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You meet
two patients with COPD. One is 53 years old, the other is 55 years
old. Each has severe airflow obstruction with an Forced Expiratory
Volume in 1 second (FEV1) = 40% of the predicted value. One complains
of becoming short of breath walking 50 yards and would like to
go on disability; the other denies breathlessness with daily activities,
works full time and walks one mile every day in about 25 minutes.
Question
24.1
What
could explain the disparity in functional capability between these
two patients?
 | FEV1
does not represent the stimulus producing dyspnea |
 | One
patient is more stoic than the other |
 | One
patient is depressed or anxious while the other is not |
 | The
patients come from different cultural backgrounds |
 | All
of the above |
| Figure
24.1: Dyspnea Experience: Sensation, Symptom, Illness
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| Harver A, Mahler DA. Dyspnea: Sensation, symptom, and illness.
In: Mahler DA, ed. Dyspnea. New York, NY: Marcel Dekker, Inc.; 1998:1-34. Reprinted with permission by Marcel Dekker, Inc.
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The variables
that affect the perception of physical sensations include age,
gender, socioeconomic factors, personal history, social learning,
beliefs, tolerance to pain and discomfort, and psychological orientation
(Harver and Mahler, 1990).
Based on these factors and the patient's experience with the sensation,
he or she determines whether or not the sensation in fact represents
something wrong with his or her body. Further processing, termed
symptom attribution, occurs as the individual evaluates the causes
and implications of the symptoms and interprets what this is likely
to mean (Harver and Mahler,
1998).
As with pain, the functional
impairment resulting from a respiratory sensation depends in part
upon the individual's ability to tolerate discomfort. Patients
may be classified based upon their perceived intensity of a painful
experience and the effect that the pain has on the individual's
sense of self-control (Turk
and Rudy, 1988). These baseline personality characteristics
may be modified further by acute changes in one's psychological
orientation, that is, levels of mood, well-being, and distress.
A symptom that may be perceived as a minor nuisance one day, when
an individual is riding high, may be interpreted as a life-threatening
problem when that same person is suffering from depression or
acute anxiety . The extent to which individuals can maintain a
sense of "control" over their bodies may determine the
intensity of the sensory experience.
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