The combination of symptoms and the life changes resulting from an inability to exercise affect patients' ADLs. Basic ADLs include ambulating; eating; bathing, dressing, and grooming; and unassisted toilet use. Instrumental ADLs involve higher functioning, such as home maintenance, shopping for clothing and food, preparing meals, traveling alone via car or public transportation, and managing finances.
The elimination or alteration of ADLs depends on the necessity or desirability of the activity, the intensity of symptoms, tolerance level of symptoms, and changes in health expectations. Leisure activities are often the first to be eliminated, as they generally require greater effort and are not critical to daily life. In addition, most patients with COPD have clinically significant comorbid conditions (eg, cachexia, heart disease, peripheral vascular disease) and may have adverse effects from medication. These conditions add to declining functional status in patients with COPD but are often overlooked during pulmonary assessment. Elimination of these activities may be the primary determinant of impaired quality of life.