The primary purpose of this secondary analysis was to determine whether 103 participants with chronic obstructive pulmonary disease rated the affective dimension of dyspnea (dyspnea-related anxiety and dyspnea-related distress) separately from the sensory dimension (intensity) during baseline exercise testing conducted as part of a randomized clinical trial. A secondary purpose was to determine if dyspnea-related anxiety and distress were rated distinctly different from other measurements of anxiety. At the end of a 6-minute walk and an incremental treadmill test, participant ratings of the magnitude of dyspnea-related anxiety and distress on the Modified Borg Scale were significantly different from their ratings of the intensity of dyspnea. Dyspnea-related anxiety and distress also appeared to be concepts independent from measures of state anxiety, negative affect, and anxiety before a treadmill test. Keywords COPD; dyspnea; anxiety; affective dimensionFor people living with chronic cardiopulmonary diseases, dyspnea or breathlessness is a distressing symptom that must be managed daily. Dyspnea is a broad term that encompasses different sensations and subjective experiences. How individuals describe dyspnea depends on the question they are asked, the condition causing the dyspnea, and the magnitude of the work that triggers the symptom (O'Donnell et al., 2007;Schwartzstein, 2005). When medical therapies are ineffective in reducing the intensity of dyspnea, especially in the palliative phase of illness, treatment of affective responses to dyspnea, such as anxiety and distress, may decrease the perceived intensity of the symptom (Carrieri-Kohlman et al., 2001). Valid and reliable measurements of this affective dimension could be used to determine the efficacy of complementary therapies, used with medical treatment, to manage dyspnea. Dyspnea has been defined by a multidisciplinary committee as a "… subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, Address correspondence to: Virginia Carrieri-Kohlman, RN, DNSc, FAAN, Professor, Department of Physiological Nursing, University of California, San Francisco, Box 0610, 2 Koret Way, San Francisco, Tel: (415) 476-8899, ginger.carrieri-kohlman@nursing.ucsf.edu. NIH Public Access Author ManuscriptRes Nurs Health. Author manuscript; available in PMC 2011 February 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript psychological, social and environmental factors, and may induce secondary physiological and behavioral responses" (American Thoracic Society [ATS], 1999, p. 322). In this definition, the symptom is acknowledged to be not only a physiological phenomenon, but also, similar to pain, it is multidimensional and influenced by an individual's experience and the mechanisms. The perceived symptom is ultimately shaped by emotions and psychological, social, and environmental experiences.Investig...

Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates. Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge. Methods. Inpatients (N = 32) had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death. Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4–8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2–13.2; 1.2–75.1; 1.7–99.7). Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients.

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