Measurement of fatigue in chronic obstructive pulmonary disease and in asthma

Despite recognition of a high prevalence of fatigue in individuals with chronic airflow obstruction conditions, including chronic obstructive pulmonary disease and asthma, and its importance from a quality of life perspective, no research was found in which fatigue was measured directly in these populations. This may be due to a seeming lack of appropriate instruments for measuring fatigue in these populations. The purpose of this study, therefore, was to pretest an instrument, the Piper Fatigue Scale, which was developed to measure chronic fatigue in clinical populations. The outpatient sample consisted of 17 persons with chronic obstructive pulmonary disease and 19 with asthma. Findings revealed that the visual analogue scale version of the Piper Fatigue Scale may not be appropriate for measuring fatigue in these populations. Instruments with validity and reliability for fatigue in chronic obstructive pulmonary disease and asthma need to be developed.     

Living with chronic obstructive pulmonary disease: insiders' perspectives

AIM: This paper reports a study of the experiences of older adults with severe chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease had affected their lives. BACKGROUND: Chronic obstructive pulmonary disease is a major personal and public health burden and is the fifth cause of mortality worldwide. The brief encounters that healthcare professionals have with patients in hospitals, physicians' offices and other outpatient settings are insufficient to be able to truly understand the challenges that people face in the attempt to integrate a chronic illness into their lives. Previous qualitative studies on chronic obstructive pulmonary disease have tended to focus on specific problems associated with the disease, such as fatigue and social isolation. METHOD: A hermeneutic phenomenological study was carried out with 10 older adults who participated in a local hospital's case management or pulmonary rehabilitation programme. Data were collected by interviews in 2003. FINDINGS: Three major themes were identified: Knowing What Works, Hanging On...Barely, and Losing Control-Gaining Control. The changes associated with chronic obstructive pulmonary disease were described as increasingly challenging and even threatening to participants' current lifestyles. The impact of dyspnoea was great and invaded almost every aspect of their lives. Participants identified the most effective methods to resolve shortness of breath. CONCLUSION: People with severe chronic obstructive pulmonary disease have had extensive experience of managing their disease and are familiar with techniques that have helped them integrate the illness and symptoms into their lives. Nurses can synthesize patient knowledge with nursing knowledge to assist patients with severe chronic obstructive pulmonary disease to achieve their maximum quality of life.     

Need of support in people with chronic obstructive pulmonary disease

Aim and objective

The aim of this study was to describe peoples’ experiences and expectations of support when living with chronic obstructive pulmonary disease.

Method

We conducted and analysed face‐to‐face or telephone interviews with 17 individuals (aged 44–77 years) diagnosed with chronic obstructive pulmonary disease. The interviewer asked open‐ended questions aimed at encouraging further narration, and we analysed the participants’ narratives using a phenomenological hermeneutical approach. This report adheres to the COREQ guidelines.

Results

The overall theme suggests that people with chronic obstructive pulmonary disease describe support as shared knowledge and experiences, based on the following subthemes; similar experiences, the need of genuine professional knowledge, self‐reliance versus self‐blame, and the Internet – feeling safe but uncertain.

Conclusions

People with chronic obstructive pulmonary disease find their strength through shared knowledge and dialogical support with others who have similar experiences and with professionals. A person‐centred eHealth approach may be suitable for this group as it offers both collaboration and support.

Relevance to clinical practice

There is a demand for access to genuine professional knowledge as additional support to patients’ own capabilities and needs. Patient associations were assessed as reliable sources of information and to some extent also support, but the importance of access to professional sources was also stressed.     

A Qualitative Metasynthesis of the Experience of Fatigue Across Five Chronic Conditions

ContextFatigue is a symptom reported by patients with a variety of chronic conditions. However, it is unclear whether fatigue is similar across conditions. Better understanding its nature could provide important clues regarding the mechanisms underlying fatigue and aid in developing more effective therapeutic interventions to decrease fatigue and improve quality of life.ObjectivesTo better understand the nature of fatigue, we performed a qualitative metasynthesis exploring patients' experiences of fatigue across five chronic noninfectious conditions: heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease.MethodsWe identified 34 qualitative studies written in the last 10 years describing fatigue in patients with one of the aforementioned conditions using three databases (Embase, PubMed, and CINAHL). Studies with patient quotes describing fatigue were synthesized, integrated, and interpreted.ResultsAcross conditions, patients consistently described fatigue as persistent overwhelming tiredness, severe lack of energy, and physical weakness that worsened over time. Four common themes emerged: running out of batteries, a bad life, associated symptoms (e.g., sleep disturbance, impaired cognition, and depression), and feeling misunderstood by others, with a fear of not being believed or being perceived negatively.ConclusionIn adults with heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease, we found that fatigue was characterized by severe energy depletion, which had negative impacts on patients' lives and caused associated symptoms that exacerbated fatigue. Yet, fatigue is commonly misunderstood and inadequately acknowledged.     

