title: Therapeutic paralysis in veterans with COPD.
abstract: BACKGROUND
  Chronic Obstructive Pulmonary Disease (COPD) is a common disorder of Veterans that causes significant morbidity and mortality. To measure Veterans' perceptions about COPD, the effect of COPD on their lives and health, and their needs for improved health, we performed a postal survey.
  
  
  METHODS
  3263 Veterans with a diagnosis of COPD who received care at the Cincinnati Veterans Affairs Medical Center in 2008 were stratified into quintiles by Veterans Health Administration-associated COPD healthcare cost and uniformly sampled.
  
  
  RESULTS
  493 of 1000 surveys (49%) were completed and returned. COPD had different effects on respondents in top and bottom quintiles (highest and lowest COPD-related cost) for: knowledge of COPD diagnosis (89% vs. 73%, p = 0.03); activities affected by breathing, including work (69% vs. 45%), recreation (85% vs. 62%), change in living arrangements (36% vs 16%), and increased need for help (54% vs. 25%) (p < 0.05 for all comparisons); emotional effect of respiratory symptoms, including depression (53% vs. 30%), fear (41% vs. 15%), and helplessness (49% vs. 24%) (p < 0.05 for all comparisons). 91% of Veterans were prescribed inhalers and one-quarter had difficulties using them. 25% of Veterans did nothing when they had symptoms of an exacerbation.
  
  
  CONCLUSIONS
  COPD has profound effects on Veterans' breathing related activities and generates many negative emotions. Primary care providers are critical in conveying the diagnosis of COPD and providing information about the disease and its management. Veterans with COPD adhere poorly to their medications, and report little instruction about COPD or its management.
authors.affiliation: Department of Internal Medicine, University of Cincinnati Academic Health Center, 231 Albert Sabin Way, Cincinnati, OH 45267, USA. Electronic address: mulhalan@ucmail.uc.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Mulhall
authors.forename: Laura A
authors.initials: LA
authors.lastname: Lach
authors.forename: Sara M
authors.initials: SM
authors.lastname: Krzywkowski-Mohn
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Welge
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Panos
mesh_terms: D000203:Activities of Daily Living; D000342:Affective Symptoms / Q000209:etiology; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers; D009820:Ohio; D010353:Patient Education as Topic / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation / Q000628:therapy; D012646:Self Administration / Q000592:standards; D012648:Self Care / Q000379:methods / Q000592:standards; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health / Q000706:statistics & numerical data*
keywords: Chronic obstructive pulmonary disease (COPD); Patient-centered; Questionnaire; Self-management; Survey