Home-based aerobic exercise feasibility in oxaliplatin-receiving newly-diagnosed cancer survivors.

PURPOSE: Physical activity (PA) is beneficial but difficult to maintain during chemotherapy. This pilot RCT explored the feasibility of the MI-Walk intervention-an 8-week motivational enhancement therapy- and home-based brisk walking intervention-among gastrointestinal (GI) cancer survivors receiving chemotherapy. METHODS: Sixty stage II-IV GI cancer survivors were recruited from 5 sites at their second infusion visit. Participants were randomized to receive PA education alone or the MI-Walk intervention: motivational enhancement therapy consisting of 3 motivational interviewing and self-efficacy-enhancing counseling sessions, a Fitbit Charge 2, exercise diaries, telephone follow-up, scripted motivational email messages, and optional weekly walking groups. RESULTS: The enrollment and completion rates were 62% and 90%, respectively. The MI-Walk participants (n = 29; mean age = 56.79, SD = 11.72; 97% white; 79% male) reported a baseline moderate-vigorous PA duration of 250.93 (SD = 636.52) min/wk. The mean MI-Walk Intervention acceptability score was 50.32 (SD = 12.02) on a scale of 14-70. Mean Fitbit and counseling helpfulness scores on a 5-point scale were 3.67 (SD = 1.43) and 3.44 (SD = 1.36), respectively. Participants' Fitbit moderate-vigorous PA 8-week averages ranged from 0 to 716.88 min/wk; 64% of participants adhered to ≥127 min/wk. Several characteristics (e.g., age, comorbidity, PA level, employment status, BMI, education level, gender, symptoms) were associated with enrollment, attrition, and intervention acceptability and adherence (p < 0.05). CONCLUSION: Enrollment and retention were adequate. The Fitbit and counseling were the most helpful. Acceptability and adherence varied based on participant characteristics; therefore, intervention tailoring and further research among cancer survivors less physically active at baseline and most in need of complex exercise intervention are needed. CLINICALTRIALS: gov NCT03515356.

Development and preliminary psychometric evaluation of the COPD-related Stigma Scale.

BACKGROUND: Stigma experiences contribute to psychological distress and negatively affect healthcare-seeking behavior in people with chronic obstructive pulmonary disease (COPD). Most evidence comes from qualitative research, and no well-established measure of COPD-related stigma exists. Prior research yielded a preliminary measure of COPD-related stigma, but it required item reduction and validation. OBJECTIVES: The purpose of this study was to revise the preliminary measure, reduce the number of items, identify underlying constructs, and evaluate the reliability and validity of the shortened version. METHODS: A descriptive, cross-sectional study was conducted. Participants (N = 148; mean = 64 ± 7.27 years) completed the 51-item preliminary COPD-related Stigma Scale (COPDSS). Item-level analysis was conducted before running exploratory factor analysis (EFA). Reliability was assessed using Cronbach's alpha. Convergent validity and known-groups validity were evaluated. RESULTS: In the item-level analysis, eight items were deleted, leaving 43 items for factor analysis. A four-factor model with 24 items (α = 0.93) was derived from EFA: social stigma (α = 0.95), felt stigma (α = 0.95), anticipated stigma-oxygen (α = 0.80), and smoking-related stigma (α = 0.81). The 24-item COPDSS was significantly correlated with the 8-item Stigma Scale for Chronic Illness (r = 0.83), the Hospital Anxiety and Depression Scale (r = 0.57), and the PROMIS Physical Function (r = -0.48). The 24-item COPDSS discriminated between known groups based on age (p = .03), use of inhalers (p = .002) and use of supplemental oxygen (p < .001), and psychological distress levels (ps < .001). CONCLUSION: Findings support the reliability and validity of the 24-item COPDSS. This instrument can be used to understand underlying stigma processes in people with COPD.

Comparison of Pre-Diagnosis Physical Activity and Its Correlates between Lung and Other Cancer Patients: Accelerometer Data from the UK Biobank Prospective Cohort.