Promoting Physical Activity and Exercise in Patients With Asthma and Chronic Obstructive Pulmonary Disease

Chronic lower respiratory diseases, including asthma and chronic obstructive pulmonary disease, are a significant public health burden owing to their high incidence and prevalence. Nurse practitioners in primary care routinely see patients with these diagnoses. Although inhaled pharmacotherapy is the mainstay of treatment for individuals with these diseases, providing an overall approach to health and wellness, which includes physical activity and exercise, is imperative in optimizing patient outcomes. The purpose of this article is to provide nurse practitioners in primary care with foundational information regarding the promotion of physical activity and exercise for patients with asthma and chronic obstructive pulmonary disease.     

Chronic obstructive pulmonary disease: a phenomenological study of patients' experiences

Aim. The purpose of this study is to explore the experience of living with chronic obstructive pulmonary disease by investigating the subjective phenomenon as described by the patient. Background. Chronic obstructive pulmonary disease is now recognized as one of the most common chronic respiratory diseases in the United Kingdom, with a high prevalence of morbidity and mortality. As the disease progresses, symptoms increase which gradually influence all aspects of the lives of those affected by it. Method. A phenomenological approach was identified as the most appropriate method to gain an understanding of living with chronic obstructive pulmonary disease. The data were obtained from 10 participants using unstructured interviews to capture detailed experiences verbatim. Analysis, based on the framework of Diekelmann et al. (The NLN Criteria for Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, NLN Press, New York, 1989), was employed to interpret the data and determine shared themes that evolved during the course of the research. Results. The data revealed valuable insights, from a patient's perspective, into the impact chronic obstructive pulmonary disease had on their daily lives. The accounts obtained from participants, many of who had severe chronic obstructive pulmonary disease, illustrate the detrimental effects of this debilitating disease. Breathlessness was identified as the most troublesome symptom leading to anxiety, panic and fear. Participants also described feeling frustrated and tired because of their breathlessness, which led to loss of social activity. This also resulted in a loss of their role within the family including loss of intimacy in personal relationships. Despite this, half of the participants felt they had a fairly good quality of life. Conclusion. The use of phenomenology as a research methodology fulfilled the aim of gaining a greater understanding of the experiences of living with chronic obstructive pulmonary disease. It provided valuable insights into how patients view the overall impact and their subsequent degree of coping with chronic obstructive pulmonary disease from day to day. Relevance to clinical practice. Whilst there is no cure for chronic obstructive pulmonary disease and medical interventions have limited effect, health professionals can do much to improve patient's symptoms and experiences of living with chronic obstructive pulmonary disease by listening to how their symptoms affect them and adapting coping strategies. It is hoped that the themes revealed in this study generate additional understanding and insight for future innovative practice.     

孟鲁司特钠治疗慢性阻塞性肺疾病临床疗效观察

目的 探讨盂鲁司特钠在慢性阻塞性肺病治疗中的作用.方法 50例慢性阻塞性肺疾病患者随机分为治疗组(n=26)及对照组(n=24).对照组给予静脉抗感染、止咳、化痰、平喘、吸氧等对症治疗;治疗组在对照组基础上加用孟鲁司特钠10 mg/d,4周为1个疗程.结果 与治疗前比较,对照组治疗后第一秒末用力呼气量(FEV1)百分比...     

Fatigue,anxiety and depression levels,activities of daily living of patients with chronic obstructive pulmonary disease

The aim of this cross‐sectional study was to determine the fatigue, anxiety and depression levels, activities of daily living of patients with chronic obstructive pulmonary disease (n = 255). It was found that there was significant difference between Visual Analogue Scale for Fatigue (VAS‐F) point averages and gender, education levels, marital status and economical status of patient with chronic obstructive pulmonary disease. Among the participants in this study, 36.5% had an anxiety disorder whereas 69.0% exhibited depression. In the study, it was determined that 85.5% of those were independent in their Katz's Index of Activities of Daily Living (ADLs) and 49.4% of those were independent in their Lawton and Brody's Index of Instrumental Activities of Daily Living (IADLs). This study has shown that VAS‐F, the Hospital Anxiety and Depression Scale, ADL and IADL instruments that measure the various aspects of health‐related quality of living can contribute considerably to a more diversified understanding of the patients' situation with chronic obstructive pulmonary disease.     

