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)A rollator device was found to reduce dyspnea and improve functional exercise capacity in 40 patients withCOPD in one repeated-measures randomized crossover design study (Solway, Brooks, Lau & Goldstein, 2002). Arandomized parallel groups trial with 110 patients found that physical disability was reduced with use of awheeled walker (Yohannes & Connolly, 2003).See Appendix I for Energy Conservation Tips.Relaxation TechniquesThe American Thoracic Society consensus statement (1999) concludes that relaxation training mayimprove dyspnea in the short term, but has not been shown to have long-term effects. In a qualitative study,25% of the patients reported using relaxation techniques to control dyspnea (Carrieri & Janson-Bjerklie, 1986).Relaxation techniques often taught are progressive muscular relaxation, positive thinking and visualization,use of music, yoga, and humour.Progressive Muscular Relaxation. The Institute for Clinical Systems Improvement guideline (2003) statedthat progressive muscle relaxation has been shown to reduce psychological distress and dyspnea. Tworandomized controlled trials looked at progressive muscle relaxation to reduce the anxiety associated withdyspnea in patients with COPD (Gift et al., 1992; Renfroe, 1988). Both studies demonstrated an improvementin dyspnea scores in the relaxation group.Positive Thinking and Visualization. In one qualitative study, 13% of the subjects used positive thinking,focusing on a desire to live, or they ignored their shortness of breath and tried not to worry about it (Carrieri& Janson-Bjerklie, 1986). There is little evidence to support this strategy.Music. The American Thoracic Society consensus statement on dyspnea (1999) states that improvement indyspnea and anxiety has been shown following distraction interventions such as music during exercise.Yoga. There is one study with 11 patients that supports training in yoga breathing exercises and postures toimprove dyspnea (Tandon, 1978).Positioning. Positioning is a strategy described by patients to help them cope with dyspnea (Carrieri & Janson-Bjerklie, 1986; Roberts et al., 1993). The AmericanThoracic Society consensus statement (1999) concludes thatthe leaning forward position has been reported to improve overall inspiratory muscle strength (O’Neill &McCarthy, 1983), increase diaphragm recruitment, reduce participation of neck and upper costal muscles inrespiration, and decrease abdominal paradoxical breathing, as well as reduce dyspnea in COPD (Barach,1974; Barach & Beck, 1954; Sharp, Drutz, Moisan, Foster & Machnach, 1980).Use of Fresh Air or Fan. Cold facial stimulation has been shown to reduce induced breathlessness in normalsubjects (Schwartzstein et al., 1987). The best support for this strategy comes from qualitative studies in whichpatients say that it helps (Carrieri & Janson-Bjerklie, 1986; Roberts et al., 1993).See Appendix J for instructions on some of the relaxation techniques.30