Breathlessness Beliefs And Its Effect On Functional Status In Patients With Chronic Obstructive Pulmonary Disease

Background:The functional status of chronic obstructive pulmonary disease (COPD) has been widely reported poor. The influential factors of functional status were varied and complex. The main measures to improve the functional status (pulmonary rehabilitation training) can only increase the exercise endurance of the patients with COPD. However, the functional status of patients was not be improved. At present, some scholars put forward a concept:breathlessness beliefs and thought that breathlessness beliefs may help understand patients’motivations for (not) being active. This may be an important breakthrough to change the behavior of COPD patients. Then only knowing the influence of breathlessness beliefs on functional status in COPD patients can we find out some corresponding measures, and improve the functional status of patients. Therefore, it is necessary to explore the situation of breathlessness beliefs and its effect on functional status in COPD patients.Objective:To describe the breathlessness beliefs and functional status of patients with COPD, and to explore the effect of breathlessness beliefs on functional status in COPD patients.Methods:A descriptive, cross-sectional study was used. By convenience sampling, a total of 147 outpatients with COPD in PUMC hospital were recruited in this study. They were asked to complete a series of questionnaires. General information questionnaire was used to collect information on demographic and clinical data. The Modified Medical Research Council (mMRC) was used to evaluate the degree of dyspnea in COPD patients. The Chinese version of the Breathlessness Beliefs Questionnaire was used to collect the breathlessness beliefs of patients with COPD. The Pulmonary Functional Status and Dyspnea Questionnaire-modified (PFSDQ-M) was used to assess the degree of limited daily activity in COPD patients, and the anxiety and depression were assessed using the Hospital Anxiety and Depression scale (HAD). Six-minute walking distance (6MWD) was measured using procedures recommended by the American Thoracic Society (ATS) after interview. The data was recorded using the Epidata3.0 and analyzed using the SPSS20.0. Multiple linear stepwise regression analyses were used to explore the association between breathlessness beliefs and functional status of patients with COPD.Results:(1) No significant difference in the average score of breathlessness beliefs was found between Chinese COPD patients and Dutch patients with respiratory diseases (t=0.920, P>0.05). (2) A score of eight or more in HAD scale was used as cut-off value for discrimination of clinical anxiety and depression, and 27(18.4%) were predisposed to anxiety and 19(12.9%) to depression. (3) The median score of degree of limited daily activity was 0.90, ranging from 0.00 to 7.80. Among these daily activities, physically exhausting daily activities were the best limited (including walk on bumpy terrain, walk on inclines and climb 3 stairs). (4) Multiple linear stepwise regression analyses indicated that breathlessness beliefs (Beta=0.429), exercise capacity (6MWD) (Beta=-0.188) and dyspnea (Beta=0.174) were major factors and explained 39.2% of the variance in functional status of patients with COPD.Conclusions:There was no difference in the breathlessness beliefs between Chinese COPD outpatients and Dutch outpatients with respiratory diseases. The functional status of patients with COPD remained to be improved. The breathlessness beliefs, exercise capacity (6MWD) and dyspnea are the main factors of functional status in COPD patients, especially the breathlessness beliefs.