Christine Råheim Borge

Association of breathlessness with multiple symptoms in chronic obstructive pulmonary disease

AIM This paper is a report of an exploration of relationships between demographic and clinical variables and the symptoms of breathlessness, depression, anxiety, fatigue, sleeping difficulties and pain for patients with chronic obstructive pulmonary disease. BACKGROUND Research into chronic obstructive pulmonary disease has focused on single symptoms and we lack knowledge about possible associations between several symptoms. METHODS A total of 154 patients with chronic obstructive pulmonary disease participated in a cross-sectional study from June 2006 to December 2007 (response rate 40%). All underwent pulmonary lung function tests and completed questionnaires including demographic variables, the Brief Pain Inventory, Hospital Anxiety and Depression Scale, Lee Fatigue Scale, General Sleep Disturbance Scale and the Respiratory Quality of Life Questionnaire. Bivariate correlation and multiple regression analyses were performed. RESULTS Breathlessness was statistically significantly positively associated with the other symptoms, after controlling for demographic and clinical variables. Younger age was statistically significantly related to more breathlessness, anxiety and sleeping difficulties and lower levels of education was statistically significantly related to more breathlessness, depression and anxiety. In relation to clinical variables, smoking was statistically significantly related to more depression, whereas more co-morbidity was statistically significantly related to more breathlessness and pain. Poorer lung function was statistically significantly related to more breathlessness. However, higher lung function was related to more sleeping difficulties. CONCLUSION Breathlessness is associated with symptoms such as depression, anxiety, fatigue, sleeping difficulties and pain, suggesting the need for an expanded focus on symptoms in chronic obstructive pulmonary disease guidelines, health care and research.

Pain and quality of life with chronic obstructive pulmonary disease

BACKGROUND Pain as a symptom may be underrecognized in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE The aim of this study is to explore the prevalence and intensity of pain, its location, how demographic and clinical variables may be related to pain, and how pain is associated with quality of life (QOL). METHODS In this cross-sectional study, 154 patients with COPD answered the Brief Pain Inventory, Respiratory Quality of Life Questionnaire, and Quality of Life Scale, and performed spirometry. RESULTS Seventy-two percent of the patients indicated the location of pain on a body diagram. Lower lung function, higher score of pain intensity, and pain interference were associated with lower disease QOL. A higher score of pain interference was associated with lower global QOL. When controlling for disease QOL in the equation of global QOL, pain interference was no longer significant. CONCLUSION The experience of pain is related to disease QOL in patients with COPD.

Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews.

BackgroundThis paper reviews evidence and quality of Systematic Reviews (SRs) on the effects of breathing control exercises (BCEs) and respiratory muscle training (RMT) on breathlessness/dyspnea and other symptoms, and quality of life (QOL) for individuals with chronic obstructive pulmonary disease (COPD).MethodsA search for BCE and RMT literature in COPD published between January 1, 2002 and December 31, 2013 was performed in the following databases: PubMed, Ovid, CINAHL, PsycINFO, AMED, Cochrane and PEDro. The AMSTAR criteria were used to evaluate quality.ResultsAfter reviewing 642 reports, seven SRs were identified on RMT and BCEs. Three SRs were of high quality, three were of moderate quality, and one was of low quality. Two high-quality SRs reported significantly beneficial effects of RMT on dyspnea, and one reported significant effects on disease-specific QOL and fatigue. In these SRs, pooled data analyses were performed with three to fourteen single randomised control trials (RCTs) included in the analysis. In one of the SRs the quality of the single RCTs were rated by the authors to be between 5–7 (with10 best) and in the other one the quality of the single RCTs were rated to be between 30-83% of the maximum score.One high-quality SR found a significant positive effect of BCE based on pooled data analysis with two single RCTs in regard to pursed-lip breathing (PLB) on breathlessness. In this SR, one single RCT on diaphragmatic breathing (DB) and another one on yoga breathing (YB) showed effect on disease-specific QOL. The single RCTs included in the SR were rated by the authors in the SRs to be of low and moderate quality.ConclusionsBased on three high-quality SRs performing pooled data analyses, there is evidence that RMT has effect on breathlessness, fatigue and disease-specific QOL and PLB on breathlessness. There is also evidence that single studies on DB and YB has effect on disease-specific QOL. Few RCTs are available and the variable quality of the single RCTs in the SRs, seem to require more RCTs in particular for BCEs, but also RMT before conclusions regarding effects and high quality SRs can be written.

