Dyspnea & HRQOL

The most debilitating symptom of COPD is dyspnea, the awareness of breathlessness or shortness of breath. Dyspnea increases as the disease progresses, ultimately severely compromising a patient's HRQOL. Patients with COPD may alter their lifestyles to avoid the feeling of dyspnea. Patients with mild COPD may find they are short of breath only upon exertion, such as exercising. Until lung damage has progressed considerably, the patient may blame feelings of dyspnea on age, extra weight, or being out of shape. A patient with moderate COPD may begin to notice difficulty breathing with mild exertion—taking a brief walk, for instance, or climbing a flight of stairs. Finally, a patient with severe COPD may be unable to perform simple activities of daily living without help.

The most common descriptors of HRQOL include:

Dyspnea when exercising: This descriptor ranges from dyspnea with vigorous exercise among patients with mild COPD to an inability to walk more than a few steps in patients with severe COPD.

Dyspnea when performing daily activities: Dyspnea when performing daily activities also becomes more obvious and severe as the disease progresses. A patient with mild COPD may experience shortness of breath after a flight of stairs, while a patient with severe COPD may become short of breath when tying shoelaces or making a pot of coffee.

Inability to perform daily activities: As COPD progresses, the dyspnea experienced with daily activities leads to a complete inability to perform those activities.

Inability to leave the home/bed: By the time COPD reaches end-stage, many patients do not have the physical ability to leave the home or—in very severe cases—the bed or armchair.

Patients with mild to moderate dyspnea may consciously or unconsciously develop coping strategies, such as cutting back on the level of exercise or giving up activities they enjoy, such as gardening, skiing, and daily walks. As the disease progresses, they must rely on friends, family, or caregivers for help with routine tasks such as cleaning, washing, and cooking.

The need to curtail activities can often lead to depression and feelings of isolation. Patients may no longer be able to see friends, go out socially, or entertain. They may become depressed as the disease progresses and they find they can no longer perform activities they enjoy, as they need more and more help around the house, or as they become unable to function.

Severe reductions in physical abilities can lead to a lack of social contact and ultimately, depression. As patients find it harder and harder to function physically, they are unable to entertain or go out with friends and may find the only coping mechanism they have available is to withdraw from social contact. Physical inabilities combined with a withdrawal from social contact often lead to depression.,

In Summary Dyspnea and HRQOL:

• dyspnea increases as the disease progresses, severely compromising HRQOL
• common descriptors of HRQOL in terms of dyspnea include:
• dyspnea when exercising:  ranges from dyspnea when performing vigorous exercise in patients with mild COPD to the inability to walk more than a few steps in patients with severe COPD
• dyspnea when performing daily activities:  this becomes more severe as the disease progresses
• inability to perform daily activities:  patients with severe COPD cannot perform even the simplest tasks without experiencing dyspnea
• inability to leave the home/bed:  frequently seen in end-stage patients
• the need to curtail activities may lead to depression and isolation