Purpose: Physical activity (PA) plays an important role in health outcomes for people with cancer, and pre-diagnosis PA influences PA behaviors after cancer treatment. Less is known about the PA of lung cancer patients, and the strong history of smoking could influence pre-diagnosis levels of PA and place them at risk for health problems. This study aimed to compare pre-diagnosis PA and its correlates in patients with lung cancer and other types of cancer (female breast, colorectal, and prostate cancer) and examine the relationship between pre-diagnosis PA and all-cause mortality. Methods: This study used data from the UK Biobank, which is a national cohort study with accelerometry data. We included 2662 participants and used adjusted linear regressions and survival analyses. Results: Male and female lung cancer groups spent a mean of 78 and 91 min/day in pre-diagnosis moderate to vigorous PA (MVPA), respectively; this is lower than the 3 other types of cancer (p < 0.001). Younger age and faster walking pace had a strong association with PA in all the four types of cancer (p < 0.01). Smoking status had a strong association with PA in the lung cancer group, while obesity had a strong association with PA in female breast, colorectal, and prostate cancer (p < 0.01). Higher levels of pre-diagnosis MVPA (≥1.5 h/day) were associated with a significantly lower all-cause mortality risk. Conclusions: The present study suggests that lung cancer patients are the most inactive population before diagnosis. The identified difference in correlates of PA suggest that cancer-specific approaches are needed in PA research and practices. This study also highlights the importance of high PA for individuals with high cancer risk.

Physical activity in surgical lung cancer patients: a systematic review.

PURPOSE: Perioperative exercise could improve health outcomes of surgical lung cancer patients, but less is known about their natural physical activity (PA) behavior before exercise interventions. This review aimed to synthesize evidence on PA, regarding the following: (1) proportion of patients meeting PA guidelines, (2) amount of PA, (3) PA trajectory following surgery, and (4) correlates of PA before or after surgery. METHODS: We conducted a systematic review using PubMed, CINHAL, Scopus, and SPORTDiscus (July 2021). Observational or experimental studies that measure PA of lung cancer patients before/after surgery were included. We assessed methodological quality using the NIH Quality Assessment Tools and extracted data using a standardized form. RESULTS: Seventeen studies (25 articles, N = 1737 participants) published between 2009 and 2021 were included. Fourteen studies had sample sizes less than 100. Thirteen studies were of fair quality and four studies were of good quality. Only 23-28% of patients met PA guideline (150 min/week moderate-vigorous PA) at 6 months-6 years after surgery. Patients took an average of 3822-10,603 daily steps before surgery and 3934-8863 steps at 1-3 months after surgery. Physical activity was lower at 1 day-3 months after surgery, compared with preoperative levels. Perioperative PA was positively associated with exercise capacity, quality of life and reduced postoperative complications. CONCLUSION: This review suggests that PA is low among surgical lung cancer patients, and it may not recover within 3 months following surgery. Physical activity has the potential to improve postoperative outcomes. However, the existing evidence is weak, and future larger longitudinal studies are needed.

Efficacy of the Motivational Interviewing-Walk Intervention for Chemotherapy-Induced Peripheral Neuropathy and Quality of Life During Oxaliplatin Treatment: A Pilot Randomized Controlled Trial.

BACKGROUND: Oxaliplatin-induced peripheral neuropathy (OIPN) is prevalent among gastrointestinal cancer survivors and often impairs quality of life (QOL). OBJECTIVE: This pilot randomized controlled trial aimed to explore the effect of an 8-week home-based brisk walking (the "MI-Walk") intervention on (1) OIPN severity and (2) QOL at 8 weeks, compared with physical activity (PA) education alone in oxaliplatin-receiving adults with gastrointestinal cancer. INTERVENTIONS/METHODS: Participants (N = 57) recruited from 5 infusion sites received PA education at their second oxaliplatin visit, followed by phone assessments of adverse events over 8 weeks. Half (n = 29) received additional MI-Walk intervention motivational supports (eg, a Fitbit Charge 2 and motivational enhancement therapy sessions). Self-reported OIPN, QOL, and PA were measured before and after intervention. RESULTS: The intervention compared with the control condition had no effect on sensory OIPN (mean difference [] = -0.01; P > .99), motor OIPN (=2.39; P = .17), and QOL (= -1.43; P > .99). Eight-week sensory (=11.48 ± 0.38) and motor OIPN severities ( = 7.48 ± 0.36) were mild but higher than baseline (P ≤ .01). Self-reported PA level increased over time in both groups (=44.85; P = .01). Averaging ≥225 moderate to vigorous PA minutes per week led to less sensory OIPN, particularly finger/hand tingling (= -26.35; P = .01). CONCLUSIONS: This study failed to detect beneficial effects of the MI-Walk intervention; however, the findings suggest that aerobic walking may blunt but not completely prevent OIPN. Further research is necessary. IMPLICATIONS FOR PRACTICE: Although the effectiveness of brisk walking in reducing OIPN is unclear, this study supports prior evidence that moderate to vigorous PA is beneficial and safe during chemotherapy treatment.

