The purposes of this pilot study are to describe the 24-hr patterns of dyspnea, fatigue, and peak expiratory flow rate (PEFR) in patients with chronic obstructive pulmonary disease (COPD) and examine their interrelationships. The repeated-measures design protocol involved 10 patients with moderate to severe COPD who self-assessed dyspnea, fatigue, and PEFR five times a day for 8 days. Circadian rhythms were documented by single cosinor analysis in 40% of the participants for dyspnea, 60% for fatigue, and 60% for PEFR. The 8-day, 24-hr means of dyspnea and fatigue were moderately correlated; 70% of the sample displayed significant correlations. The means of PEFR and both dyspnea and fatigue were weakly negatively correlated. The findings suggest that circadian rhythm in lung function may not be temporally coupled with the circadian rhythm in dyspnea and fatigue in all patients and that the mean self-perceived levels of dyspnea and fatigue are moderately related.
Aitken, R.C. (1969). A growing edge of measurement of feelings. Proceeds of theRoyal Society of Medicine, 62, 17-24.
2.
Alonso, J., Anto, J., Gonzalez, M., Fiz, J.A., Izquierdo, J., & Morera, J. (1992). Measurement of general health status of non-oxygen-dependent chronic obstructive pulmonary disease patients. Medical Care , 30(5, Suppl), MS125-MS135.
3.
American Thoracic Society. (1995). Standardization of spirometry: 1994 update. American Journal of Respiratory and Critical Care Medicine, 152, 1107-1136.
4.
American Thoracic Society/European Respiratory Society Task Force. (2004). Standards for the diagnosis and management of patients with COPD [Internet] Version 1.2. New York: American Thoracic Society. Updated September 8, 2005; retrieved from http://www.thoracic.org/go/copd
5.
Bland, J.M., & Altman, D.G. (1986, February 8). Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet, pp. 307-310.
6.
Brand, P.L., Postma, D.S., Kerstjens, H.A., Koeter, G.H., & the Dutch CNSLD Study Group. ( 1991). Relationship of airway hyperresponsiveness to respiratory symptoms and diurnal peak flow variation in patients with obstructive lung disease. American Review of Respiratory Disease, 143, 916-921.
7.
Burioka, N., Miyata, M., Endo, M., Fukuoka, Y., Suyama, H., Nakazaki, H., Igawa, K., & Shimizu, E. (2005). Alteration of circadian rhythm in peak expiratory flow of nocturnal asthma following nighttime transdermal B2-Adrenoceptor Agonist Tulobuterol chronotherapy. Chronobiology International , 22, 383-390.
8.
Crapo, R.O., & Jensen, R.L. (1998). Test report: Micro Medical Limited diary card spirometer. Salt Lake City, UT: LDS Hospital Laboratory.
9.
Dawkins, K.D., & Muers, M.F. (1981). Diurnal variation in airflow obstruction in chronic bronchitis. Thorax, 36, 618-621.
10.
Douma, W.R., van der Mark, T.W., Folgering, H.T.M., Kort, E., Kerstjens, H.A.M., Koeter, G.H., et al. (1997). Mini-Wright peak flow meters are reliable after 5 years use. European Respiratory Journal, 10, 457-459.
Gardner, R.M., Crapo, R.O., Jackson, B.R., & Jensen, R.L. (1992). Evaluation of accuracy and reproducibility of peak flow meters at 1,400 m. Chest, 101, 948-952.
13.
Gift, A.G., & Narsavage, G. (1998). Validity of the numeric rating scale as a measure of dyspnea. American Journal of Critical Care, 7, 200-204.
14.
Gift, A.G., Plaut, S.M., & Jacox, A. (1986). Psychologic and physiologic factors related to dyspnea in subjects with chronic obstructive pulmonary disease. Heart & Lung, 15, 595-601.
15.
