Abstract
Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including earlier symptom resolution and reduced risk of future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care or do not report worsening symptoms to their healthcare provider. In this study, we aimed to understand how patients perceived their breathing symptoms and identify factors that led to seeking or delaying care for an acute exacerbation of COPD. We conducted semistructured interviews with 60 individuals following a recent COPD exacerbation. Participants were identified from a larger study of outpatients with COPD by purposive sampling by exacerbation type: 15 untreated, 15 treated with prednisone and/or antibiotics in the outpatient setting, 16 treated in an urgent care or ED setting, and 14 hospitalized. Data were analyzed using inductive content analysis. Participants were primarily male (97%) with a mean age of 69.1 ± 6.9 years, mean FEV1 1.42 (±0.63), and mean mMRC dyspnea of 2.7 (±1.1). We identified 4 primary themes: (i) access and attitudinal barriers contribute to reluctance to seek care, (ii) waiting is a typical response to new exacerbations, (iii) transitioning from waiting to care-seeking: the tipping point, and (iv) learning from and avoiding worse outcomes. Interventions to encourage earlier care-seeking for COPD exacerbations should consider individuals’ existing self-management approaches, address attitudinal barriers to seeking care, and consider health-system changes to increase access to non-emergent outpatient treatment for exacerbations.Clinical Trial Registration NCT02725294
Highlights
Persons with chronic obstructive pulmonary disease (COPD)frequently experience acute exacerbations that are associated with decreased quality of life[1] and can lead to emergencydepartment (ED) visits and hospitalizations[2]
Published in partnership with Primary Care Respiratory Society UK. Participants in this qualitative study were identified from a prospective observational study of 410 outpatients with COPD enrolled in primary care at two Veterans Affairs (VA) Medical Centers
Among the participants who experienced exacerbations during the study, we identified individuals eligible to participate in this qualitative study if they had exacerbations that met the following criteria: (i) untreated exacerbations with worsening symptoms that persisted for ≥7 days and
Summary
Persons with chronic obstructive pulmonary disease (COPD). Frequently experience acute exacerbations that are associated with decreased quality of life[1] and can lead to emergencydepartment (ED) visits and hospitalizations[2]. In the United States in 2010 there were an estimated 1.5 million ED visits and 699,000 COPD hospitalizations with a mean cost of $8,228 per hospitalization[3,4]. Patients with exacerbations may require pharmacologic treatment, including bronchodilators, corticosteroids or antibiotics[5]. Earlier treatment can lead to more rapid symptom recovery and fewer ED visits and hospitalizations[1,6]. In one study, more than 70% of patients presenting to the ED with a COPD exacerbation waited more than 24 h before seeking care, thereby increasing the risk of hospitalization[6].
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