Abstract
Background: Chronic obstructive pulmonary disease (COPD) is the umbrella term for a group of lung diseases which are degenerative and marked by progressively worsening symptoms including: breathlessness; fatigue; acute exacerbation; multiple comorbidities; and eventually death.
Acute exacerbations of COPD (AECOPD) resulting in hospitalisation may be responsible for up to 25 percent of reductions in lung function. In New Zealand an estimated 23% of those discharged from hospital after an initial episode of AECOPD are readmitted within 30 days, a situation which is both costly and disadvantageous to the patient.
Objective: The aim of this study was to understand patients’ perspectives on the causes and prevention of re-hospitalisation for AECOPD.
Method: Data for this study was collected from a subgroup of participants who had been recruited as part of a feasibility study using randomised controlled trial methods to explore the effectiveness of a novel self-management intervention, called “Taking Charge of COPD”. All participants were initially recruited in hospital after an episode of severe AECOPD. The subgroup of participants in this qualitative study were interviewed 12 months later and ask about their views and experiences regarding what had helped or hindered them to stay well and out of hospital. Grounded theory was used to analyse results and construct concept. Data were also collected on disease specific health status (using the Chronic COPD Questionnaire), depression and anxiety (using the Hospital Depression and Anxiety Scale), and number of moderate episodes (requiring antibiotics or steroids) or severe episodes of AECOPD (requiring hospitalisation) during the prior 12 months.
Results: Twelve participants were interviewed (mean age 69.3 years (SD 13.6); range 29 – 84; 6 female, 2 Māori, 2 Pacific, 7 New Zealand European). These participants had experienced between 0 and 7 episodes of moderate AECOPD (average 1.8) and 0 to 3 episodes of severe AECOPD (average 0.7) in the 12 months since their original hospitalisation. Three main concepts were identified to describe the participants’ views on what helped or hinder them to stay well and out of hospital: 1) Being Proactive – which encompasses practical steps participants took to reduce AECOPD; 2) Being Positive – which describes the importance of a positive mindset; and 3) Taking Charge – the concept of believing in oneself. Impacting on each of these was the influence of significant others, particularly family and friends.
Conclusion: This research expands our understanding of how patients manage COPD and adds a patient’s perspective to the current knowledge on how to prevent AECOPD. Programmes which promote self-efficacy and positive mental health would be beneficial additions to AECOPD prevention, as could the inclusion of family or significant others in health planning/treatment plans.