Stigma Experiences in People with Chronic Obstructive Pulmonary Disease: An Integrative Review.

Background: People with chronic obstructive pulmonary disease (COPD) are stigmatized by smoking history. Although little is known about COPD-related stigma, it can adversely affect self-management and quality of life. Objective: To synthesize relevant scientific literature exploring stigma experiences and their impacts on people with COPD. Methods: CINAHL/PsycINFO/PubMed/Scopus were searched for relevant studies. Findings were organized using Major et al's conceptual model. Results: Fifteen studies documented COPD-related stigma processes: enacted, felt, internalized, and anticipated. Moderating factors included visibility, origin, and illness perception. Individual-level stigma responses included emotional distress, limited social interactions, and negative effects on medication adherence and help-seeking. Social/community-level stigma experiences included healthcare provider and employer behaviors. Smoking is interwoven throughout all domains of stigma processes and responses to stigma. Conclusion: Substantial evidence documents processes, moderating factors, and individual and social/community responses to the complex phenomenon of COPD-related stigma; however, prevalence of COPD-related stigma and its health effects are unclear.

Effects of perioperative exercise interventions on lung cancer patients: An overview of systematic reviews.

AIMS AND OBJECTIVES: To identify, appraise and summarise systematic reviews of exercise interventions for surgical lung cancer patients. BACKGROUND: Low exercise capacity, reduced pulmonary function, impaired health-related quality of life and postoperative pulmonary complications are common in surgical lung cancer patients. Numerous systematic reviews address these health problems and examine the effects of exercise intervention. However, differences in the quality and scope of the systematic reviews and discordant findings from the reviews make it difficult for decisions-makers to interpret the evidence and establish best practices in the clinical settings. DESIGN: Overview of systematic reviews. METHODS: This overview was conducted following the PRISMA guideline. A literature search of PubMed, CINAHL, EMBASE, Cochrane Library, SPORTDiscus and PEDro was conducted (October 2019). Peer-reviewed systematic reviews of randomised controlled trials focusing on the effects of exercise interventions for lung cancer patients who underwent surgery were included. The methodological quality of included reviews was assessed using AMSTAR 2. The results of reviews with meta-analysis were synthesised and presented by each health outcome. RESULTS: Seven systematic reviews published between 2013 and 2019 were included. High/moderate-quality evidence showed that postoperative exercise interventions could increase the exercise capacity and muscle strength, and low/very-low-quality evidence showed that postoperative exercise interventions may increase the physical component of health-related quality of life and decease dyspnoea. Low-quality evidence showed that preoperative exercise interventions may increase exercise capacity and pulmonary function, decrease the risk of postoperative pulmonary complications and reduce the length of hospital stay. CONCLUSIONS: Postoperative and preoperative exercises have the potential to improve health outcomes in surgical lung cancer patients. Further research is needed to evaluate the effects of different types of exercise and varying amounts of exercise. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence to support the implementation of exercise interventions for surgical lung cancer patients.

Exercise Effects on Chemotherapy-Induced Peripheral Neuropathy: A Comprehensive Integrative Review.

BACKGROUND: No effective cures for chemotherapy-induced peripheral neuropathy (CIPN) are known; however, exercise may be beneficial. OBJECTIVE: The purpose of this review was to synthesize high-quality research publications reporting the effects of exercise on CIPN and related outcomes among people of all age groups who received neurotoxic chemotherapy. METHODS: PubMed, CINAHL, Scopus, PsycINFO, and SPORTDiscus databases were searched first between May and November 2016 and then again in April 2019 for all clinical trials and meta-analyses. Subsequent hand-searching continued through April 2019. Potential scientific bias was rigorously evaluated, using the CONSORT (Consolidated Standards of Reporting Trials) guidelines. RESULTS: Thirteen studies (7 randomized controlled trials, 6 quasi-experiments) were found that reported exercise effects in various adult CIPN populations (ie, mixed cancer types and stages, chemotherapy regimens and status, and CIPN presence and severity). No studies provided high-quality evidence; 2 studies provided moderate-quality evidence. Most studies (76.3%) evaluated combined aerobic, strength, and balance training interventions of varying dosages. The most commonly improved outcomes were CIPN, balance, and fitness. All 7 studies with an aerobic exercise component led to significant-most studies showing moderate to large-CIPN benefits. CONCLUSIONS: Few studies-none of high quality or in child/adolescent populations-have evaluated exercise effects on CIPN. The exercise interventions, dosages, and settings have been too heterogeneous to identify the most beneficial intervention for other CIPN-related outcomes. However, aerobic exercise may be a key component of exercise interventions for CIPN. IMPLICATIONS FOR PRACTICE: Although promising, the empirical evidence is insufficient to definitively conclude that exercise interventions ameliorate CIPN.

