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| Figure
33.1: Theoretical Model Showing Links between Breathlessness,
Disability, and Other Factors that may Impair the Quality
of Life in Patients with COPD
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| Jones
PW. Dyspnea and the quality of life in chronic obstructive
pulmonary disease.
In: Mahler DA, ed.: Dyspnea. New York, NY: Marcel Dekker,
Inc; 1998:199-220.
Reprinted with permission by Marcel Dekker, Inc. |
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In the study of dyspnea, particularly with respect to interventions
to reduce breathing discomfort, there is a tendency to focus on
outcomes that directly assess the intensity of breathlessness
or that measure physiological characteristics of the patient that
are felt to reflect the mechanisms by which the disease state
leads to dyspnea. In the final analysis, however, clinicians should
be concerned about the ways in which a particular disease affects
the manner in which a given individual is able to live his or
her life. Furthermore, the symptom may lead to changes in lifestyle
that, by virtue of a more sedentary existence, may worsen the
symptom, or by creating anxiety and depression may lead to greater
compromises in activity and interpersonal relationships. Measures
of health-related quality of life are designed to assess the impact
of a disease and its associated symptoms on the individual's functional
and emotional state (Jones, 1998).
There are multiple
tools used to assess health-related quality of life (Jones,
1998), many of which have components that provide one with
a relatively direct measure of dyspnea as well as the other factors
that alter functional status (Hajiro
et al., 1998). Increasingly, these measures are being used
to define a clinically significant response to a therapy.
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