Molin Katrine Rutkær, Langberg Henning, Lange Peter, Egerod Ingrid
Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Eur Clin Respir J. 2020 May 31;7(1):1762376. doi: 10.1080/20018525.2020.1762376.
Treatment of patients with moderate chronic obstructive pulmonary disease (COPD) is challenged by the low priority of the disease by patients and general practitioners (GPs) affecting the extent of self-management. The aim of this study was to explore (i) attitudes to COPD self-management in patients with moderate COPD, (ii) perceptions of GP commitment to pulmonary rehabilitation in patients with moderate COPD, and (iii) COPD knowledge in patients with moderate COPD.
The study had a qualitative design using semi-structured interviews to explore the views of 14 patients diagnosed with moderate COPD. We applied strategic sampling to obtain maximum variation and conducted a thematic analysis of the data.
Our main findings were that the degree of COPD self-management was linked to the resources of the informants. Further, the patients experienced that GPs only availed themselves of selected parts of the recommendations for COPD treatment by focusing on medical treatment and smoking cessation rather than physical activity and diet. Many patients lacked knowledge regarding the tolerated level of physical activity and therefore avoided activity increasing their heart rate. Finally, many patients were reluctant to accept the diagnosis because the disease is known to be self-inflicted.
Our study suggests that patients with moderate COPD need more information, especially regarding the positive effects of physical activity. GPs might need to devote more time to the three main elements of COPD treatment, smoking cessation, medical treatment, and physical activity, to promote self-management and a healthier lifestyle in patients with COPD.
中度慢性阻塞性肺疾病（COPD）患者的治疗面临挑战，患者和全科医生（GP）对该疾病的重视程度较低，影响了自我管理的程度。本研究的目的是探讨：（i）中度COPD患者对COPD自我管理的态度；（ii）中度COPD患者对全科医生参与肺康复治疗的看法；（iii）中度COPD患者的COPD知识。
本研究采用定性设计，通过半结构化访谈来探究14例诊断为中度COPD患者的观点。我们采用策略性抽样以获取最大程度的差异，并对数据进行了主题分析。
我们的主要发现是，COPD自我管理的程度与受访者的资源有关。此外，患者们感到全科医生仅采用了COPD治疗建议中的某些部分，主要关注药物治疗和戒烟，而非身体活动和饮食。许多患者缺乏关于身体活动耐受水平的知识，因此避免进行会增加心率的活动。最后，许多患者不愿接受诊断，因为该疾病被认为是自身造成的。
我们的研究表明，中度COPD患者需要更多信息，尤其是关于身体活动的积极影响。全科医生可能需要在COPD治疗的三个主要方面投入更多时间，即戒烟、药物治疗和身体活动，以促进COPD患者的自我管理和更健康的生活方式。
