Patients' perspective of the impact of COPD on quality of life: a focus group study for patients with COPD

Determinants of poor chronic obstructive pulmonary disease control

Uncontrolled COPD has been associated with reduced health-related quality of life, activity impairment, and increased use of healthcare resources. However, limited research is available on the factors associated with poor disease control in COPD patients. This study aimed to explore the factors associated with poor disease control in patients with COPD. The current cross-sectional study was conducted on patients with COPD who attended outpatient respiratory clinics at two major hospitals in Jordan. Information about disease and medication-related characteristics was collected through patient interviews and medical files. Validated instruments, including the 4-item medication adherence scale and the hospital anxiety and depression scales, were used to assess medication adherence, anxiety, and depression among the study participants. COPD severity was assessed using the GOLD classification criteria. Ordinal regression analysis was conducted to explore the variables associated with poor COPD control. In total, 702 patients participated in the study, with a median (interquartile range) age of 68 years (58-77). According to the GOLD report, most of the participants were in the B group (low risk/high symptoms; 40.2%), followed by the D group (high risk/high symptoms; 28.2%). Older age, higher depression scores, and a higher number of prescribed medications were associated with poorer COPD control, while not receiving LAMA (long-acting muscarinic antagonists) was associated with better control. Future mental health care initiatives should address the prevalence of depression symptoms in COPD patients and manage them effectively to improve COPD control and prevent further complications, with special attention to older patients, those receiving multiple medications, and those using LAMA.

Living with COPD and its psychological effects on participating in community-based physical activity in Brazil: a qualitative study. Findings from the Breathe Well group

Physical activity (PA) improves dyspnoea, psychological wellbeing and quality of life (QoL) for people with COPD reducing their risk of exacerbation. However, engagement in PA is low especially amongst those with anxiety and depression, and PA programmes are limited in countries with limited resources such as Brazil. We explored perceptions of 21 people with COPD about the impact of their disease on taking part in community-based PA programmes in Sao Paulo, Brazil through semi-structured telephone interviews from October 2020 to April 2021. Discussions were audio-recorded, transcribed, and analysed using the Framework method. Five themes were identified: Knowledge about COPD and its management; Self-perception of life with COPD; Knowledge and experiences of depression and anxiety; Opinions on PA and repercussions of COVID-19. PA was considered to be important in bringing physical and mental health benefits but there were barriers in accessibility of formal PR programmes and therefore local community PA programmes were considered to be important. People with mental health conditions tended to view PA more negatively. COVID-19 had reduced PA opportunities, access to COPD treatment and social interaction, and was associated with more exacerbations and emotional suffering. In general, this study showed an urgent need to improve knowledge about COPD and its risk factors and management among both patients, the public and primary healthcare professionals. We provide important content for the formulation of public policies for the implementation of specific activity programmes for people with COPD in community spaces using local resources and intersectoral partnerships.

Occupational Therapy for Improving Occupational Performance in COPD Patients: A Scoping Review

Background. Chronic obstructive pulmonary disease (COPD) is a multisystemic chronic condition which may induce significant consequences in daily life activities. Preserving activities of daily living in COPD is therefore a common treatment goal among people living with COPD, which leaves ample opportunity for occupational therapy interventions to comprise part of their rehabilitation. However, the question of how exactly occupational therapists can and do contribute to pulmonary rehabilitation remains underexplored. Purpose. To reveal the contribution of occupational therapy intervention in the pulmonary rehabilitation on improving the occupational performance of patients with COPD. Method. A scoping review was performed by selecting articles focusing on occupational therapy in pulmonary rehabilitation for patients with COPD. A total of four databases were surveyed for article selection. Findings. Among nine studies selected, seven studies reported a significant improvement in the occupational performance of patients with occupational therapy. However, two studies did not observe differences between the groups regarding occupational performance. Implications. Occupational therapy in pulmonary rehabilitation seems to contribute to the improvement of occupational performances of patients with COPD. Nevertheless, research focused on this field needs to be further developed to support the positive impact of occupational therapy in COPD management.

Influence of ethnicity on adherence to nonsurgical interventions for COPD: a scoping review

Objective

Poor therapeutic adherence and the contributing factors have been extensively researched in several chronic diseases, including COPD. However, the influence of ethnicity on adherence to nonsurgical treatment interventions for COPD (e.g. smoking cessation and pulmonary rehabilitation) is not well understood. This scoping review was performed to better understand variations in adherence among people from minority ethnic communities diagnosed with COPD.

Method

This scoping review was designed based on the refined frameworks of Arksey and O'Malley, developed by JBI (Joanna Briggs Institute). Systematic searches were performed across three databases: CINHAL (EBSCO), MEDLINE (Ovid) and Embase (Ovid).

