Dyspnea, or shortness of breath, is the most frequent and severe complaint of patients with pulmonary disease. It disrupts activities of daily living and decreases quality of life. The investigators have shown that the sensory and affective dimensions of dyspnea can be significantly decreased in chronic obstructive pulmonary disease (COPD) patients by a self-paced exercise training program that provides exposure to dyspnea in a nurse- monitored environment. This reduction in dyspnea after a 12-session exercise program occurred because of both better exercise performance (increased efficiency and conditioning), which requires less ventilation, and desensitization (a decrease in the symptom relative to ventilation). The overall objective of this study is to determine whether dyspnea decreases as much with home walking as it does with short exposure to the symptom in a monitored environment or with typical high-intensity pulmonary rehabilitation exercise training. The primary aim is to test differences in the effectiveness of three treatments for dyspnea: education about dyspnea and a home walking prescription; nurse-coached exposure to dyspnea with education and a home walking prescription; and a model of pulmonary rehabilitation with high- intensity exercise, education, and a home walking prescription. Secondary aims are to determine if dyspnea decreases after as little as one incremental treadmill test and whether the treatment response depends on disease severity, gender, ethnicity, or adherence to a home walking prescription. The study also seeks to determine whether the duration of the response differs depending upon the treatment. The design is an experimental longitudinal study extending over one year. Ninety patients with COPD and limited by dyspnea will be assigned randomly to one of three treatment groups. All groups will receive education about strategies for dealing with dyspnea and a home exercise prescription. In addition, the exposure group will complete four self- paced sessions on a treadmill designed to allow nurse-coached exposure to dyspnea, and the high intensity training group will complete 24 sessions of high intensity treadmill training. Immediate and long-term outcomes include: a) sensory and affective dimensions of dyspnea with exercise; b) dyspnea with activities of daily living; c) exercise capacity; d) health status; e) health-related quality of life, including functional status, social status, and health perception; f) self- efficacy; g) perceived control of dyspnea; and h) mood state. If shorter and less intensive treatments for dyspnea prove to be as effective as a high-intensity exercise training program in decreasing the symptom of dyspnea and improving the quality of life, the impact on the care of patients with COPD will be substantial.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR002131-07
Application #
2655408
Study Section
Nursing Research Study Section (NURS)
Program Officer
Sigmon, Hilary D
Project Start
1995-05-01
Project End
2000-01-31
Budget Start
1998-02-01
Budget End
1999-01-31
Support Year
7
Fiscal Year
1998
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
073133571
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Donesky, Doranne; Nguyen, Huong Q; Paul, Steven M et al. (2014) The affective dimension of dyspnea improves in a dyspnea self-management program with exercise training. J Pain Symptom Manage 47:757-71
Donesky, DorAnne; Janson, Susan L; Nguyen, Huong Q et al. (2011) Determinants of frequency, duration, and continuity of home walking in patients with COPD. Geriatr Nurs 32:178-87
Carrieri-Kohlman, Virginia; Donesky-Cuenco, DorAnne; Park, Soo Kyung et al. (2010) Additional evidence for the affective dimension of dyspnea in patients with COPD. Res Nurs Health 33:4-19
Nguyen, Huong Q; Donesky-Cuenco, DorAnne; Carrieri-Kohlman, Virginia (2008) Associations between symptoms, functioning, and perceptions of mastery with global self-rated health in patients with COPD: a cross-sectional study. Int J Nurs Stud 45:1355-65
Carrieri-Kohlman, Virginia; Nguyen, Huong Q; Donesky-Cuenco, DorAnne et al. (2005) Impact of brief or extended exercise training on the benefit of a dyspnea self-management program in COPD. J Cardiopulm Rehabil 25:275-84
Nguyen, Huong Q; Carrieri-Kohlman, Virginia (2005) Dyspnea self-management in patients with chronic obstructive pulmonary disease: moderating effects of depressed mood. Psychosomatics 46:402-10
Nguyen, Huong Q; Carrieri-Kohlman, Virginia; Rankin, Sally H et al. (2005) Is Internet-based support for dyspnea self-management in patients with chronic obstructive pulmonary disease possible? Results of a pilot study. Heart Lung 34:51-62
Nguyen, Huong Q; Altinger, Julie; Carrieri-Kohlman, Virginia et al. (2003) Factor analysis of laboratory and clinical measurements of dyspnea in patients with chronic obstructive pulmonary disease. J Pain Symptom Manage 25:118-27
Carrieri-Kohlman, V; Gormley, J M; Eiser, S et al. (2001) Dyspnea and the affective response during exercise training in obstructive pulmonary disease. Nurs Res 50:136-46
Carrieri-Kohlman, V; Gormley, J M; Douglas, M K et al. (1996) Differentiation between dyspnea and its affective components. West J Nurs Res 18:626-42

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