title: Association of breathlessness with multiple symptoms in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  This paper is a report of an exploration of relationships between demographic and clinical variables and the symptoms of breathlessness, depression, anxiety, fatigue, sleeping difficulties and pain for patients with chronic obstructive pulmonary disease.
  
  
  BACKGROUND
  Research into chronic obstructive pulmonary disease has focused on single symptoms and we lack knowledge about possible associations between several symptoms.
  
  
  METHODS
  A total of 154 patients with chronic obstructive pulmonary disease participated in a cross-sectional study from June 2006 to December 2007 (response rate 40%). All underwent pulmonary lung function tests and completed questionnaires including demographic variables, the Brief Pain Inventory, Hospital Anxiety and Depression Scale, Lee Fatigue Scale, General Sleep Disturbance Scale and the Respiratory Quality of Life Questionnaire. Bivariate correlation and multiple regression analyses were performed.
  
  
  RESULTS
  Breathlessness was statistically significantly positively associated with the other symptoms, after controlling for demographic and clinical variables. Younger age was statistically significantly related to more breathlessness, anxiety and sleeping difficulties and lower levels of education was statistically significantly related to more breathlessness, depression and anxiety. In relation to clinical variables, smoking was statistically significantly related to more depression, whereas more co-morbidity was statistically significantly related to more breathlessness and pain. Poorer lung function was statistically significantly related to more breathlessness. However, higher lung function was related to more sleeping difficulties.
  
  
  CONCLUSIONS
  Breathlessness is associated with symptoms such as depression, anxiety, fatigue, sleeping difficulties and pain, suggesting the need for an expanded focus on symptoms in chronic obstructive pulmonary disease guidelines, health care and research.
authors.affiliation: Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway. christineraaheim.borge@lds.no
authors.forename: Christine Råheim
authors.initials: CR
authors.lastname: Borge
authors.forename: Astrid K
authors.initials: AK
authors.lastname: Wahl
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003710:Demography; D003863:Depression / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D011788:Quality of Life; D012044:Regression Analysis; D012893:Sleep Wake Disorders / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry; D011795:Surveys and Questionnaires