**5. Discussion**

Chronic obstructive pulmonay disease is characterised by significant physical and psychosocial challanges. Dyspnea and fatigue are the two most common symptoms experienced by patients with COPD (Blinderman et al., 2009; Gift & Shepard, 1999; Kinsman et al., 1983). Dyspnea is predominantly related to a reduction in vital capacity of lungs. Dyspnea is the most commonly experienced complaint of the COPD patients (Rabe et al., 2006; Tel & Akdemir, 1998; Wong et al., 2010). Fatigue may be affected by dyspnea and is frequently told by the patients (Janson-Bjerklie et al., 1986; Reishtein 2005). Wong et al.(2010) found that fatigue was experienced by almost all participants with COPD. Çnar and Olgun (2010) were reported that 97% of patients with COPD experienced high levels of fatigue. The

It was concluded in our research that there was a positive correlation between dyspnea and fatigue (r=0.636, p<0.01) and as dyspnea scores increased so did mean fatigue scores. Also, there was a significant negative correlation between the measured FEV1 values of the

Table 2 demonstrates mean scores of dyspnea, fatigue levels and levels of the daily activities

It was explored that there was not any statistically significant difference between fatigue levels, levels of the daily activities affected by fatigue and dyspnea scores in terms of age and sex(p>0.05). It was found out that there was statistically significant difference between fatigue level and levels of the daily activities affected by fatigue and disease length (year) (p<0.05).

It was found out that there was statistically significant difference between fatigue level and levels of the daily activities affected by fatigue and dyspnea according disease severity, the number of repeated hospitalization, patients' perception about their health condition and frequency of fatigue-experience. High fatigue score and score of the daily activities affected by fatigue were presented by those who had the disease for ≥ 12 years. High fatigue score and score of the daily activities affected by fatigue and dyspnea score were presented by who fourth stage of COPD, who were repeatedly, had hospitalized for ≥ 4 times a year and who identified their own health condition as very bad and frequency of fatigue as always.

Chronic obstructive pulmonay disease is characterised by significant physical and psychosocial challanges. Dyspnea and fatigue are the two most common symptoms experienced by patients with COPD (Blinderman et al., 2009; Gift & Shepard, 1999; Kinsman et al., 1983). Dyspnea is predominantly related to a reduction in vital capacity of lungs. Dyspnea is the most commonly experienced complaint of the COPD patients (Rabe et al., 2006; Tel & Akdemir, 1998; Wong et al., 2010). Fatigue may be affected by dyspnea and is frequently told by the patients (Janson-Bjerklie et al., 1986; Reishtein 2005). Wong et al.(2010) found that fatigue was experienced by almost all participants with COPD. Çnar and Olgun (2010) were reported that 97% of patients with COPD experienced high levels of fatigue. The

patients and dyspnea scores (r=-.341 p<0.01) and fatigue scores (r=-.260 p<0.01).

affected by fatigue accoding to some socio demographic and disease characteristics.

12(4.0) 68(22.7) 220(73.3)

298(99.3) 2(0.7)

60(20.0) 93(31.0) 147(49.0)

**Characteristics n (%)** 

**Dyspnea Complaint** 

**Fatigue Complaint** 

**Frequency Of Fatigue Experience** 

Table 1. Dyspnea severity and fatigue experience of the patients

Mild Moderate Severe

Yes No

Sometimes Often Always

**5. Discussion** 


Table 2. Mean scores of dyspnea, fatigue levels and levels of the daily activities affected by fatigue accoding to some characteristics

Evaluation of Dyspnea and Fatigue Among the COPD Patients 267

experienced COPD patients whereas Kapella et al. (2006) reported that there was significant correlation between dyspnea and fatigue scores among the COPD patients. Reishtein (2005) reported that there was moderately negative correlation between dyspnea and fatigue and functional lung capacity among the COPD patients. Baghai-Ravary et al.(2009) found that fatigue was related to change in FEV1. Breslin et al.(1998) found that there was a significant negative correlation between general and physical fatigue and predicted FEV1 values and that physical aspect of fatigue was associated with the severity of pulmonary deterioration. In the light of these findings, patients undergo dyspnea and fatigue more as lung capacity

According to the results of the present research which was conducted in order to investigate dyspnea, fatigue-experience and the correlation between dyspnea and fatigue; all of the patients experienced dyspnea and almost all of them had fatigue. Mean scores of fatigue and dyspnea of the women were higher than those of men. Dyspnea severity and fatigue was more intensified among those who belonged to ≥ 65 age group, who had the disease for ≥ 12 years, who had fourth stage of COPD, who were repeatedly hospitalized and fatigue scores increased as dyspnea severity increased and there was significant negative correlation between FEV1 values and dyspnea and fatigue scores. As a result, it was recommended that nurses who care COPD patients should assess dyspnea and fatigue-situations and the complaint severity of the patients using scales; should plan and practice the appropriate nursing interventions considering the linear correlation between dyspnea and fatigue; should perform personal care plans for those COPD patients who belonged to ≥ 65 age group, who had longer disease length, who had advanced stage of COPD, who were repeatedly hospitalized due to the fact that the rates of severe dyspnea and fatigue were higher. Dyspnea and fatigue should be evaluated in usual care with a questionnaire that corrects for them in order to tailor treatment to patients' need. Dyspnea and fatigue is an

important symptom requiring evaluation and management in patients with COPD.

