September 7, 2016
Dr. Len Horovitz, Pulmonary Consultant, Lenox Hill Hospital
LONDON -- Less than 20% of patients diagnosed with congestive obstructive pulmonary disease (COPD) said they received education from their doctors on how to self-monitor for signs of impending flares that could put them in hospital, Swiss researchers said here.
Of a cohort of 317 patients selected for a clinical trial, just 53 remembered ever being instructed to monitor their own symptoms, Anja Frei, PhD, of the University of Zurich, told MedPage Today.
"That is somewhat disappointing," she said at her poster presentation at the European Respiratory Society annual meeting.
About 36% of the patients recalled being given instructions to change medications or non-drug treatments in case of deteriorating health conditions, Frei said. She said that 29% of the patients took action in the face of such deteriorating health conditions. Of this group of 92 patients, 50 of them said they called their general practitioner in face of these problems; 30 said they employed short-acting beta agonists; 27 increasing use of long-acting beta agonists; 19 said they avoided aggravating situations; 17 of them reduced physical activity; 11 started therapy with systemic steroids and five began therapy with antibiotics. Several answers were given when asked how they responded to deteriorating COPD.
"We have a lot of work to do in education of these patients," said Claudia Steurer-Stey, MD, also of University of Zurich, and the principal investigator for the study.
"The general practitioner who sees the majority of their patients is a very important target of our work so that we can improve the quality of primary care," Steurer told MedPage Today.
In commenting on the study, Len Horovitz, MD, pulmonary consultant at Lenox Hill Hospital, told MedPage Today, "I can't respond as to what people do in other countries or even elsewhere in the United States. What I do when it comes to physician-to-patient education is something that I do face-to face at just about every visit with a patient."
"The first thing you do is to show them how to use their inhalers to make sure they are using them correctly and the second thing that you do is tell them how to monitor themselves or give them cues that would make them pick up the phone and call you," he said.
"For instance, if they are having shortness of breath or are finding that they are needing a rescue inhaler like albuterol more than twice a week, those would be cues that something is not under control and you need to call me or come in. That education is something that is just part of managing these patients because they do have triggers that cause flares."
"Pulmonologists know that when you show patients how to use a metered dose inhaler, half the time when they come back and you ask them to show you how they are using the devices, they are doing it incorrectly. At every visit you have to reinforce these lessons," Horovitz said.
In the study, Frei and colleagues enrolled patients nested within the so-called ICE COLD ERIC trial, and included 187 Dutch patients and 130 Swiss patients from primary care sites. Self-management and self-reported behaviors were assessed by study nurses in telephone interviews at 3 years follow-up.
The average age of the patients included in the study was 69.1 years, and 57.7% of them were men. Over the 3 years of follow-up they experienced an average of 1.72 COPD exacerbations. The cohort of people living with COPD included 101 patients (32.1%) who were current smokers. Another 198 patients or 62.9% were classified as former smokers; 16 patients or about 5% said they had never smoked.
About 35% of the patients included in the study were living alone; the rest lived either with a partner or with their children. Most of the patients in the study were retired – 64.7%; 18.9% were still working; 10.4% were disabled; 4.7% described themselves as housewives.
"Patients with worse health status reported taking more actions and could be a good target population for effective self-management interventions," Frei noted.