title: Differences in Symptom Burden Among Patients With Moderate, Severe, or Very Severe Chronic Obstructive Pulmonary Disease.
abstract: The symptom experience of patients with chronic obstructive pulmonary disease (COPD) is extremely complex. It is characterized by multiple co-occurring symptoms. However, very few studies have described this experience in COPD patients.
  
  
  
  The aims of this study were to evaluate for differences in symptom occurrence rates, as well as ratings of symptom severity, frequency, and distress among patients (n = 267) with moderate, severe, and very severe COPD.
  
  
  
  The Memorial Symptom Assessment Scale was used to evaluate the multiple dimensions of the patient's symptom experience. Binary and ordinal logistic regression analyses with stage of disease as an ordinal predictor variable were used to evaluate for differences in symptom occurrence rates and ratings of symptom severity, frequency, and distress.
  
  
  
  Regardless of the severity of their disease, patients reported an average of 12 co-occurring symptoms. Shortness of breath and lack of energy were the only two symptoms that differed significantly among the three disease severity groups in terms of occurrence, severity, frequency, and distress. Patients with very severe COPD reported the highest ratings for shortness of breath and lack of energy across all four symptom dimensions.
  
  
  
  Regardless of stage of disease, the high symptom burden identified in this study underscores the need for COPD patients to be screened for multiple co-occurring symptoms.
authors.affiliation: Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: v.l.christensen@medisin.uio.no.
authors.forename: Vivi Lycke
authors.initials: VL
authors.lastname: Christensen
authors.affiliation: Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Are Martin
authors.initials: AM
authors.lastname: Holm
authors.affiliation: Department of Community Health Systems, University of California, San Francisco, California, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Cooper
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, California, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.affiliation: Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway; Institute of Health and Society Department of Nursing Science, University of Oslo, Oslo, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Rustøen
mesh_terms: D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology
keywords: Symptom occurrence; chronic obstructive pulmonary disease; shortness of breath; symptom burden; symptom distress; symptom severity