Memory for symptoms in COPD patients: how accurate are their reports?

The purpose of this study was to examine the accuracy of self-reports of symptom intensity in patients with chronic obstructive pulmonary disease (COPD) and factors that might influence recall of that intensity. Thirty COPD (forced expiratory volume in one second (FEV1) 36 +/- 17% predicted) subjects recorded their dyspnoea and fatigue intensity scores on a 0-10 scale for 14 consecutive days. On the fourteenth day, subjects recalled their average, greatest and least symptom intensity for the previous 14 days. General cognitive function, spirometry, and oxygenation were also measured. No significant differences were found between actual and recalled scores for dyspnoea or fatigue. General cognitive function, measured by the Mini Mental State Exam, correlated with the greatest and least dyspnoea and average fatigue difference scores (recall-actual) and contributed to the variance in the average and least dyspnoea recalled scores. The greatest contributor to the variance in the recall scores of both symptoms was the symptom intensity level on the day of recall. These results highlight the importance of current levels of symptom intensity and cognitive function when appraising symptoms in chronic obstructive pulmonary disease patients.

Dyspnea in patients with chronic obstructive pulmonary disease: does dyspnea worsen longitudinally in the presence of declining lung function?

OBJECTIVE: To determine the direction and rate of change in the symptom of dyspnea in patients with chronic obstructive pulmonary disease (COPD) whose lung function has worsened over time. DESIGN: Secondary analysis of a longitudinal data set. SETTING: Outpatient clinic. PATIENTS: Thirty-four medically stable male subjects with chronic obstructive pulmonary disease studied for 5.3 +/- 3.5 years, with a mean reduction in FEV1 over the period studied of 330.9 +/- 288.0 mL. Subjects were 63.3 +/- 5.5 years of age at entry into the study. OUTCOME MEASURES: Dyspnea and functional status scores were obtained using the Pulmonary Functional Status and Dyspnea Questionnaire. RESULTS: There was no significant difference in reports of dyspnea from the beginning to the end of the study, despite significant reductions in lung function. Of all activities studied, dyspnea when raising arms overhead was the only activity showing a relationship to the slope of change in FEV1 %. CONCLUSION: These findings suggest that, although patients with chronic lung disease experience varying degrees of deterioration in lung function longitudinally, there is no evidence that they report worsening of dyspnea in tandem with these physiologic changes. In this study, patient ratings of dyspnea longitudinally were not directly linked to changes in lung impairment.

Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M).

OBJECTIVE: Describe the process of development and testing to reduce the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) from 164 items to a modified questionnaire (the PFSDQ-M) consisting of 40 items. DESIGN: Instrument development and testing for reliability, validity, and practicality. SETTING: Hospital-based outpatients. PATIENTS: Testing was done on three groups of clinically stable patients with chronic obstructive pulmonary disease: a secondary analysis of 131 subjects for item selection, reliability, and validity; 50 additional subjects evaluating the PFSDQ-M for internal consistency, test-retest correlations, and construct validity; and 34 subjects from a longitudinal study for responsiveness. OUTCOME MEASURES: PFSDQ, PFSDQ-M, and spirometry. RESULTS: The practicality of the PFSDQ-M was supported by its sixth- to seventh-grade reading level, ease of reading (Flesch-Kincaid 69.5), self-administration, brief period for testing (7 minutes initially, 6 minutes on repeated testing), and limited missing data (< 8%). Reliability of the three components was supported by internal consistency alpha = 0.93 for change experienced by the patient with activities (CA), 0.95 for dyspnea with activities (DA), and 0.95 for fatigue with activities (FA). Good stability of the PFSDQ-M was demonstrated on test-retest; r = 0.70 for change, 0.83 for dyspnea, and 0.79 for fatigue (with activities). The usefulness of the PFSDQ-M in discriminating between dyspnea scores in patients based on their rate of deterioration in lung function was demonstrated. CONCLUSIONS: The PFSDQ was modified by reducing the number of activities evaluated, standardizing scaling formats, and adding a fatigue component. Findings suggest that the PFSDQ-M demonstrates initial reliability; good validity estimates, as seen with the factor analysis, and the dyspnea and activity scores appear responsive to physiologic changes in lung function over time.