Results

Out of 3654 identified records, 37 studies were deemed eligible for inclusion; these were conducted in various countries and involved populations of diverse ethnic groups diagnosed with COPD. The included studies considered provision and/or adherence to medication (n=8, 21.6%), smoking cessation (n=11, 29.7%), influenza vaccinations (n=7, 18.9%), pulmonary rehabilitation (n=11, 29.7%) and oxygen therapy (n=2, 5.4%). Outcomes varied widely between studies within a single intervention (e.g. initiation, adherence and completion of pulmonary rehabilitation programme). However, most of the included studies suggested the presence of inequalities linked to ethnicity across interventions.

Conclusion

This review indicated the presence of poor adherence to nonsurgical interventions among people from minority ethnic backgrounds living with COPD. However, due to the heterogeneity in population groups considered and compared within the individual studies, it is challenging to identify and understand the key inequalities influencing adherence to nonsurgical interventions. Further research is needed to better explore this.

COPD-Related Anxiety: A Systematic Review of Patient Perspectives

Background

Anxiety in patients with chronic obstructive pulmonary disease (COPD) is prevalent but often unidentified and therefore not adequately managed. Clinicians find it difficult to detect anxiety symptoms and to differentiate subclinical anxiety from anxiety disorders, because of the considerable overlap between symptoms of COPD and anxiety.

Purpose

We synthesized existing qualitative research on patients' experiences of COPD-related anxiety with the purpose of gaining a richer understanding and proposing a model of the construct.

Methods

Searches for qualitative studies of patients' experiences of COPD-related anxiety were conducted independently by two authors in the databases of PubMed (MEDLINE), CINAHL (EBSCO), and PsycInfo (APA). English-language studies including patients diagnosed with COPD were reviewed, and data were analyzed using thematic analysis.

Results

A total of 41 studies were included in the review. Four themes related to COPD-related anxiety were identified: initial events; internal maintaining factors; external maintaining factors; and behavioral maintaining factors. Based on the identified four themes, a conceptual model of COPD-related anxiety from the patient perspective was developed.

Conclusion

A conceptual model of COPD-related anxiety from the patient perspective is now available, with the potential to inform future attempts at improving identification and management of COPD-related anxiety. Future research should focus on the development of a COPD-specific anxiety questionnaire containing domains that are relevant from the patient perspective.

Caring for patients at home after acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study of family caregivers' experiences

AIMS AND OBJECTIVES

To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation.

BACKGROUND

The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful.

DESIGN

Phenomenology.

METHODS

This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist.

RESULTS

Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals.

CONCLUSIONS

Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.

The Impact of Asthma and Chronic Obstructive Pulmonary Disease (COPD) on Patient-Reported Outcomes in Systemic Lupus Erythematosus (SLE)

Background

Risk of asthma and chronic obstructive pulmonary disease (COPD) may be elevated in systemic lupus erythematosus (SLE), but little research has studied the impact of these conditions on SLE outcomes. We examined prevalence, incidence, and impact of self‐reported asthma and COPD in two US‐based SLE cohorts (FORWARD and Lupus Outcomes Study [LOS]).

Methods

Prevalence of asthma and COPD were defined as presence of conditions at individuals’ first interviews; incidence was defined as new reports over the next 3 years. Cross‐sectional associations of asthma/COPD with patient‐reported outcomes (PROs) and longitudinal analyses associations with asthma/COPD at entry with PROs 3 years later were examined.

Results

In FORWARD, 19.8% and 8.3% participants reported asthma and COPD, respectively, at entry. In LOS, 36.0% reported the presence of either (US population comparisons: asthma, 9.7%; COPD, 6.1%). Cross‐sectionally, asthma/COPD was associated with worse PROs, including disease activity. In FORWARD, individuals with asthma experienced greater worsening of fatigue, pain, and global health ratings longitudinally; individuals with COPD experienced greater increases in self‐reported SLE activity. However, no such patterns were noted in the LOS.

Conclusion

Asthma and COPD appeared to be more common in SLE than in the general US population and were associated with worse status on PROs cross‐sectionally. Asthma was linked to decrements in PROs longitudinally.

Quality of life, anxiety and depression in patients with chronic obstructive pulmonary disease

OBJECTIVE

to assess quality of life, anxiety and depression in patients with Chronic Obstructive Pulmonary Disease.

METHOD

a cross-sectional, quantitative study, conducted in a reference hospital for the treatment of pulmonary diseases. Seventy patients were assessed, using a sociodemographic and clinical questionnaire, Beck's anxiety and Depression Inventories and the SF-36 Quality of Life Scale.

RESULTS

the participants had better quality of life in the vitality, mental health and social role functioning domains (median=50.0) and worse in limitation by physical and emotional role functioning (median=0.0 points). Anxiety, depression and oxygen dependence were associated with poorer results in the quality of life domains.

CONCLUSION

all patients were classified with severe anxiety level and moderate depression predominance. Patients had low quality of life scores in all domains.