Abant İzzet Baysal University, Bolu, Turkey

*Medicine,*Vol.159, pp.321-40.

*European Heart Journal*, 9, pp.758-764.

Akbal, S.(2003). Evaluation of Fatigue that Affected Daily Living Activities of COPD

American Thorasic Society. (1991). Lung function testing : selection of reference values and

American Thorasic Society. (1999). Dyspnea: mechanisms, assessment, and management: a

Appels, A., & Mulder, P. (1988). Excess fatigue as a precursor of myocardial infarction.

Aras A., & Tel, H. (2009). Determination of perceived social support for patients with COPD and related factors. *Turkish Thorax Journal*, Vol.10, Number.2, pp.63-68.

Patients, Master's Thesis, Nursing Department of Health Sciences Institute of

interpretative strategies. *American Review of Respiratory Disease*, Vol.144, pp.1202-

consensus statement. *American Journal of Respiratory and Critical Care* 

decreases.

**6. Conclusion** 

**7. References** 

1218.

rates of the patients who experienced dyspnea and fatigue were higher in our study too; which concurred with literature.

Reishtein (2005) found out that means scores for dyspnea and fatigue were moderately high in patients with COPD. In this study, it was found that the mean scores of fatigue and dyspnea of the participant patients were high.

It was explored that there was not any statistically significant difference between fatigue levels, levels of the daily activities affected by fatigue and dyspnea scores in terms of age and sex. Kapella et al. (2006) reported that fatigue complaint was significantly correlated with age. Skumlien et al. (2006) reported that 82% of the women and 70% of the men had dyspnea complaint and there was not any difference among the sex in terms of dyspnea number and dyspnea scores. Gift and Shepard (1999) reported that men and women did not differ in their level of fatigue. Oh et al. (2004) and Kapella et al. (2006), reported that there were small differences between women and men; however, these difference were not statistically significant. It was observed in our research that although the dyspnea scores and fatigue scores of the women were higher than those of men, it was statistically insignificant.

High fatigue score and score of the daily activities affected by fatigue were presented by those who had the disease for ≥ 12 years. High fatigue score and score of the daily activities affected by fatigue and dyspnea score were presented by who fourth stage of COPD, who were repeatedly, had hospitalized for ≥ 4 times a year and who identified their own health condition as very bad and frequency of fatigue as always. Several studies show that fatigue is a common symptom in COPD and it has been associated with reduced health status and dyspnea (Breslin et al., 1998; Guyatt et al.,1987). We were found out that dyspnea and fatigue scores were higher in patients which health status is very bad. This result was statically significant. Hospitalization rates in the patients with COPD are high, and increase with age. Baghai-Ravary et al (2009) suggested that increased fatigue was related to dyspnea, exacerbation frequency, health status and time spent outdoors. In this study, we found that the hospitalization rates in the patients with COPD were high and these patients'dyspnea and fatigue scores were also high.

Baghai-Ravary et al.(2009) and Wong et al.(2010) explored that they did not find a correlation betweeen severty of COPD and fatigue. Breslin et al.(1998) reported that physical dimensions of fatigue correlated with an increase in the severity of pulmonary impairment and reduction in exercise tolerance. In this study we found that fatigue score was higher in patients with very severe COPD. These data show a relationship between fatigue and pulmonary function in COPD.

Previous studies have noted significant relationships between dyspnea and fatigue (Baghai-Ravary et al., 2009; Janson-Bjerklie et al.,1986; Kinsman et al.,1983; Peters et al.,2010, Reishtein, 2005; Theander et al., 2009). As in earlier studies, we found correlations between fatigue and dyspnea. It was concluded in our research that there was a positive correlation between dyspnea and fatigue (r=0.636, p<0.01) and as dyspnea scores increased so did mean fatigue scores. This result is consistent with previous research reports. Also, there was a significant negative correlation between the measured FEV1 values of the patients and dyspnea scores (r=-.341 p<0.01) and fatigue scores (r=-.260 p<0.01). McCarley (2003) discovered that there was moderately significant correlation between dyspnea and fatigue experienced COPD patients whereas Kapella et al. (2006) reported that there was significant correlation between dyspnea and fatigue scores among the COPD patients. Reishtein (2005) reported that there was moderately negative correlation between dyspnea and fatigue and functional lung capacity among the COPD patients. Baghai-Ravary et al.(2009) found that fatigue was related to change in FEV1. Breslin et al.(1998) found that there was a significant negative correlation between general and physical fatigue and predicted FEV1 values and that physical aspect of fatigue was associated with the severity of pulmonary deterioration. In the light of these findings, patients undergo dyspnea and fatigue more as lung capacity decreases.