Functional status instruments: outcome measure in the evaluation of patients with chronic obstructive pulmonary disease.

The purpose of this article is to review the instruments developed to measure functional status in patients with chronic obstructive pulmonary disease. Because the ability to carry out day-to-day activities is of primary importance to patients with chronic obstructive pulmonary disease, it is necessary for clinicians to understand which instruments provide the best measures of patient activity levels. Furthermore, as a critical outcome in managed care services, pulmonary critical pathways, and patient disability, the measurement of functional status in clinical practice assumes greater relevance. Functional status instruments in this review will refer to questionnaires measuring the day-to-day activities of patients. Questionnaires reviewed will include those that provide measures of general health status with activity-specific items, as well as questionnaires specifically designed to evaluate patients with pulmonary disease. The psychometric strengths, reliability and validity, and clinical utility of the instruments will be presented.

Development and testing of the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ).

OBJECTIVE: To develop and test the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) that measures both intensity of dyspnea with activities and changes (reductions or improvements) in the ability of patients with chronic obstructive pulmonary, disease to perform daily activities. DESIGN: Instrument development and initial testing for validity and reliability. SETTING: Hospital-based pulmonary rehabilitation program. PATIENTS: One hundred thirty-one adult male patients with chronic obstructive pulmonary disease. Mean age was 63.7 +/- 6.2 years. OUTCOME MEASURES: Pulmonary Functional Status and Dyspnea Questionnaire, pulmonary function and exercise parameters. RESULTS: The PFSDQ is a 164-item paper and pencil self-administered questionnaire and consists of two components measuring dyspnea intensity with activities and changes in functional ability related to 79 activities of daily living. Activities are grouped into scales of self-care, mobility, eating, home management, social, and recreational. The dyspnea component measures the level of dyspnea patients report with these activities. The functional abilities component evaluates the degree to which the performance of activities has changed as the result of chronic obstructive pulmonary disease. The activities are relevant for adults of both sexes and reflect various energy workload requirements. Normative data for both components were described. Content and initial construct validity of the PFSDQ was supported by clinical experts and findings related related to expected theoretical relationships. Internal consistency reliability for both the dyspnea and functional abilities components was 0.91. The alpha coefficients for the scales ranged from 0.88 to 0.94. A case study was used to describe the clinical application of the PFSDQ. CONCLUSION: The PFSDQ can be used clinically and in research studies to assess dyspnea and changes in the functional ability of patients with pulmonary disease. Although further testing is warranted, initial evaluation supports the validity and reliability of the PFSDQ.

Sleep disorders: insomnias.

An inability to sleep or sleep prematurely ended or interrupted by periods of wakefulness (insomnia) are some of the most frequent complaints heard from patients. Insomnia can be situationally related or persistent in nature. Persistent insomnia may be associated with biological rhythm disturbances, drug dependency, psychophysiologic abnormalities, psychiatric disturbance, sleep apnea syndrome or nocturnal myoclonus. This article describes these pathologies, gives clues toward differential diagnosis, suggests patient subgroups that would benefit from referral for specialized evaluation at a sleep disorder center and describes current treatment options.

The relationship between frequency of ventilator circuit changes and infectious hazard.

The relationship between frequency of ventilator circuit changes and risk of ventilator-associated pneumonia was studied using 2 independent approaches. The first was an in-use aerosol contamination study with patients on 8-hour, 16-hour, or 24-hour ventilator changing schedules. The second approach was a study comparing the incidence of pneumonia in patients on ventilators for 2 one-year periods when the ventilator circuit changing time differed. In-use aerosol sampling of 513 ventilator treatment periods showed bacterial contamination greater than 100 organisms per aerosol in 1.8 per cent of 8-hour cycles, in 2.5 per cent of 16-hour cycles, and in 5.4 per cent of 24-hour cycles. These differences were not significant. The incidence of ventilator-associated pneumonia was the same for one-year periods when ventilator circuits were changed either every 8 or every 24 hours. It was concluded that changing ventilator circuits every 24 hours provides adequate protection from ventilator-associated pneumonia.