COPD patientLife changes or stressful life events frequently cause psychological and physiological changes. For the COPD patient, these changes may lead to increased symptoms and physiological insufficiency which provide the input for further changes, and in change, prolonged exposure, lack of preparedness, lack of prior experience, and low psychosocial assets have each been found to heighten the impact of stressful events.

As noted by Rabkin and Struening, “In their original work, Holmes and Rahe scaled life events in terms of the intensity and length of time necessary to accommodate to a life event.” From that orientation, any major event is a Kfe stressor. Gersten et al regard undesirability or negative life stress rather than simply total amount of change as the better definition of stressor. Decrease stress with remedies of Canadian Health&Care Mall.

From the Holmes and Rahe data, with the accumulation of 300 or more life-change units in any given year, the patient has a high probability (about 60 percent to 80 percent) of developing additional medical difficulties. The physician or team member who is watching the patient should be on the lookout for occurrence of these change events in the patients life. It would be desirable to inquire into possible life changes during each visit with the patient. The patient and physician can look at events in the patient’s life according to the number of life-change units he has accumulated, and the patient can be shown that, for most individuals, the probability of increasing medical problems is directly related to a significant increase in his life-change units. The physician can then suggest that, if possible, the patient should avoid some of these events, alter his appraisal of the significance of potentially harmful, challenging, or threatening events, or find social support systems that might be available to buffer the experience of stress. Usually, the patient will ask for help in doing so. In this case, an ideal opportunity is provided for discussion of the whole area of behavior, emotion, and illness.


The role of psychosocial and psychologic techniques in the treatment and evaluation of a disease for which there is no known “cure” cannot be overemphasized. It is one thing to have a disease and another to be sick or ill. They are not the same thing. With the use of existing medical, psychosocial, and psychologic techniques, many patients with significant COPD can live fairly comfortable and productive lives. The clear message to patients should be that learning to live with and cope with COPD is possible and worthwhile. Part III of this series will review the use of psychopharmacology in the treatment of what would be considered traditional “psychiatric” diseases that may be concomitant with COPD in some patients.

Table 2—Social Readjustment Rating Scale

Life Event Mean Value
1. Death of spouse 100
2. Divorce 73
3. Marital separation 65
4. Jail term 63
5. Death of close family member 63
6. Personal injury or illness 53
7. Marriage 50
8. Fired from job 47
9. Marital reconciliation 45
10. Retirement 45
11. Change in health of family member 44
12. Pregnancy 40
13. Sex difficulties 39
14. Gain of new family member 39
15. Business readjustment 39
16. Change in financial state 38
17. Death of close friend 37
18. Change to different line of work 36
19. Change in number of arguments with spouse 35
20. Mortgage over $10,000 31
21. Foreclosure of mortgage or loan 30
22. Change in responsibilities at work 29
23. Son or daughter leaving home 29
24. Trouble with in-laws 29
25. Outstanding personal achievement 28
26. Wife begins or stops work 26
27. Begin or end school 26
28. Change in living conditions 25
29. Revision of personal habits 24
30. Trouble with boss 23
31. Change in work hours or conditions 20
32. Change in residence 20
33. Change in schools 20
34. Change in recreation 19
35. Change in church activities 19
36. Change in social activities 18
37. Mortgage or loan less than $10,000 17
38. Change in sleeping habits 16
39. Change in number of family get-togethers 15
40. Change in eating habits 15
41. Vacation 13
42. Minor violations of the law 11