Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Background - Dyspnea and COPD

In Canada 3.9% of Canadians aged 35 years or more (466,812 adults) have probable COPD (Canadian Institute for Health Information, Canadian Lung Association, Health Canada & Statistics Canada, 2001). These figures likely underestimate the true prevalence of COPD because a diagnosis is often not made until the patient is over 55 years of age and has advanced changes in the lung tissue. Furthermore, studies have estimated more than 50% of patients with COPD remain undiagnosed in the community (Calverley & Bellamy, 2000).

Dyspnea and COPD

Similar to pain, often referred to as the fifth vital sign (McCaffrey & Pasero, 1997; 1998; RNAO, 2002a), Dyspnea should be understood as the sixth vital sign for individuals living with COPD. Dyspnea, the subjective experience of breathlessness (Gift, 1990; 1993; GOLD Scientific Committee, 2003; 2004), is the most disabling symptom of COPD. As a progressive respiratory disorder, COPD is characterized by progressive airway obstruction precipitating ongoing dyspnea and systemic manifestations including peripheral muscle dysfunction, right heart failure, polycythemia and changes in nutritional status. Although smoking is the major risk factor, much is yet unknown about the causes of COPD (GOLD Scientific Committee, 2003; 2004; O’Donnell et al., 2003).