Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...

Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)Background ContextIn Canada 3.9% of Canadians aged 35 years or more (466,812 adults) have probable COPD (Canadian Institutefor Health Information, Canadian Lung Association, Health Canada & Statistics Canada, 2001). These figures likelyunderestimate the true prevalence of COPD because a diagnosis is often not made until the patient is over55 years of age and has advanced changes in the lung tissue. Furthermore, studies have estimated morethan 50% of patients with COPD remain undiagnosed in the community (Calverley & Bellamy, 2000).Dyspnea and COPDSimilar to pain, often referred to as the fifth vital sign (McCaffrey & Pasero, 1997; 1998; RNAO, 2002a), dyspneashould be understood as the sixth vital sign for individuals living with COPD. Dyspnea, the subjectiveexperience of breathlessness (Gift, 1990; 1993; GOLD Scientific Committee, 2003; 2004), is the most disablingsymptom of COPD. As a progressive respiratory disorder, COPD is characterized by progressive airwayobstruction precipitating ongoing dyspnea and systemic manifestations including peripheral muscledysfunction, right heart failure, polycythemia and changes in nutritional status. Although smoking is themajor risk factor, much is yet unknown about the causes of COPD (GOLD Scientific Committee, 2003; 2004;O’Donnell et al., 2003).Acute Exacerbation Episodes of COPD (AECOPD)People living with COPD experience dyspnea on a daily basis. As the disease progresses individuals have anever-increasing number of acute exacerbation episodes of their illness (AECOPD), averaging 2-3 per year.These episodes involve a sudden or sustained worsening of dyspnea, cough or sputum productionand increased use in maintenance medications. These events are the most frequent reason for hospitalvisits and mortality. Critically ill individuals with a history of COPD present at healthcare institutionswith elevated pulse and respiratory rates, incapacitated by severe dyspnea—the sixth vital sign ofindividuals with COPD (Gift, Moore & Soeken, 1992; Kinsman, Fernandez, Schocket, Dirks & Covino, 1983; Kinsman,Yaroush, Fernandez, Dirks, Schocket & Fukuhara, 1983; Kroenke, Arrington & Mangelsdorff, 1990; Mahler, Faryniarz, Tomlinson,Colice, Robins, Olmstead et al., 1992).Key points■■■■Dyspnea is the sixth vital sign for individuals living with COPD.Dyspnea is the most common disabling symptom of COPD.Incapacitating dyspnea is the most common presenting symptomof AECOPD.People living with COPD experience 2-3 AECOPD per year.18