Abstract
BackgroundAsthma and COPD are major health problems and an extensive burden for the patient and the health care system. Patient education has been recommended, but the influence on knowledge and health outcomes is not fully examined. Our aims were to compare patient characteristics, education and knowledge in patients who had an emergency room (ER) visit, to explore factors related to disease knowledge, and to investigate patient characteristics, patient education and knowledge in relation to further ER visits over a 12 month period.MethodsEighty-four patients with asthma and 52 with COPD, who had had an ER visit, were included. They were interviewed by telephone 4 to 6 weeks after the ER visit and followed for a year.ResultsPatients with COPD were older, more sedentary, had had more ER visits the previous year, and had more co morbidity than patients with asthma. About 80% of the patients had received information from health professionals or participated in education/rehabilitation, but a minority (< 20%) reported that their knowledge about how to handle the disease was good. Patients with "good knowledge" were younger, were more likely to have asthma diagnose, and had a higher educational background (p < 0.05). Sixty-seven percent of the patients with COPD had repeated ER visits during the following year versus 42% in asthma (p < 0.05) (adjusted HRR: 1.73 (1.03-2.90)). Patients who had had ER visits the year before inclusion had a higher risk of ER visits the following year (adjusted HRR: 3.83 (1.99-7.38)). There were no significant differences regarding patient education and knowledge between the group with and without further ER visits after adjusting for sex, diagnose, age, and educational background.ConclusionPatients with asthma had a better self reported knowledge of disease management and were less likely to have new exacerbations than patients with COPD. Reported level of knowledge was, however, in it self not a predictor of exacerbations. This indicates that information is not sufficient to reduce the burden of disease. Patient education focused on self-management and behavioral change should be emphasized.
Highlights
Asthma and chronic obstructive pulmonary disease (COPD) are major health problems and an extensive burden for the patient and the health care system
Patients with COPD were significantly older, more sedentary, ex-smokers, had a lower educational background, more co morbidity, and had had more emergency room (ER) visits the previous year compared to patients with asthma
Independent of diagnose, had received information regarding their disease from a physician or nurse, but few had participated in more formal education or rehabilitation
Summary
Asthma and COPD are major health problems and an extensive burden for the patient and the health care system. Asthma and chronic obstructive pulmonary disease (COPD) are major health problems and an extensive burden on the patient, health care system, and the economy [1]. Patients with a poor asthma control [4] and persistent asthma are associated with higher costs [5]. It has previously been shown that exacerbations in asthma are associated with psychological dysfunction [8,9], poor symptom and disease control [10,11,12], older age [4], high doses of inhaled corticosteroids (ICS), oral corticosteroids, concomitant chronic sinusititis, and having a long history of asthma [13]. In COPD, exacerbations are associated with impaired quality of life [14,15], increased mortality [16,17], limitations of daily activities [18], disease progression [19,20], poor lung function, previous admissions, under prescription of oxygen [21], increased risk of readmission [7], and low physical capacity [22]
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