疲劳量表在COPD患者呼吸康复中的应用进展

本文通过检索、整理、分析疲劳量表在COPD患者呼吸康复中的应用现状,旨在引起临床医护人员及研究者对COPD患者呼吸康复中疲劳问题的重视,为COPD患者在呼吸康复中疲劳评估量表的选择提供参考。     

三种方法培养慢性阻塞性肺疾病大鼠气道平滑肌细胞的比较

背景：原代培养方法被广泛应用于正常和哮喘大鼠气道平滑肌细胞的培养,但少见用于慢性阻塞性肺疾病大鼠气道平滑肌细胞培养的报道。目的：建立大鼠慢性阻塞性肺疾病模型,比较组织块法、酶消化法和改良组织块消化法原代培养模型大鼠气道平滑肌细胞生长情况的差异。方法：将16只清洁级雄性健康SD大鼠随机分成2组,对照组正常饲养,慢性阻塞性肺疾病组用熏烟法建立大鼠慢性阻塞性肺疾病模型,显微镜下观察大鼠肺组织病理学特点。分别应用上述3种方法原代培养慢性阻塞性肺疾病大鼠气道平滑肌细胞,相差显微镜下观察细胞形态,用α-平滑肌肌动蛋白免疫组织化学染色鉴定细胞类型。结果与结论：经病理学证实成功构建慢性阻塞性肺疾病大鼠模型。在倒置相差显微镜下见培养的细胞表现为典型的＂谷-峰状＂生长。经免疫细胞化学染色后,可见胞质呈棕色阳性反应,所培养的细胞有94%以上为气道平滑肌细胞。3种方法在耗时和细胞质量方面均无明显差别,但组织块法更经济、稳定可靠和简单。     

Attitudes toward patient expertise in chronic illness

Although it has become an accepted standard to acknowledge the patient as a full partner in health care decisions, replacing traditional authoritative relationships with those based on an emancipatory model, the experiences of persons living with chronic illness confirm that this paradigm shift is not yet apparent in many health care relationships. In this paper, the authors present a qualitative secondary analysis of combined data sets from their research into chronic illness experience with two quite different chronic diseases - Type I Diabetes (a socially legitimized chronic disease) and Environmental Sensitivities (a disease which is currently treated with considerable scepticism). Comparing the experiences of individuals with diseases that are quite differently socially constructed, it becomes possible to detect common underlying health professional values and attitudes that powerfully influence the experience of living with and negotiating health care for a chronic illness. In the discussion of findings from this study, the authors examine the implications of the spiral of behaviors that fuels mutual alienation in chronic illness care relationships if professionals are unable to value patient expertise.     

Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study

Title. Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study Aim. This paper is a report of a study to describe the essential structure of the lived experience of living with severe chronic obstructive pulmonary disease (COPD) during the palliative phase of the disease. Background. Chronic obstructive pulmonary disease is one of the most common diseases throughout the world. Shortness of breath, fatigue and cough are the most troublesome symptoms, and living with COPD often imposes limitations on daily living. The disease has a great impact on quality of life and affects the extent to which people can be active in daily life. Methods. We conducted qualitative interviews of eight people with COPD and collected data over a 2‐month period in 2003. Our patients were recruited from two pulmonary disease clinics in West Sweden. We used a phenomenological methodology to analyse the interviews. Findings. Daily life for people with COPD is affected in several different ways. The patients described how their physical limitations forced them to refrain from meaningful activities in everyday life and led to social isolation. Everyday emotions vacillated between viewing life as meaningful and meaningless. A sense of involvement and the belief that life was meaningful gave the individual the energy and the desire to continue living and to envision a future. Conclusion. Nursing care should include support and facilitation, so that patients can live rather than exist to the end of their lives. It is important to learn from patients and tailor activities to their social, existential and physical priorities, where appropriate family‐centred support may be most effective.     

