**15. References**


 Patients with COPD present late with chronic respiratory symptoms and majority of early stage is asymptomatic and hence needs a high index of suspicion for diagnosis.

 Pulmonary function tests reveal airflow obstruction (ie, a forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] ratio less than 0.70) which is

 The GOLD staging system is based on spirometry and is well recognized and commonly used as a guide for management. It has been criticized for underestimating the importance of the extrapulmonary effects of COPD in predicting outcome, which is

 Cessation of smoking is a central point in treatment of COPD. A short-acting inhaled bronchodilator for use on as-needed basis is a reasonable initiation therapy for early stage disease(StageIA). Addition of a long-acting inhaled bronchodilator and/or glucocorticoid should be considered to improve symptoms, improve lung function, and

 Pulmonary rehabilitation is recommended to improve symptoms, exercise capacity, and quality of life. Long-term oxygen therapy is indicated in COPD patients who have

All patients with COPD should be advised to quit smoking, educated about COPD, and

Patients who continue to have significant symptoms despite the above interventions

Extensive research is ongoing in various aspects of understanding etiopathogenesis and

Adams PF, Barnes PM, Vickerie JL.(Nov 2008) Summary health statistics for the U.S. population: National Health Interview Survey, 2007. *Vital Health Stat* 10. ;1-104. American Thoracic Society(1962): Chronic bronchitis, asthma and pulmonary emphysema.

Americn Thoracic Society(1987): Standards for the diagnosis and care of patients with

American Thoracic Society(1995). Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. *Am J Respir Crit Care Med* ; 152:S77. Anthonisen NR, Connett JE, Kiley JP, et al(1994): Effects of smoking intervention and the use

ATS/ERS Task Force2004[updated 2005]: Standards for the diagnosis and management of

patients with COPD. Version 1.2. New York: ATS . Acessed from:

A statement by the committee on diagnostic standards for nontuberculous

chronic obstructive pulmonary disease (COPD) and asthma. *Am Rev Respir Dis*;

of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. *JAMA* ;

reduce the frequency of exacerbations in Stage IB disease and onwards.

influenza/pneumococcal vaccines advised as recommended.

respiratory diseases. *Am Rev Respir Dis*; 85:762-768.

pathologic process with earlier and more severe disease presentation.

Some patients present with an acute exacerbation.

incompletely reversible.

chronic hypoxemia.

**15. References** 

addressed by the BODE index.

may be candidates for surgical therapy.

treatment options for COPD.

136:225-244.

272:1497-1505.

http://www.thoracic.org/go/copd.

extracellular matrix injury which heals with incomplete and disorganized repair mechanisms ultimately leading to permanent progressive airflow obstruction. Deficiency of anti-protease deficiency makes individuals particularly susceptible to this


**8** 

Janice Gullick

*Australia* 

**Psychosocial Dimensions of** 

*Sydney Nursing School, University of Sydney* 

*Concord Repatriation General Hospital* 

**COPD for the Patient and Family** 

This chapter will review our current understanding from the qualitative research literature on the experience of COPD for the patient and family. It will provide exemplars from the author's past research to ground these concepts within patient and family experience. Whilst research into symptom measurement, functional and biochemical measurements of lung function and pharmacological outcomes give important insights into the physiological dimensions of COPD, methodologies that explore the psychosocial dimensions are not always well understood. Research output is increasingly valued according to clearly definable 'Levels of Evidence' (National Health and Medical Research Council, 2009). This approach makes visible the rigour of processes that underpin clinical evidence and considers practices confirmed at one extreme by double-blinded, randomised, controlled trials, through to the accepted wisdom of experts in the field. Demonstrable rigour in research is particularly important when evaluating the safety and efficacy of new drugs and interventions. In this case, large sample-sizes, strict control of variables and meticulous monitoring of the research protocol to maintain objectivity means that clinicians can weigh up, with confidence, the therapeutic choices available to them. This quantitative approach to

Clinicians have sought ways to apply quantitative research methods to measure psychosocial dimensions of illness and treatments. Symptom and impact scales such as the Hospital Anxiety and Depression Scale (Zigmond et al., 1983) and the International Continence Society Sex Questionnaire (Blanker et al., 2001), are examples of instruments that can identify the presence and frequency of issues of importance to patients across the COPD population. Instruments like the SF-36 (Mahler & Mackowiak, 1995) and the Sickness Impact Profile (McDowell & Newell, 1987) allow us to determine the influence of disease and interventions on a person's quality of life. Measures of adaption to illness such as the Jalowiec Coping Scale (Jalowiec et al., 1984) quantify the behavioural and cognitive coping

These quantitative measures of psychosocial aspects of COPD are useful in their ease of applicability to large research samples. They provide an aspect of evaluation that goes beyond the purely physiological concerns of health professionals to consider the patient-

research relies on statistical methods to determine 'truth'.

strategies people use to deal with social, physical end emotional stressors.

**1. Introduction** 

