COPD self-management exacerbation action plans: predictors of adherence

Abstract

Adherence is an important contributor towards effective Chronic Obstructive Pulmonary Disease (COPD) self-treatment. Our aim was to evaluate which patient characteristics predict various categories of adherence to exacerbation action plans in COPD patients. Diary data on adherence were obtained from two COPD self-management trials. Only patients with ≥1 exacerbation or ≥1 performed self-treatment action (starting a course of prednisolone) during 1 year follow-up were included. Optimal treatment was defined as ‘self-initiating treatment within two days from the COPD exacerbation start’. A multinomial logistic regression model was developed to identify predictors of adherence to COPD exacerbation action plans. 145 COPD patients (COPE-II: n=64; COPE-III n=81; COPD exacerbations mean 3.0 (SD 2.5); self-treatment actions 4.1 (SD 2.9)) were assigned to four adherence categories: significant delay or no treatment (24.4%), some delay in treatment (15.7%), optimal treatment (27.6%), or treatment outside actual exacerbation period (32.2%). Low dyspnoea score was a significant risk factor for ‘significant delay or no treatment’ (OR 1.64 (95% CI 1.07-2.50)) and cardiac comorbidity increased the risk of ‘treatment outside actual exacerbation period’ (OR 2.40 (95% CI 0.98-5.85)) compared to ‘optimal treatment’. Our study results show that dyspnoea score and cardiac comorbidity are predictors of patient adherence to exacerbation action plans. Associations between adherence categories and health outcomes of COPD exacerbation action plans need to be explored to identify effective self-managers, define the clinical consequences of non-adherence, and further tailor support to improve adherence.