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BG Steele, VA Puget Sound Health Care System; B Belza, University of Washington School of Nursing; L Holt, VA Puget Sound Health Care System; S Lakshminaryan, VA Puget Sound Health Care System; D Buchner, National Center for Chronic Disease Prevention and Health Promotion, CDC

Objectives: The experience of dyspnea defines the lives of persons with severe COPD. Although it is universally accepted that dyspnea limits the inventory of physical activities people perform in their daily lives, few investigators have sought to identify those essential activities that people with severe COPD chose to undertake in spite of dyspnea with its accompanying discomfort and distress. The purpose of this study was to identify dyspnea-inducing activities deemed essential to the everyday lives of male veterans with severe COPD and to quantify their relative importance.

Methods: An exploratory, descriptive, cross-sectional design was used. Sixty male outpatients with stable COPD (mean age 65.6 years, mean forced expiratory volume in one second, percent predicted, 35) were studied prior to a pulmonary rehabilitation program. Seven were employed outside the home. Activities considered essential were identified using the dyspnea subscale of the Chronic Respiratory Disease Questionnaire (CRQ) (Guyatt et al, 1987). The CRQ is a disease-specific interviewer-administered instrument measuring four dimensions of quality of life: dyspnea, fatigue, emotional function, and mastery. Subjects recalled activities associated with dyspnea that they performed in the past two weeks and selected additional dyspnea-inducing activities from a list. From the entire list, subjects prioritized five activities most important to their day-to-day lives with higher numbers indicating more importance on a 5-point scale. Frequency distributions, mean importance rankings, and overall importance rankings were calculated for each of the five essential activities identified. Mean importance subjects placed on the activity was first calculated (1-5 scale); overall importance was determined by multiplying the percentage of the total subjects identifying the activity as essential by the mean importance of each activity.

Results: Twenty-five essential, dyspnea-inducing activities were identified. Twenty-five percent of those studied named the following activities and mean importance ratings: bathing (4.12), carrying things (2.97), shopping (2.65), walking upstairs (2.38), walking uphill (3.13), hurrying (2.13), and going for a walk (2.67). Other activities reported by fewer than 25% included dressing, housework, walking. playing with children/grandchildren, trying to sleep, talking, bending, being angry, mowing the lawn, eating, running to catch a bus, vacuuming, mopping, meal preparation, reaching over the head, washing the car and playing sports. The activities with the five highest mean importance were bathing, carrying things, walking uphill, shopping, and going for a walk.

Conclusions: This study offers a glimpse into activities that veterans choose to perform despite dyspnea. Activities that are fundamental to independent living and undertaken daily, such as the various forms of walking, bathing, and homemaking constituted the preponderance of those defined as essential. Few subjects identified social, sexual, and recreational exertions as being worth experiencing dyspnea, suggesting one factor in the psychosocial isolation experienced by many male veterans with severe COPD.

Impact: Interventions that pinpoint individually-selected, essential functions for treatment endpoints may be more effective in achieving functional outcomes than those adopting broad, group-defined goals. Maintaining a focus on dyspnea treatment in the setting of essential functions may reduce daily discomfort and improve life quality in this population.