Associations between health literacy and preventive health behaviors among older adults: findings from the health and retirement study.

BACKGROUND: While the association between inadequate health literacy and adverse health outcomes has been well documented, less is known about the impact of health literacy on health perceptions, such as perceptions of control over health, and preventive health behaviors. METHODS: We identified a subsample of participants (N = 707) from the Health and Retirement Study (HRS), a nationally representative sample of older adults, who participated in health literacy testing. Self-reported health literacy was measured with a literacy screening question, and objective health literacy with a summed score of items from the Test of Functional Health Literacy. We compared answers on these items to those related to participation in health behaviors such as cancer screening, exercise, and tobacco use, as well as self-referencing health beliefs. RESULTS: In logistic regression models adjusted for gender, education, race, and age, participants with adequate self-reported health literacy (compared to poorer levels of health literacy) had greater odds of participation in mammography within the last 2 years (Odds ratio [OR] = 2.215, p = 0.01) and participation in moderate exercise two or more times per week (OR = 1.512, p = 0.03). Participants with adequate objective health literacy had reduced odds of participation in monthly breast self-exams (OR = 0.369, p = 0.004) and reduced odds of current tobacco use (OR = 0.456, p = 0.03). In adjusted linear regression analyses, self-reported health literacy made a small but significant contribution to explaining perceived control of health (ß 0.151, p = <0.001) and perceived social standing (ß 0.112, p = 0.002). CONCLUSION: In a subsample of older adult participants of the HRS, measures of health literacy were positively related to several health promoting behaviors and health-related beliefs and non-use of breast self-exams, a screening behavior of questionable benefit. These relationships varied however, between self-reported and objectively-measured health literacy. Further investigation into the specific mechanisms that lead higher literacy people to pursue health promoting actions appears clearly warranted.

Sleep Patterns During Hospitalization Following Hematopoietic Stem Cell Transplantation.

PURPOSE/OBJECTIVES: To characterize patient-reported and objective sleep assessments and provide a preliminary examination of the relationships among sleep, quality of life, and demographic or treatment factors. DESIGN: A secondary data analysis using a descriptive-correlational design. SETTING: University of Illinois Hospital and Health Sciences System. SAMPLE: 40 patients undergoing a hematopoietic stem cell transplantation (HCT) hospitalized for the conditioning regimen, stem cell infusion, and immediate recovery period. METHODS: Each patient wore a wrist actigraph continuously from the fourth day following HCT to the eighth day to objectively assess sleep patterns (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings). At the end of the five-day period, patients completed measures of sleep disturbance and quality of life. MAIN RESEARCH VARIABLES: Objective sleep (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings), subjective sleep (sleep disturbance), and quality of life. FINDINGS: The mean total nighttime sleep (objectively obtained) was 232 minutes (SD = 71 minutes), with 14 patients (35%) sleeping less than three consecutive hours during one or more study days. Age was negatively correlated with patient-reported sleep disturbance. Patient-reported sleep disturbance was significantly associated with length of hospital stay. No correlations were found between patient-reported and objective sleep assessments. CONCLUSIONS: This study objectively documents inadequate and irregular sleep in hospitalized patients undergoing HCT. Sole reliance on patient-reported sleep assessments may not represent the full extent of the problem. IMPLICATIONS FOR NURSING: Attempts to streamline care during the night by not waking patients for routine care unless indicated by the patient's condition (as advocated by the American Academy of Nursing) and providing supportive care for symptoms (such as diarrhea) during the night may reduce the number of awakenings and possibly improve overall sleep quality.