Compliance of adolescents with chronic disease

The purpose of this paper is to describe the factors that affect compliance in adolescents with a chronic illness and to compare compliance and factors connected to compliance between adolescents with asthma, epilepsy, rheumatoid arthritis (JRA) and insulin dependent diabetes mellitus (IDDM). The data were collected by questionnaire. Altogether 1200 individuals were selected from the Finnish Social Insurance Institution's register. The response percentage was 88 (n = 1061). One-fifth (23%) of adolescents with chronic disease felt that they had complied fully with health regimens, while 60% placed themselves in the category of satisfactory compliance and the remaining 17% reported poor compliance. In each patient group compliance was promoted by good motivation, a strong sense of normality, a positive attitude towards the disease and treatment, energy and will-power, experience of results, support from the parents, nurses and physicians, and a feeling that the disease was not a threat to social well-being.     

慢性阻塞性肺疾病病人生活质量的影响因素及护理干预现状

从一般人口学资料、疾病相关资料等方面综述了影响慢性阻塞性肺疾病病人生活质量的主要因素,并阐述了心理情绪干预、躯体功能干预、生活行为干预对提高慢性阻塞性肺疾病病人生活质量的作用.     

Early discharge of people with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe any respiratory condition that causes long-standing airflow obstruction, which is non or only partially reversible with bronchodilator therapy. These diseases include emphysema, chronic bronchitis, chronic airflow limitation and some cases of chronic asthma. The World Health Organization global initiative for chronic obstructive lung disease (GOLD) recommendations proposed a new definition of COPD as 'a disease state characterised by a progressive airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases' (Pauwels et al, 2001).     

The effect of a pulmonary rehabilitation programme on older patients with chronic pulmonary disease

Aim. The aim of this study was to answer the question: is there an effect on the respiratory capacity and activity tolerance of older patients with chronic obstructive pulmonary disease who participate in a pulmonary rehabilitation programme? Background. Pulmonary rehabilitation is now an integral part of chronic obstructive pulmonary disease management. Evidence supports the positive effects of breath training and exercising training on quality of life, exercise tolerance and improved physical condition of individual with chronic obstructive pulmonary disease. Limited empirical documentation exists to support the effectiveness of a nurse managed rehabilitation programme for older patients with chronic obstructive pulmonary disease. The study was done to evaluate the effects of pulmonary rehabilitation provided by nurses on the pulmonary function, gas exchange and exercise tolerance in older patients with chronic obstructive pulmonary disease. Design. A one group pre‐test–post‐test design was used to evaluate the effects of a pulmonary rehabilitation programme. Method. The sample consisted of 20 patients with chronic obstructive pulmonary disease who participated in a pulmonary rehabilitation programme including breathing exercises, upper‐limb exercises and inspiratory muscle training. Results. The findings indicated improvement in exercise performance and a decrease in dyspnea after participation in the pulmonary rehabilitation programme. Relevance to clinical practice. The clinical nurse can make a significant impact on the illness trajectory and quality of life for patients with chronic obstructive pulmonary disease. The nurse has a critical role in helping patient with chronic obstructive pulmonary disease learn to cope, adjust and adapt to life with a chronic illness. Active nurse involvement with a patient in a pulmonary rehabilitation programme can assist in the identification of factors that motivate the patient, help in establishing realistic out comes expectations and provide patient teaching opportunities. The nurse can assist the patient to develop skills of self‐awareness regarding particular symptoms, self‐monitoring and health status change identification.     

Severity of fatigue is related to functional limitation and health in patients with chronic obstructive pulmonary disease

Fatigue is one of the most prevalent symptoms in patients with chronic obstructive pulmonary disease (COPD). In research as well as in clinical practise, fatigue and its influence on functioning and health has not been in focus. The aim of this study was to compare fatigue, functional limitations owing to fatigue and health between patients with COPD and individuals from the general population to assess the differences between patients experiencing no, moderate and severe fatigue. Patients with COPD (n = 151) and individuals from the general population (n = 95) answered questions about fatigue, the Fatigue Impact Scale and the Medical Outcomes Survey Short Form‐36. The patients with COPD reported a higher frequency, longer daily duration and more severity of fatigue compared with individuals from the general population as well as more functional limitations and worse health. The patients who reported severe fatigue had more functional limitations and worse health compared with patients reporting moderate fatigue. These results indicate that fatigue severity should be screened for during the nursing care process with purpose to reduce the symptom burden.