The effect of pulmonary rehabilitation on perceptions of breathlessness and activity in COPD patients: a qualitative study

Abstract

Aim: The aim of this study was to explore, using qualitative research methods, how pulmonary rehabilitation (PR) programmes affect the experience of activity and breathlessness of people with COPD.Methods: A qualitative, interview-based approach was employed. Participants were interviewed pre-and post-PR. Data were analysed using systematic strategies informed by grounded theory methods.Results: Nine participants (three female) took part. A change in participants' perception of breathlessness and lessening of fear of activity were the main themes identified. PR appeared to impact on the experience of physical social activities, allowing participants to overcome feelings of social isolation.Conclusions: Prior to PR, participants associated activities with breathlessness and panic; post PR, participants reported reduced fear and felt able to increase their activities. These findings add to our understanding of the impact of PR on individuals' experience of activity and may contribute to improved programmes by addressing patients' needs.

Psychosocial Dimensions of COPD for the Patient and Family

“…Under supervision, people become more comfortable exerting their body and are less likely to become panicked by exertional dyspnoea (Williams et al, 2010). Chris learned to manage his panic through the classes: "The most helpful was avoiding panic attacks… It changed my outlook… I probably looked at it from the aspect 'Well, Bugger it!…”

“…Pulmonary rehabilitation has led to improvements in health related quality of life even where no significant improvement in lung function is demonstrated (Haave et al, 2007, Camp et al, 2000. This is in part, due to the reduction in social isolation and improved opportunities for expression of 'self' (Gullick, 2008, Toms & Harrison, 2002; patients describe feelings of enhanced well-being and hope (Milne et al, 2009, O'Shea et al, 2007, have higher self-esteem and mood (Arnold et al, 2006) and, following rehabilitation, are more likely to talk about their abilities rather than their limitations (Williams et al, 2010). Pulmonary rehabilitation can lead to a change in physical appearance and in turn, body image, and creates a sense of pride, satisfaction and achievement (O'Shea et al, 2007).…”

“…Whilst breathlessness is still a feature of the person's experience after rehabilitation, it is the change in the way breathlessness is perceived that is most important, resulting from increased confidence and a loss of fear of physical exertion. With an increased sense of control over breathing, people often find panic and anxiety are reduced or eliminated and they increase their activity levels as a result (Williams et al, 2010, O'Shea et al, 2007.…”

Illness experiences of persons with chronic obstructive pulmonary disease: self-perceived efficacy of home-based pulmonary rehabilitation

“…Recall that retired Señor Pablo critiques his diminished capacity to stroll at the same pace with friends or to stop his grandchildren's hands from slipping out of his grasp and them running off. Even though some studies reveal restrictions and losses in COPD patients' emotional and social realms 13,14 , this anthropological study details the meaning of functional limitations in real life contexts. It probes what really matters 40 .…”

“…What is lacking is a dense ethnographic description of COPD as a "cultural idiom of distress" 12 . Medical anthropologists have revealed that providers' and patients' constructions of disease and illness, respectively, often contest each other 3,13,14 . In 1977, Eisenberg 15 first drew a distinction between the professional biomedical notion of disease and popular ideas of illness.…”