The relationship between physical activity and metabolic syndrome in people with chronic obstructive pulmonary disease.

BACKGROUND: The prevalence of metabolic syndrome has been reported to be 20% to 50% in people with chronic obstructive pulmonary disease (COPD). Because such people are sedentary and physically inactive, they are at risk of metabolic syndrome. The extent of this problem, however, is not fully understood. OBJECTIVES: This study examined the relationship of sedentary time and physical activity to metabolic syndrome and the components of metabolic syndrome in a population-based sample of people with COPD. METHODS: This was a secondary analysis of existing cross-sectional data. Subjects with COPD (n = 223) were drawn from the National Health and Nutrition Examination Survey data set (2003-2006). Physical activity was measured by accelerometry. Waist circumference, triglyceride level, high-density lipoprotein cholesterol level, blood pressure, and fasting glucose level were used to describe metabolic syndrome. Descriptive and inferential statistics were used for analysis. RESULTS: Fifty-five percent of the sample had metabolic syndrome. No significant differences in sedentary time and level of physical activity were found in people with COPD and metabolic syndrome and people with COPD only. However, those with a mean activity count of greater than 240 counts per minute had a lower prevalence of metabolic syndrome. Waist circumference and glucose level were significantly associated with the time spent in sedentary, light, and moderate to vigorous physical activity. CONCLUSION: Metabolic syndrome is highly prevalent in people with COPD, and greater physical activity and less sedentary time are associated with lower rates of metabolic syndrome. This suggests that interventions to decrease the risk of metabolic syndrome in people with COPD should include both reducing sedentary time and increasing the time and intensity of physical activity.

Physical activity in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003-2006).

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) are sedentary but the extent of the problem is not fully understood. PURPOSES: This study examines sedentary time and physical activity (PA) and the relative effects of demographic and clinical characteristics on sedentary time and PA in a population-based sample of people with COPD and a comparison group from the general population. METHODS: Subjects were drawn from the National Health and Nutrition Examination Survey dataset (2003-2006). Physical activity was measured by accelerometry. RESULTS: People with COPD were sedentary and spent less time in most levels of PA. Age, gender, race, level of education, working status, shortness of breath, self-reported health, and body mass index were significantly associated with sedentary time or level of PA. CONCLUSION: Findings emphasize the need to decrease sedentary time and increase PA in people with COPD.

Cognitive behavioral therapy for insomnia comorbid with COPD is feasible with preliminary evidence of positive sleep and fatigue effects.

BACKGROUND: Many people with COPD report difficulties falling asleep or staying asleep, insufficient sleep duration, or nonrestorative sleep. Cognitive behavioral therapy for insomnia (CBT-I) has proved effective not only in people with primary insomnia but also in people with insomnia comorbid with psychiatric and medical illness (eg, depression, cancer, and chronic pain). However, CBT-I has rarely been tested in those with COPD who have disease-related features that interfere with sleep and may lessen the effectiveness of such therapies. The purpose of this study was to determine the feasibility of applying a CBT-I intervention for people with COPD and to assess the impact of CBT-I on insomnia severity and sleep-related outcomes, fatigue, mood, and daytime functioning. METHODS: The study had two phases. In Phase 1, a 6-weekly session CBT-I intervention protocol in participants with COPD was assessed to examine feasibility and acceptability. Phase 2 was a small trial utilizing a prospective two-group pre- and post-test design with random assignment to the six-session CBT-I or a six-session wellness education (WE) program to determine the effects of each intervention, with both interventions being provided by a nurse behavioral sleep medicine specialist. RESULTS: Fourteen participants (five in Phase 1 and nine in Phase 2) completed six sessions of CBT-I and nine participants completed six sessions of WE. Participants indicated that both interventions were acceptable. Significant positive treatment-related effects of the CBT-I intervention were noted for insomnia severity (P = 0.000), global sleep quality (P = 0.002), wake after sleep onset (P = 0.03), sleep efficiency (P = 0.02), fatigue (P = 0.005), and beliefs and attitudes about sleep (P = 0.000). Significant positive effects were noted for depressed mood after WE (P = 0.005). CONCLUSION: Results suggest that using CBT-I in COPD is feasible and the outcomes compare favorably with those obtained in older adults with insomnia in the context of other chronic illnesses.

Exploring the relationship between patient call-light use rate and nurse call-light response time in acute care settings.

