiple symptoms related to worsening disease status. Consequences of symptom burden included decreased survival, poor prognosis, delay or termination of treatment, increased hospitalizations and medical costs, decreased functional status, and lowered self-reported quality of life. Symptom burden is defined as the subjective, quantifiable prevalence, frequency, and severity of symptoms placing a physiologic burden on patients and producing multiple negative, physical, and emotional patient responses.
Symptom burden is an important concept in the symptoms experience, separate from symptom distress and other related terms. The continued differentiation of symptom concepts is important for sound methodologic research and meaningful interventions that affect and improve patient experiences.
Clarifying multiple symptom concepts in the symptoms experience, determining appropriate measurement methodologies for the concepts, and identifying appropriate strategies will lessen the burden of symptoms and contribute to improved quality of life and better patient outcomes.
Range and severity of symptoms over time among older adults with COPD and HF
- Walke
Range and severity of symptoms over time among older adults with COPD and HF
- L Walke
- A Byers
- M Tinetti
- J Dubin
- R Mccorkle
- T Fried
Walke, L., Byers, A., Tinetti, M., Dubin, J., McCorkle, R., & Fried, T. (2007). Range and
severity of symptoms over time among older adults with COPD and HF. Archives of
Internal Medicine, 167(22), 2503-2508.