Oral health-related quality-of-life and mental health in individuals with chronic obstructive pulmonary disease (COPD)

Abstract Objectives. To investigate the association between oral health, oral health-related quality-of-life (OHRQoL) and mental health-related quality-of-life (QoL) in persons with chronic obstructive pulmonary disease (COPD) with respect to demographic, social and clinical oral health variables. Materials and methods. One hundred participants were included in a cross-sectional study at a hospital in Norway. Data were collected via the Oral Health Impact Profile (OHIP-14), the SF-36v2 Health Survey Mental Component (MCS), other self-reported factors, an interview and a clinical examination. Multiple regression analyses were performed. The Regional Committee for Medical and Health Research Ethics approved the study. Results. Higher education (p < 0.01), being a smoker (p < 0.05) and experience of oral health problems (p < 0.001) were significantly associated with oral health-related quality-of-life (OHRQoL). Furthermore, those with feelings of dry mouth (p < 0.05) and impaired OHRQoL (p < 0.001) experienced more mental health problems. Conclusions. This study demonstrated that oral health and personal factors are related to mental health-related QoL and OHRQoL in individuals with COPD. This finding shows the need to focus on oral care.

Illness perception in people with chronic obstructive pulmonary disease

Illness perception (IP) concerns how patients evaluate living with a disease. To get a broader understanding of IP in patients with chronic obstructive pulmonary disease (COPD), we investigated whether breathlessness is an important precursor of IP and whether IP in its turn is related to mental health, physical health and global quality of life (QOL). One hundred and fifty-four patients with COPD participated in a cross-sectional survey. Participants underwent pulmonary function testing, provided socio-demographic and clinical information, and completed the following standardized instruments: Brief Illness Perception Questionnaire, Respiratory Quality of Life Questionnaire, Short-Form 12 Health Survey and the Quality of Life Scale. Multiple regression analyses were performed. A high IP score indicates that a patient believes that his/her illness represents a threat. Participants with a high score on the IP dimensions consequences, identity, concern and emotional representation, experienced more breathlessness. High scores on the IP dimensions consequences, identity and concern were associated with impaired physical health and high scores on the IP dimensions consequences, identity and emotional representation were associated with impaired mental health. Impaired global QOL was associated with high scores on the IP dimensions consequences, identity, concern, coherence and emotional representation. The strength of the associations between breathlessness and physical/mental health and global QOL decreased when certain dimensions of IP were included as predictors, indicating that IP to some extent acts as a mediating factor. These findings may have practical implications of patient counselling by helping COPD patients to cope with their disease by restructuring their personal models of illness.

An evaluation of the short physical performance battery following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

ObjectiveThere is a need for simple tools to evaluate physical performance in patients with COPD before and after pulmonary rehabilitation. The aims of this study were to evaluate changes in short physical performance battery (SPPB)-scores in patients with COPD after a 4-week pulmonary rehabilitation program; explore possible relationships between SPPB-scores and exercise capacity (6-min walk distance), dyspnea (modified Medical Research Council’s dyspnea scale), disease-specific quality of life (COPD assessment test), and pulmonary function (predicted forced expiratory volume in one second) at baseline; and explore if changes in SPPB-scores are related to changes in exercise capacity, dyspnea, and disease-specific quality of life following pulmonary rehabilitation.ResultsForty-five patients with COPD were included in the final analysis. SPPB-scores improved following pulmonary rehabilitation (mean change: 1.2 ± 1.7 points, p < 0.001). There were moderate correlations between SPPB-scores and exercise capacity (r = 0.50, p < 0.001) and dyspnea (r = − 0.45, p = 0.003) at baseline, but not with pulmonary function or disease-specific quality of life. Changes in SPPB-scores were not associated with changes in exercise capacity or dyspnea scores. The SPPB may be a useful tool for evaluating physical performance in COPDTrial registration ClinicalTrials.gov NCT02314338, December 11, 2014.