Patient call-light usage and nurse responsiveness to call lights are two intertwined concepts that could affect patients' safety during hospital stays. Little is known about the relationship between call-light usage and call-light response time. Consequently, this exploratory study examined the relationship between the patient-initiated call-light use rate and the nursing staff's average call-light response time in a Michigan community hospital. It used hospital archived data retrieved from the call-light tracking system for the period from February 2007 through June 2008. Curve estimation regression and multiple regression analyses were conducted. The results showed that the call-light response time was not affected by the total nursing hours or RN hours. The nurse call-light response time was longer when the patient call-light use rate was higher and the average length of stay was shorter. It is likely that a shorter length of stay contributes to the nursing care activity level on the unit because it is associated with a higher frequency of patient admissions/discharges and treatment per patient-day. This suggests that the nursing care activity level on the unit and number of call-light alarms could affect nurse call-light response time, independently of the number of nurses available to respond.

Exercise in patients receiving hematopoietic stem cell transplantation: lessons learned and results from a feasibility study.

PURPOSE/OBJECTIVES: To test the feasibility and acceptability of a strength-training intervention in patients receiving hematopoietic stem cell transplantation (HSCT). DESIGN: One-group prospective, repeated-measures design. SETTING: Academic medical center in the midwestern United States. SAMPLE: Convenience sample of 10 patients receiving HSCT. METHODS: The strength-training intervention consisted of a comprehensive program of progressive resistance to strengthen the upper body, lower body, and abdominal muscles using elastic resistance bands. Instruction and low-intensity training began while the patients were hospitalized and progressed to a moderate level immediately following discharge from the hospital. Training continued for six weeks following hospital discharge. MAIN RESEARCH VARIABLES: Acceptability of the strength-training intervention was evaluated via subjective assessment and by determining the patient's ability to perform the exercises. Feasibility was evaluated by determining the number of patients who were able to complete the prescribed strength intervention and whether the patients used elastic resistance bands. FINDINGS: The strength-training intervention was refined from an unsupervised, home-based program to a combination supervised and unsupervised program with weekly clinic visits. Patients reported that the exercises were very acceptable, although some started out at a very low intensity. CONCLUSIONS: This pilot study demonstrates the feasibility and acceptability of the strength-training intervention. The level of supervision required for the strength-training intervention was higher than expected. IMPLICATIONS FOR NURSING: Strength training may be an effective intervention to alleviate problems with decreased physical activity, reduced muscle mass, and fatigue in HSCT recipients. Additional research is needed.

Exploring the relationship between patient call-light use rate and nurse call-light response time in acute care settings.

Patient call-light usage and nurse responsiveness to call lights are two intertwined concepts that could affect patients' safety during hospital stays. Little is known about the relationship between call-light usage and call-light response time. Consequently, this exploratory study examined the relationship between the patient-initiated call-light use rate and the nursing staff's average call-light response time in a Michigan community hospital. It used hospital archived data retrieved from the call-light tracking system for the period from February 2007 through June 2008. Curve estimation regression and multiple regression analyses were conducted. The results showed that the call-light response time was not affected by the total nursing hours or RN hours. The nurse call-light response time was longer when the patient call-light use rate was higher and the average length of stay was shorter. It is likely that a shorter length of stay contributes to the nursing care activity level on the unit because it is associated with a higher frequency of patient admissions/discharges and treatment per patient-day. This suggests that the nursing care activity level on the unit and number of call-light alarms could affect nurse call-light response time, independently of the number of nurses available to respond.

The experience of stigma in chronic obstructive pulmonary disease.

People with chronic obstructive pulmonary disease (COPD) can experience severe dyspnea, tenacious secretions, and a disruptive cough. They often struggle with daily activities and over time tend to decrease the amount of time they spend outside the home. The functional decline accompanying these changes is not adequately explained by physical changes alone. This descriptive, qualitative study describes social changes and experiences of stigma from the perspective of people with moderate to severe COPD. A total of 16 participants (11 men, 5 women) participated in individual interviews regarding effects of COPD on social relationships and experiences with COPD-related stigma. Participants were aware of the potential for stigma related to COPD. Emerging themes included the prevalence of blame related to smoking, both from others, including health care providers, and from themselves. Although many decreases in social activities appear to be pragmatic adaptations to functional limitations, these decisions may also be attempts to avoid potentially stigmatizing situations.