Gift, A.G., & Shepard, C.E. (1999). Fatigue and other symptoms in patients with chronic obstructive pulmonary diseases: Do women and men differ?Nursing Journal of Obstetric, Gynecologic, and Neonatal Nursing, 28, 201-208.
16.
Graydon, J.E., Ross, E., Webster, P.M., Goldstein, R.S., & Avendano, M. (1995). Predictors of functioning of patients with chronic obstructive pulmonary disease. Heart & Lung, 24, 369-375.
17.
Gregg, I. (2000). PER versus FEV1. Thorax, 55, 807.
18.
Guyatt, G.H., Berman, L.B., Townsend, M., Pugsley, S.O., & Chambers, L.W. (1987). A measure of quality of life for clinical trials in chronic lung disease. Thorax, 42, 773-778.
19.
Halberg, F. (1969). Chronobiology. Annual Review of Physiology, 31, 675-725.
20.
Haus, E., & Touitou, Y. (1994). Principles of clinical chronobiology. In Y. Touitou & E. Haus (Eds.), Biologic rhythms in clinical and laboratory medicine (pp. 6-34). New York/Berlin : Springer-Verlag.
21.
Hetzel, M.R., & Clark, T.J.H. (1980). Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate. Thorax, 35, 732-738.
22.
Holcroft, C., Eisen, E., Sama, S., & Wegman, D. (2003). Measurement characteristics of peak expiratory flow. Chest, 124, 501-510.
23.
Irvin, C.G., Martin, R.J., Chinchilli, V.M., Kunselman, S.J., Cherniack, R.M., & Asthma Clinical Research Network. (1997). Quality control of peak flow meters for multicenter clinical trials. American Journal of Respiratory Critical Care Medicine, 156, 396-402.
24.
Janson-Bjerklie, S., Carrieri, V., & Hudes, M. (1986). The sensations of pulmonary dyspnea. Nursing Research, 35, 154-159.
25.
Kamps, A.W., Roorda, R.J., & Brand, P.L. (2001). Peak flow diaries in childhood asthma are unreliable . Thorax, 56, 180-182.
Kelly, E.A.B., Houtman, J.J., & Jarjour, N.N. (2004). Inflammatory changes associated with circadian variation in pulmonary function in subjects with mild asthma. Clinical & Experimental Allergy, 34, 227-233.
28.
Kinsmen, R.A., Yaroush, R.A., Fernandez, E., Dirks, J.F., Schocket, M., & Fukuhara, J. (1983). Symptoms and experiences in chronic bronchitis and emphysema. Chest, 83, 755-761.
29.
Lee, K.A., Hicks, G., & Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. Psychiatry Research, 36, 291-298.
Minors, D.S., & Waterhouse, J.M. (1988). Mathematical and statistical analysis of circadian rhythms. Psychoneuro-endocrinology, 13, 443-464.
32.
Morrill, C.G., Dickey, D.W., Weiser, P.C., Kinsman, R.A., Chai, H., & Spector, S.L. (1981). Calibration and stability of standard and mini-Wright peak flow meters. Annals of Allergy, 46, 70-73.
33.
Muza, S.R., Silverman, M.T., Gilmore, G.C., Hellerstien, H.K., & Kelsen, S.G. (1990). Comparison of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive pulmonary disease . American Review of Respiratory Disease, 141, 909-913.
34.
Nelson, W., Tong, Y.L., Lee, J., & Halberg, F. (1979). Methods for cosinor-rhythmometry. Chronobiologia, 6, 305-323.
35.
Nunnally, J.C., & Bernstein, I.H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.
36.
Ott, R.L. (1993). Probability and probability distributions. In R. L. Ott, An introduction to statistical methods and data analysis (4th ed., pp. 123-194). Belmont, CA: Duxbury.
37.
Pauwels, R.A., Buist, A.S., Calverley, P.M.A., Jenkins, C.R., & Hurd, S.S. (2001). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary. American Journal of Respiratory and Critical Care Medicine, 163, 1256-1276.
