Knowledge, attitudes and practices of patients and healthcare professionals regarding oral health and COPD in S\xe3o Paulo, Brazil: a qualitative study

Matthew Riley,Rachel E Jordan,Amber Swann,Alexander J Morris,Rachel Adams,Sonia M Martins

doi:10.1038/s41533-021-00235-x

Abstract

Poor oral health is associated with worse clinical outcomes in Chronic Obstructive Pulmonary Disease (COPD). This qualitative study aimed to investigate the knowledge, attitudes and practices of COPD patients and primary health care professionals (HCPs) in Brazil - where there are high rates of COPD and periodontal disease. Semi-structured interviews with COPD patients (n = 9) and three semi-structured focus groups with HCPs (n = 25) were conducted in São Paulo. Interviews were thematically analysed using The Framework Method. Despite a high prevalence of edentulism, patients viewed tooth loss and decay as a norm and neglected preventative oral health practices. HCPs blamed patients for avoiding preventative opportunities, whilst patients discussed significant barriers to oral healthcare. Knowledge of the relationship between oral health and COPD was lacking among HCPs and patients, but all participants were receptive to oral health education. Practitioners identified the need for a COPD primary care pathway that integrates oral health protocols. This study indicates that Brazil must incorporate preventative oral health into COPD management and expand public dental services to increase uptake.

Highlights

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death among adults in Brazil[1]
This paper reports qualitative data exploring Brazilian patient and health care professionals (HCPs) knowledge, attitudes and practices related to oral health and COPD, aiming to provide information to inform the design of future care systems
Twenty-five HCPs were recruited for three focus groups (FG); most participants were female (96%) and between 20 to 40 years old (Table 2)

Summary

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death among adults in Brazil[1]. Lung Disease committee guidelines does not include guidance on managing oral health[11], evidence suggests that periodontal health differs significantly between frequent and infrequent COPD exacerbators[5,12,13], with a significant decrease in COPD exacerbation frequency following periodontal treatment[5,7,9]. These factors are of particular relevance in Brazil. While Brazil’s universal healthcare system was introduced in 1988, oral health was low priority and limited to curative treatment[14,15]

Objectives

Results

Conclusion