Variability Of Chronic Obstructive Pulmonary Disease Symptom Clusters During The Trajectory Of Disease: A Longitudinal Study

Objective: The patients with Chronic Obstructive Pulmonary Disease experienced multiple symptoms concurrently.Symptom cluster was groups of related symptom that occur together,which had a greater effect on health-related outcomes than an individual symptom.The aim of this study was to(1)identify symptom clusters of Chronic Obstructive Pulmonary Disease during the trajectory of disease;(2)examine the relationship between the symptom clusters before admission with exacerbation,readmission or mortality.Methods: This study was a descriptive longitudinal design.This study was approved by the Research Ethics Committee of Nursing School,Jilin University.Hospitalized patients with Chronic Obstructive Pulmonary Disease who visited the pulmonary department at two university-affiliated –hospitals in Changchun,China between December 2006 and November 2017,and followed up three months.The demographic and clinical characteristics questionnaire,the Memorial Symptom Assessment Scale was used to measure the patients' characteristics and symptoms.Data were analyzed using SPSS version 22.0(IBM SPSS Statistics,SPSS,Chicago,Illinois).All continuous variables were presented as means and standard deviation;categorical variables were expressed as percentage,frequency,or median.Symptoms reported on the MSAS by more than 30% of the sample were used to perform exploratory factor analysis.Results: 1.The patients with Chronic Obstructive Pulmonary Disease experienced multiple symptoms concurrently.Chronic Obstructive Pulmonary Disease symptoms before admission had been divided into five cluster: emotional symptom cluster,fatigue symptom cluster,pain-appetite symptom cluster,dyspnea-dry mouth symptom cluster,and cough-sleep symptom cluster.When the patients lived in the hospital,five symptom clusters were identified,which included emotion-sleep symptom cluster,sweat-appetite symptom cluster,fatigue symptom cluster,respiratory symptom cluster,and feeling drowsy formed a third unique solution.2.Before admission and in hospital,the Chronic Obstructive Pulmonary Disease symptom clusters contained a variety of symptoms with a complicated structure.One month and 3 months after discharge,the distribution and structure of symptom clusters had changed a lot.But the symptom clusters at 3 months discharge were similar to those at 1 month discharge.The structure of symptom clusters and the disease tend to be stable.3.Survival analysis indicated that the fatigue symptom cluster and respiratory symptom cluster in admission were the protective factor for exacerbation,readmission or mortality.Conclusion: This study explored the Chronic Obstructive Pulmonary Disease symptom clusters and the pattern of change through the progression of disease.Before admission and in hospital,the Chronic Obstructive Pulmonary Disease symptom clusters contained a variety of symptoms with a complicated structure.While the symptom clusters at 3 months discharge were similar to those at 1 month discharge.The structure of symptom clusters and the disease tend to be stable.Survival analysis indicated that the fatigue symptom cluster and respiratory symptom cluster in admission were the protective factor for exacerbation,readmission or mortality.