38.
Peiffer, C., Marsac, J., & Lockhart, A. (1989). Chronobiological study of the relationship between dyspnoea and airway obstruction in symptomatic asthmatic subjects. Clinical Science, 77, 237-244.
39.
Prevost, E.J., Smolensky, M.H., Reinberg, A., & McGovern, J.P. (1980). Circadian rhythm of respiratory distress in asthmatic, bronchitic and emphysemic patients. In M. H. Smolensky, A. Reinberg , & J. P. McGovern (Eds.), Recent advances in the chronobiology of allergy and immunology (pp. 237-250). Elmsford, NY: Pergamon.
40.
Quackenboss, J.J., Lebowitz, M.D., & Krzyzanowski, M. (1991). The normal range of diurnal changes in peak expiratory flow rates. American Review of Respiratory Disease, 143, 323-330.
41.
Ream, E., & Richardson, A. (1997). Fatigue in patients with cancer and chronic obstructive airways disease: A phenomenological enquiry. InternationalJournal of Nursing Studies, 34, 44-53.
42.
Reishtein, J.L. (2005). Relationship between symptoms and functional performance in COPD. Research in Nursing &Health, 28, 39-47.
43.
Scott, J., & Huskisson, E.C. (1979). Vertical or horizontal visual analogue scales. Annals of Rheumatic Diseases, 38, 560.
44.
Simmons, M., Wynegar, T., & Hess, D. (1993). Evaluation of the agreement between portable peak flow meters and a calibrated pneumotachometer. Respiratory Care, 38, 916-922.
45.
Smolensky, M.H., Barnes, P.J., Reinberg, A., & McGovern, J.P. (1986). Chronobiology and asthma. 1. Day-night differences in bronchial patency and dyspnea and circadian rhythm dependencies. Journal ofAsthma, 23, 321-343.
46.
Smolensky, M.H., & Halberg, F. (1977). Circadian rhythm in airways patency and lung volumes . In J. P. McGovern, M. H. Smolensky, & A. Reinberg (Eds.), Chronobiology in allergy and immunology (pp. 117-138). Springfield, IL: Charles C Thomas.
47.
Sriwatanakul, K., Kelvie, W., Lasagna, L., Calimlim, J.F., Weis, O.F., & Mehta, G. (1983). Studies with different types of visual analogue scales for measurement of pain. Clinical Pharmacology and Therapeutics, 34, 234-239.
48.
Szefler, S.J., Ando, R., Cicutto, L.C., Surs, W., Hill, M.R., & Martin, R.J. (1991). Plasma histamine, epinephrine, cortisol, and leukocyte B-adrenergic receptors in nocturnal asthma. Clinical Pharmacological Therapy, 49, 59-68.
49.
Thiadens, H.A., De Bock, G.H., Van Houwelingen, J.C., Dekker, F.W., De Waal, M.W.M., Springer, M.P., et al. (1999). Can peak expiratory flow measurements reliably identify the presence of airway obstruction and bronchodilator response as assessed by FEV1 in primary care patients presenting with a persistent cough ? Thorax, 54, 1055-1060.
50.
Touitou, Y., & Haus, E. (1994). Biologic rhythms from biblical to modern times: A preface. In Y. Touitou & E. Haus (Eds.), Biologic rhythms in clinical and laboratory medicine (pp. 1-5). New York/ Berlin: Springer-Verlag.
51.
Verschelden, P., Cartier, A., L'Archeveque, J., Trudeau, C., & Malo, J.L. (1996). Compliance with and accuracy of daily self-assessment of peak expiratory flows (PEF) in asthmatic subjects over a three-month period . European Respiratory Journal, 9, 880-885.
52.
Woo, K. ( 2000). A pilot study to examine the relationships of dyspnoea, physical activity and fatigue in patients with chronic obstructive pulmonary disease. Journal of Clinical Nursing, 9, 526-534.
