Exacerbations of chronic obstructive pulmonary disease — A patients' perspective

Abstract

SummaryBackground: Exacerbations are now an important clinical variable for research into, and management of, chronic obstructive pulmonary disease (COPD). Emphasis is usually on reductions in the incidence of exacerbations and their impact on quality of life. For such research to be useful and comparable there needs to be a clearly defined understanding of what is meant by the term 'exacerbation'. The aim of this study was to explore the notion of COPD exacerbations from the viewpoint of patients who had recently suffered an exacerbation. Methods: Using principles from grounded theory we conducted semi-structured, in-depth interviews with 23 volunteers from Denmark, the Netherlands and the UK who were identified as having had a COPD exacerbation. Interviews were recorded locally and translated into English for analysis. Notable themes were identified for each informant and their occurrences compared. Results: Patients' reasons for consulting fell into four categories: 'frightening change'; 'change in sputum colour'; 'gradual deterioration'; and 'opportunistic diagnosis'. Most patients consulted frequently about their COPD, but did not afford their exacerbations the same degree of prominence as healthcare professionals (HCPs). Conclusions: These data provide a new way of thinking about COPD exacerbations, offering a greater understanding and classification of the reasons underlying the decision of COPD patients to consult with HCPs. They suggest that the patient perspective of exacerbations is more complex than previously thought. These findings could be applied to clinical practice and research, facilitating focussed decisions on COPD management.

What are the needs of patients following discharge from hospital after an acute exacerbation of chronic obstructive pulmonary disease (COPD)?

“…One criticism of this study is that, with small subject numbers from a single location, the results are not generalisable. However, the numbers recruited are similar to other qualitative work in this therapeutic area 14 and the patient characteristics are similar to those patients included by Ram et al in their review of early discharge schemes 6 -i.e. older adults (mean age 76) with a high readmission rate (36% patients) of whom many were living alone (44%).…”

“…There was confusion about when to call for help, but also a reluctance to "bother the doctor" and a perception that "things would get better". This reluctance to consult was similarly found by Adams et al 14 and may be due to a more stoical attitude of an older generation (Patient J; "The awful thing about this generation -it was brought up not to whinge, not to whine….You know to get on with it". )…”

Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation

“…The difficulty that patients with COPD have in differentiating between the onset of an exacerbation and a self-limiting 'bad day' is well recognised, 21,22 as are the practical barriers to achieving a timely appointment. 23 The patients in our study described similar anxieties when deciding to 'cross the boundary' and seek professional help.…”

Typische Krisen und Bedürfnisse von Patienten mit COPD oder Lungenkrebs im letzten Lebensjahr - eine Literaturübersicht

“…Der Arzt wird nur bei starker oder bei beängstigender Veränderung der Symptomatik oder des Gesundheitszustandes, die über das normale Maß hinausgehen, aufgesucht; wenn also für den Patienten ein Zustand der Krise erreicht ist. Auch das Gefühl, mit der Situation allein nicht mehr umgehen zu können und starke Angst und Belastung spielen eine Rolle [22]. Während Ärzte besonders auf die Symptome fokussieren, haben Patienten andere Prioritäten [15].…”