Impact of Chronic Obstructive Pulmonary Disease on Quality of Life: The Role of Dyspnea

https://doi.org/10.1016/j.amjmed.2006.08.003Get rights and content

Abstract

Dyspnea is a common symptom that accompanies a diagnosis of chronic obstructive pulmonary disease (COPD). Dyspnea often interferes with the patient’s health-related quality of life (HRQOL), yet it is often underreported by the patient and underrecognized by the clinician. Reductions in objective pulmonary function measurements, such as forced expiratory volume in 1 second, are not well correlated with the patient’s perception of symptoms and HRQOL. The patient’s self-reported or subjective assessment is therefore important when evaluating the intensity of dyspnea and its impact on HRQOL. This article describes several well-validated questionnaires and dyspnea assessment scales that can be effective for assessing the intensity and impact that dyspnea may have on patient-perceived HRQOL. In addition, it describes the integration of pulmonary rehabilitation and specific pharmacotherapies as well as how these interventions can positively influence and modify the severity and distress of dyspnea. Effective assessment and therapeutic management of dyspnea for the patient living with COPD are opportunities to improve the patient’s overall HRQOL.

Section snippets

Assessment of dyspnea in chronic obstructive pulmonary disease

A discrepancy often exists between the patient’s perception and the physician’s clinical evaluation of the impact of symptoms that frequently accompany COPD, particularly as it relates to dyspnea. The patient’s individual perception of symptom burden frequently does not correspond precisely with the clinician’s assessment of traditional signs during physical examination, such as labored breathing, breath sounds and wheezing, accessory muscle use, or changes in respiratory rate. The American

Instruments for dyspnea assessment

Because assessment and evaluation of dyspnea depend on subjective experience, the measurement of dyspnea can be difficult and must rely on patients’ self-reports for quantification of its intensity and impact. Instruments can be discriminative, measuring differences in the intensity of dyspnea between groups of individuals, or evaluative, measuring changes in dyspnea as an outcome of intervention or treatment. Ideally, instruments to evaluate dyspnea should be of clinical value as well as

Chronic Obstructive Pulmonary Disease Interventions That Improve Dyspnea

Clinical trials of pulmonary rehabilitation and pharmacologic interventions, or a combination of both, have often included assessments of functional capacity, HRQOL, and dyspnea as important health outcomes in patients with COPD.

Summary

Increasingly recognized as an important contributor to the disability associated with COPD, dyspnea provides information about the impact of respiratory impairment on the patient’s HRQOL, likely the most important aspect of COPD from the patient’s perspective. No longer solely an outcome measure in clinical research of chronic lung disease, dyspnea is increasingly—and appropriately—considered a fundamental, and potentially modifiable, symptom of COPD in the clinical setting. Indeed, in patients

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