Introduction
The incidence of chronic obstructive pulmonary
disease (COPD) is rising throughout the world.
Approximately 11.4 million people in the United
States and millions more throughout the world are
affected.1 In Thailand it was ranked as the fifth leading
cause of death with a mortality rate of 42.9 per
100,000 Persons with COPD always suffer from
multiple concurrent symptoms that are caused by the
narrowing of the airways, which is a potentially fatal
progression. This suffering takes a longer time than
for persons with other chronic diseases, even cancer
Furthermore, persons with COPD have a high rate of
visiting emergency rooms after discharge from hospital
mostly due to the distress of symptom exacerbation,
especially respiratory difficulty. Distress from
symptoms has a high negative impact on the quality
of life Thus, helping persons to manage various
symptoms at home is essential to reduce the cost of
care and increase the quality of life. To achieve this
goal, an understanding of symptoms distress as a
cluster and a set of effectiveness management strategies
for each cluster is necessary. Although several prior
studies reported the effectiveness of each strategy for
each symptom management,8-11 little is still known
regarding the various strategies used for management
in each symptom cluster and only one study reported
for symptom cluster