Veterans fail to react to COPD exacerbations
medwireNews: A study of US Veterans with chronic obstructive pulmonary disease (COPD) has found that while the condition often significantly impairs their day-to-day life, a sizable proportion fail to take action when they experience an exacerbation of symptoms.
"This group of Veterans with treatment paralysis provides a significant opportunity for patient education and empowerment to enhance self-management and control of respiratory symptoms," say authors Aaron Mulhall (University of Cincinnati Academic Health Center, Ohio) and colleagues.
The study included 493 Veterans with COPD who responded to a postal survey.
The authors found that in response to increased respiratory symptoms, 46% of respondents took extra puffs on their inhaler, and 35% used their inhaler more frequently, while 11% took oral steroids or antibiotics. However, the survey revealed that one-quarter took no action at all, despite 96% having experienced dyspnea.
Interestingly, the patients with the lowest healthcare resource usage were those who most commonly engaged in active self-management, and responded to their worsening symptoms. For example, 43% of those in the lowest quintile of healthcare usage took their inhaler more frequently compared with just 18% of those in the highest quintile of healthcare use.
And, patients who did not respond to respiratory distress were significantly more likely to feel hopeless (25 vs 16%), have uncertainty that their inhaler was working properly (23 vs 12%), or be unsure of how and when to use their inhaler (27 vs 15%) than patients who self-managed.
In the overall population of respondents, the authors also noted the "profound, comprehensive, and deleterious effects of this disorder on nearly every aspect of a Veteran's life." Almost all reported having to adapt their activities around their condition, including at work and in their living arrangements. And there was a significant burden of negative emotions among these patients, experienced by 77%, with 42% reporting depression.
Noting that 42% of patients said they considered their primary care provider (PCP) to be the best source of information about COPD, and that these patients were more likely than those without an identified source of information to perform self-management, Mulhall and colleagues conclude that PCPs are "critical" in improving the management of Veterans.
"PCPs can educate patients to recognize COPD symptoms, avoid risk factors, and provide early referral to a Pulmonologist," they write in Respiratory Medicine.
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By Kirsty Oswald, medwireNews Reporter