Review: Coping with breathlessness among people with COPD: distinct physiological and behavioural indicators

Abstract

There is no doubt that with the global ageing population COPD will continue to be a leading cause of mortality and morbidity (Mannina and Buist, 2007). The role of coping has previously been explored in the literature but generally focuses on quality of life or patient experiences (Harris, 2007; Hesselink et al., 2004). This paper reports on a research project that builds on a previously published paper from the same project that identified four predominant types of coping with breathlessness among people with COPD. The authors use multi-modal grounded theory, combining both qualitative and quantitative data to explore whether physiological and behavioural parameters could distinguish between the aforementioned four types of coping with breathlessness and represent coping type indicators. They identified physiological and behavioural coping-type-specific indicators and found that COPD severity, intensity of breathlessness, respiratory rate, level of oxygen saturation and the patients’ use of breaks could be used to discriminate between the four coping types. Although not a new concept, the regulation of activity was identified as the fundamental strategy that participants used to reduce or avoid breathlessness. Of interest, however, is the ways in which participants regulated their activity and the relationship of this to the discussed coping types. The discussion of how participants regulated their activity by overrating, underrating, challenging or levelling provides a basis for the development of individualised and holistic care. The psychological and behavioural indicators of coping for people with chronic obstructive pulmonary disease is essential to understanding how these patients manage their chronic condition. This paper provides a basis for further research to explore whether the identified physiological and behavioural coping-type-specific indicators are relevant across populations and in different cultural contexts.