Dyspnea Management Experiences Among Patients With Chronic Obstructive Pulmonary Disease: A Qualitative Study
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Session presented on Saturday, July 26, 2014: Purpose: Dyspnea is the primary chief complains for patients with chronic obstructive pulmonary disease (COPD). Dyspnea refers to the subjective perception of illness used to describe 'a subjective experience of breathing discomfort that consists of qualitatively distinct sensations of varying intensity'. This experience is derived from the influences of physiological, psychological, social, and environmental factors and results in physiological and behavioral reactions. For patients with COPD, dyspnea is a subjective body feeling that often creates enormous distress for patients. However, most of dyspnea health examination and measurement are from objective data. There were few studies conducted from the subjective experiences of dyspnea from patients. The aim of this study was to explore the dyspnea management experiences among COPD patients. Methods: A qualitative descriptive study examining 7 purposively sampled outpatients with COPD from the Respiratory Medicine Department of a medical center in Central Taiwan. One-on-one in-depth interviews about life experiences for COPD patients with dyspnea were conducted. Results: Through content analysis of the interview data, six themes regarding the dyspnea experiences are found in this study. 1. An internal emergency signal result from the inability to breathe on the verge of death: Dyspnea is a subjective perception that often starts with constriction, tightness, and pain in the chest. During an episode of dyspnea, the patient experiences uncomfortable feelings including constriction in the chest and throttled, the inability to inhale that is similar to the stop of breathing, and indescribable pain. 'When gasping, I felt tightness in my chest. It was like being pressed by something and like someone was strangling me. I could not breathe'' (1) 2. Triggering and straining: After suffering and experiencing acute exacerbation, the patients realized that dyspnea is easily triggered in certain contexts that are likely or inevitable in daily life. These contexts include a rapid or intense physical movement, excessive emotional responses, poor weather or environmental conditions, and respiratory tract infections. ''Of course when I carry heavy things! I have to use my arm strength, and immediately start gasping.' (3) '...When I am nervous, I start gasping. If I am irritated, or angered by a conversation, I gasp when I am mad.' (1) 'If I catch a small cold and cough, it is really uncomfortable to cough and gasp with phlegm in my mouth.' (2) ''Cold weather often triggers my illness.' (4) 'The dust caused by sweeping and the smoke and poor-quality air make me gasp.' (7) 3. Constraints in daily life due to dyspnea: Dyspnea causes numerous inconveniences in daily life, altering the lifestyle of its sufferers and often resulting in the inability to work or manage daily-life activities, a reduction or loss of social and recreational activities, and an inability to sleep on the back which results in insufficient sleep. 'I gasped even though I just made a few movements, and I could not continue if I gasped. In the end, I did not go anymore. My work was laborious, and I had to carry heavy things! I use my arm strength, but I gasped when I did this. I just could not work.' (3) 'To sum up, it is very tough! I need my family to take care of my life, even when I want to go to the toilet. I cannot put on clothes and trousers or take a shower by myself! I gasp as soon as I start walking. I need someone to bring my meals. I need someone to be with me all day long.' (2) 'Difficulty in breathing requires me to sit up. I cannot fall asleep because I cannot lie down. I sleep for less than three hours every night.' (1) 4. Immediate Self-Rescue Strategies: Having suffered from dyspnea over time, patients with COPD accumulate experience and health knowledge in their illness, developing a set of coping strategies for themselves. In other words, they know the first-line treatments to alleviate the discomfort caused by dyspnea. When dyspnea occurs, the coping strategies that patients can adopt include halting the ongoing activity, changing poses or sitting down in a comfortable pose, then taking a bronchodilator or inhaling oxygen, adjusting breathing, and easing the emotion. If these first-line strategies cannot alleviate the discomfort, most patients seek medical assistance at a hospital or clinic. 'I use the sprayer first. I bear the discomfort and tell myself to breathe lightly. Inhale lightly and exhale lightly. Oxygen helps a little, and it makes me gasp less. But, when I gasp really heavily, it does not work; even if I switch it to the highest level 5 and use the sprayer, the symptoms are not eased. In this situation, I have to go to the hospital.' (2) 5. Self-Care Awareness in Daily Life Patients with COPD understand that their lung function can never recover, so they adopt daily-life protection measures, such as altering their lifestyle to reduce the frequency of dyspnea episodes. Regularly visiting a doctor and following medical advice is fundamental for decelerating the speed of exacerbation and reducing the frequency of episodes. Regarding food, COPD patients are aware that irritating and strong tonic foods can harm them and they must avoid eating cold-nature foods. Patients must also change their dietary habits and quit smoking and drinking alcohol. In addition, some patients consider their lungs to be dirty and clean them by using herbal medicines. After facing COPD, the patients identify the causes that make breathing difficult and adopt countermeasures. They know that variable weather is an inevitable trigger, so they focus keeping themselves warm, especially their necks. 'Do not eat spicy, hot, and irritating foods. If you breathe in dirty air, you have to clean your lungs. Lungs are too dirty. You should eat some detoxification matters from time to time. In the mountains where I live, there are detox herbs.' (1) 'Do not eat icy or cold-nature foods, such as Chinese radish, Chinese cabbage, and watermelons. These foods should be avoided.' (5) 6. Coexist with the Disease and Self-Repositioning: accepting fate and being optimistic Because of physical constraints, COPD patients cannot accomplish numerous daily activities; thus, they possess an altered self-concepts. Some patients consider themselves disabled and incompetent or even dead because of loss of physical function. Now, they can only sit like a fool, unable to execute their own will. Having an irreversible pulmonary disease is like heading toward death; the patient can only wait for the end to come. However, some patients believe that the time of death cannot be predicted and attempt to remain optimistic, taking care of their bodies. 'I cannot do what I want to do. I am as useless as a dead person. I can only complain that I am ill-fated and unlucky.' (1) 'I am not a person who does not feel upset, I have that feeling, but I still go out and visit my friends. We can spend the day chatting, or feel upset and keep thinking about the annoying things, which makes us feel unhappy and wear a sad face. We can spend a day in either way. To sum up, do not think too much. Be optimistic and do whatever you want to do.' (3) Conclusion: When COPD presents, patients experience discomfort, identify the risk factors of deterioration, and devise methods to address their symptoms. Most patients experience a loss of mobility that inconveniences their daily life. These patients begin repositioning themselves. The goal of the medical staff and patients is to maintain existing functions and health of patients. The findings in this study can serve as references for medical teams in developing self-management plans.