P139 Patient recognition of, and response to, acute exacerbations of COPD is related to previous experiences of help-seeking. (11th November 2022)

• Record Type: Journal Article
• Authors: Hutchinson, A; Russell, R; Cummings, H; Usmani, O; Cohen, J; Macfadyan, S; Morris, T; Mullerova, H; Xu, Y; Hellens, G; Roy, K; Crooks, M
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A156
• Page End: A156
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.274
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Acute exacerbations of COPD (AECOPD) are clinically significant events. Patients' experiences, expectations and understanding affect their recognition of and response to AECOPD. Aim: To understand i) how COPD patients recognise AECOPD and ii) how they subsequently react. Methods: Semi-structured interviews were completed remotely in a multicentre qualitative study. Interviews were transcribed and analysed thematically. Data presented as mean [SD] unless stated. Results: 40 COPD patients were interviewed (21 female; age 69 [8.1] yrs, COPD duration 11.3 [8.3] yrs, median [range] number of exacerbations in the past year 1.5 [0–9]). Three themes were identified: Theme 1: Recognition of AECOPD onset Most patients felt able to recognise AECOPD onset (increased breathlessness, fatigue, cough, coloured sputum), however some became suddenly overwhelmed. Theme 2: Response to AECOPD onset Patients' responses to AECOPD onset depended on their experience and the outcome of past help-seeking. Those previously taught breathlessness self-management typically used a stepwise approach, including non-pharmacological techniques and inhalers. If felt necessary, they would take a 'rescue pack' (antibiotics and/or steroids) or contact their GP for advice and/or medication. Those attending the hospital did so after GP contact or based on previous advice. Those not previously taught breathlessness self-management described over-reliance on inhaled medication and either i) frequent 'rescue pack' use or ii) direct presentation to the hospital. Theme 3: The role of 'rescue packs' 28/40 patients reported 'rescue pack' use. Many patients were knowledgeable about when to take a 'rescue pack' which provided them with a sense of control and security when access to clinicians was limited. However, some relied on repeated 'rescue pack' use without clinical review and experienced overall declining health. Conclusion: Most patients were able to recognise AECOPD onset and their subsequent behaviour related to responses to previous help-seeking. Some were empowered by access to 'rescue packs'. For others, limited access to clinicians and lack of self-management education may have contributed to over-reliance on 'rescue packs' and/or direct hospital presentation. It is important that all patients are guided on how to appropriately respond to AECOPD onset; when to use 'rescue packs' (if provided); and when to seek clinical review. Please refer to page A214 for declarations of interest related to this abstract.