Psychological factors associated with use of home nebulized therapy for COPD

Abstract

P Ps sy yc ch ho ol lo og gi ic ca al l f fa ac ct to or rs s a as ss so oc ci ia at te ed d w wi it th h u us se e o of f h ho om me e n ne eb bu ul li iz ze ed d t th he er ra ap py y f fo or r C CO OP PD D ABSTRACT: This study examined the relationship between adherence to domiciliary nebulized therapy and psychological factors; patient attitudes, anxiety, depression, and quality of life. Ninety three patients aged 45-77 yrs with chronic obstructive pulmonary disease (COPD) and using domiciliary nebulizers were recruited from a hospital database. They completed the St George's respiratory questionnaire (SGRQ)-1 and the hospital anxiety and depression scale (HADS) and attended a semistructured interview. Their usual nebulizers were replaced by Dataloggers, which record the date, time and duration of each treatment, to use for 4 weeks. The SGRQ was then repeated (SGRQ-2).Eighty two patients completed the study. Fifty six percent were poorly adherent; taking less than 70% of the dose prescribed (or less than 60% on regimens of ≥5 times daily). The total scores on the SGRQ-2 were negatively correlated with percentage adherence. Multiple regression analysis showed that the SGRQ-2 total score was associated with percentage adherence, depression score, feeling supported by clinic staff, and patients feeling that they tried to ignore their chest disease.Patients who report poor quality of life are more likely to be depressed, feel unsupported by clinic staff and be poorly adherent to treatment. Increased levels of clinic support, with the addition of psychological treatments, may be of benefit to some patients with chronic obstructive pulmonary disease.

Relationship Between Medication Adherence and Health-Related Quality of Life in Subjects With COPD: A Systematic Review

“…15 The included studies originated from Canada and the United Sates, 16 Hungary, 17 Japan, 15,18 The Netherlands, 14 and the United Kingdom. 12,13 The population size varied between 11 12 and 985 16 subjects, with a mean age of 58 14 to 76 15 y. The general characteristics of the reviewed studies are presented in Table 1.…”

“…12,13, 16 Turner et al 16 and Bosley et al 12 used a self-reported questionnaire and electronic monitoring for measuring adherence simultaneously, but both groups considered the subjects to be adherent based on the results of the electronic monitoring only. Except for the studies conducted by Mochizuki et al 15 and Bosley et al, 12 most studies defined adherence as a dichotomous variable.…”

“…16,17 The disease-specific St George Respiratory Questionnaire was the most commonly used quality-of-life instrument. 12,13,15,18 The association between adherence and HRQOL was evaluated in all included studies; however, only one study explored the effect of medication adherence on HRQOL, 12 and one explored the impact of HRQOL on adherence. 17 Detailed information on the measurements of adherence and HRQOL, the applied statistical methods, and the results on the association between adherence and HRQOL are summarized in Table 2.…”

“…In most studies, a disease-specific instrument was used [12][13][14][15]18 ; only 2 studies measured generic HRQOL. 16,17 The disease-specific St George Respiratory Questionnaire was the most commonly used quality-of-life instrument.…”

“…Medication adherence was analyzed by a self-reported questionnaire, 12,14,[16][17][18] counting the number of unused doses of medication, 15 or an electronic monitoring method. 12,13, 16 Turner et al 16 and Bosley et al 12 used a self-reported questionnaire and electronic monitoring for measuring adherence simultaneously, but both groups considered the subjects to be adherent based on the results of the electronic monitoring only.…”