Dyspnea Self-Management: Internet or Face-to-Face
Dyspnea Self-Management: Internet or Face-to-Face
Chronic obstructive pulmonary disease, including emphysema and chronic bronchitis, is the
 fourth most common cause of death and the second leading cause of disability in the United
 States. COPD is estimated to be responsible for more than 13.4 million physician visits and
 13% of hospitalizations nationally. These hospitalizations are usually caused by acute
 exacerbations characterized by an increase in symptoms including dyspnea or shortness of
 breath (SOB), cough, wheezing, and sputum production. The significant disability for people
 with COPD is primarily due to the symptom of dyspnea (shortness of breath) that affects an
 individual's quality of life more than does the physiological impairment. Despite optimal
 medical and pharmacological therapy, most people with COPD continue to suffer from chronic
 and progressive dyspnea and other symptoms of cough and fatigue.

 We have previously shown that an individualized face-to-face dyspnea self-management program
 was effective in improving dyspnea with activities of daily living (ADL), physical
 functioning, and self-efficacy for managing dyspnea. Using an experimental longitudinal
 design, the i-DSMP will be compared to the Face-to-Face Dyspnea Self-Management Program
 (f-DSMP) and to an Attention Control (AC) intervention
At the present time, education about symptom management for patients and treatments,
 including exercise, are primarily provided within structured and episodic pulmonary
 rehabilitation (PR) programs. These PR programs are of short duration, are available for only
 a small percentage of people because they are expensive and not covered by all third party
 payers, and often require travel by patients who are disabled. Given estimates of 10 to 24
 million U.S. adults with COPD,most of who would benefit from PR, only less than 0.1% can be
 accommodated at any given time. In the US the maintenance or exercise programs following PR
 are not reimbursed and, therefore, not available for most patients.

 A number of self-management programs have been tested in multiple chronic diseases,but there
 has been less study of self-management programs for patients with COPD. The few
 self-management programs for COPD that include only education and limited skills training
 have not significantly improved symptoms. Home-based PR and self-management programs with
 nurse home visits have been studied and provide a less costly and accessible alternative.
 Clearly there is a growing need for more accessible and alternative avenues for providing
 ongoing support and therapy for COPD patients.

 The Internet provides a new exciting delivery channel that offers patients with disabilities
 an opportunity for greater involvement in health care decision-making and unparalleled
 opportunities to learn, inform, and communicate with one another and for health care
 providers to support patients' self-management efforts. Several Internet-based studies for
 other chronic illnesses have increased self-efficacy for symptom management, perception of
 available support, and patients' involvement in health care decision making, while reducing
 symptoms and health care costs. The only published study evaluating the use of the internet
 to support self-management in COPD patients was our pilot study for this proposal. Our study
 demonstrated an improvement in both self-efficacy and dyspnea with daily activities measures.
 This study will expand on the findings of our pilot study.
Inclusion Criteria:

 -  Participants will have:

 1. a diagnosis of COPD which is clinically stable (including medications) for at
 least one month;

 2. spirometry results showing at least mild obstructive disease defined as post
 bronchodilator forced expiratory volume in one second (FEV1)/forced vital
 capacity (FVC) ratio <0.70 with FEV1<80% predicted or post-bronchodilator
 FEV1/FVC ratio <0.60 with FEV1>80% predicted;

 3. ADL limited by dyspnea;

 4. a designated primary care physician;

 5. ability to speak English and sign consent form;

 6. actively using a computer and the Internet;

 7. no formal pulmonary rehabilitation training for at least 12 months;

 8. patients receiving supplemental oxygen will be acceptable if their O2 saturation
 can be maintained at >80% on <6L/min of nasal oxygen;

 9. understands how to and is able to rate their shortness of breath during exercise;

 10. age > 40 years.

 Exclusion Criteria:

 -  Subjects will be excluded if they have active symptomatic illness (e.g., cancer, left
 heart failure, ischemic heart disease with known coronary artery or valvular heart
 disease, psychiatric illness, and neuromuscular disease).