Factors Inﬂuencing Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study
Objective: To determine the inﬂuence of disease severity perception, depression, inhaler technique, and inﬂuenza and pneumococcal vaccinations, on acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).
Design: Predictive correlational research design, with a prospective three-month follow-up.
Methodology: The subjects, selected based on a pre-set criteria, were 147 patients diagnosed with chronic obstructive pulmonary disease and receiving treatment at a tertiary hospital in Bangkok. Data were collected using 1) a personal information questionnaire; 2) an overall disease severity perception questionnaire; 3) a depression assessment questionnaire; 4) an inhaler use checklist; and a daily exacerbation symptom and management recording form. Data were analysed using descriptive statistics and enter method logistic regression statistics.
Results: Most of the subjects were males (93.3%) with an average age of 73.38 years. According to their diagnosis results, the subjects had COPD for an average of 8.53 years.About one-fourth of the subjects had experienced acute COPD exacerbations, and showed symptoms of depression (24.5% and 27.9%, respectively), whilst one-third (38.1%) displayed a moderate level of disease severity perception. The majority of the subjects (87.8%) had received inﬂuenza vaccination, but a very small number (4.1%) had received both inﬂuenza and pneumococcal vaccinations. More than half of the subjects (59.9%) practiced the inhaler technique correctly. The aforementioned factors were able to jointly predict acute COPD exacerbations at 26.7 % (Nagelkerke R2 = .267). High and highest perception of disease severity (OR 5.11, 95% CI 1.67-15.66, p = .004) and depression (OR 3.31, 95% CI 1.36-8.05, p = .008) were also capable of predicting COPD exacerbations.
Recommendations: It is suggested that nurses assess AE-COPD patients’ perception of disease severity and depression as part of risk factor evaluation. Health education is recommended for patients with high levels of disease severity perception and depression, to ensure early detection of the disease. Action plans for prevention and alleviation of acute exacerbations in COPD patients are also advised.
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