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Riegel B, Page SD, Aryal S, Lee CS, Belfiglio A, Freedland KE, Stromberg A, Vellone E, Westland H, van Rijn MM, Pettersson S, Wiebe DJ, Jaarsma T. Symptom characteristics, perceived causal attributions, and contextual factors influencing self-care behaviors: An ecological daily assessment study of adults with chronic illness. PATIENT EDUCATION AND COUNSELING 2024; 123:108227. [PMID: 38430731 DOI: 10.1016/j.pec.2024.108227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Insights into how symptoms influence self-care can guide patient education and improve symptom control. This study examined symptom characteristics, causal attributions, and contextual factors influencing self-care of adults with arthritis, asthma, chronic obstructive pulmonary disease, diabetes, or heart failure. METHODS Adults (n = 81) with a symptomatic chronic illness participated in a longitudinal observational study. Using Ecological Daily Assessment, participants described one symptom twice daily for two weeks, rating its frequency, severity, bothersomeness, duration, causes, and self-care. RESULTS The most frequent symptoms were fatigue and shortness of breath. Pain, fatigue, and joint stiffness were the most severe and bothersome. Most participants engaged in active self-care, but those with fatigue and pain engaged in passive self-care (i.e., rest or do nothing), especially when symptoms were infrequent, mild, somewhat bothersome, and fleeting. In people using passive self-care, thoughts, feelings, and the desire to conceal symptoms from others interfered with self-care. CONCLUSION Most adults with a chronic illness take an active role in managing their symptoms but some conceal or ignore symptoms until the frequency, severity, bothersomeness, or duration increases. PRACTICE IMPLICATIONS When patients report symptoms, asking about self-care behaviors may reveal inaction or ineffective approaches. A discussion of active self-care options may improve symptom control.
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Affiliation(s)
- Barbara Riegel
- Center for Home Care Policy & Research at VNS Health, New York, NY, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | | | - Subhash Aryal
- Johns Hopkins University, School of Nursing, Baltimore, MD, USA
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Andrew Belfiglio
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Anna Stromberg
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Ercole Vellone
- University of Roma Tor Vergata, Rome, Italy; Wroclaw Medical University, Department of Nursing and Obstetrics, Wroclaw, Poland
| | | | | | - Sara Pettersson
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | | | - Tiny Jaarsma
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden; University Medical Center Utrecht, Utrecht, the Netherlands
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Bhatt SP, Agusti A, Bafadhel M, Christenson SA, Bon J, Donaldson GC, Sin DD, Wedzicha JA, Martinez FJ. Phenotypes, Etiotypes, and Endotypes of Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:1026-1041. [PMID: 37560988 PMCID: PMC10867924 DOI: 10.1164/rccm.202209-1748so] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
Chronic obstructive pulmonary disease is a major health problem with a high prevalence, a rising incidence, and substantial morbidity and mortality. Its course is punctuated by acute episodes of increased respiratory symptoms, termed exacerbations of chronic obstructive pulmonary disease (ECOPD). ECOPD are important events in the natural history of the disease, as they are associated with lung function decline and prolonged negative effects on quality of life. The present-day therapy for ECOPD with short courses of antibiotics and steroids and escalation of bronchodilators has resulted in only modest improvements in outcomes. Recent data indicate that ECOPD are heterogeneous, raising the need to identify distinct etioendophenotypes, incorporating traits of the acute event and of patients who experience recurrent events, to develop novel and targeted therapies. These characterizations can provide a complete clinical picture, the severity of which will dictate acute pharmacological treatment, and may also indicate whether a change in maintenance therapy is needed to reduce the risk of future exacerbations. In this review we discuss the latest knowledge of ECOPD types on the basis of clinical presentation, etiology, natural history, frequency, severity, and biomarkers in an attempt to characterize these events.
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Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alvar Agusti
- Institut Respiratori (Clinic Barcelona), Càtedra Salut Respiratoria (Universitat de Barcelona), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-Barcelona), Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), España
| | - Mona Bafadhel
- Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Stephanie A. Christenson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gavin C. Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Don D. Sin
- Centre for Heart Lung Innovation and
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul’s Hospital, Vancouver, British Columbia, Canada; and
| | - Jadwiga A. Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Song Q, Lin L, Cheng W, Li XS, Zeng YQ, Liu C, Deng MH, Liu D, Yu ZP, Li X, Ma LB, Chen Y, Cai S, Chen P. Clinical-functional characteristics and risk of exacerbation and mortality among more symptomatic patients with chronic obstructive pulmonary disease: a retrospective cohort study. BMJ Open 2023; 13:e065625. [PMID: 36944469 PMCID: PMC10032416 DOI: 10.1136/bmjopen-2022-065625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 classified chronic obstructive pulmonary disease (COPD) patients into more and less symptomatic groups. This study aimed to analyze the clinical characteristics, risk of future exacerbation and mortality among patients in more symptomatic group. DESIGN A retrospective cohort study. SETTING Data were obtained from patients enrolled in a database setup by Second Xiangya Hospital of Central South University. PARTICIPANTS 1729 stable COPD patients listed from September 2017 to December 2019 in the database. The patients were classified into more and less symptomatic groups based on GOLD 2017 report. OUTCOMES All patients were followed up for 18 months. We collected baseline data and recorded the number of exacerbations and mortality during follow-up. RESULTS The more symptomatic patients were older, had higher Clinical COPD Questionnaire (CCQ) scores, more severe airflow limitation and higher number of exacerbations and hospitalizations in the past year (P < 0.05). Logistic regression showed that having more symptoms correlated with the CCQ scores and exacerbations in the past year (P < 0.05). After patients were followed up, there were higher numbers of exacerbations, hospitalizations and mortality rates in more symptomatic patients (P < 0.05). The multivariate model showed that age more than 65 years (OR = 2.047, 95% CI = 1.020-4.107) and COPD assessment test scores more than 30 (OR = 2.609, 95% CI = 1.339-5.085) were independent risk factors for mortality, whereas current smoker (OR = 1.565, 95% CI = 1.052-2.328), modified Medical Research Council scores (OR = 1.274, 95% CI = 1.073-1.512) and exacerbations in the past year (OR = 1.061, 95% CI = 1.013-1.112) were independent risk factors for exacerbation in more symptomatic patients (P < 0.05). CONCLUSIONS More symptomatic COPD patients have worse outcomes. In addition, several independent risk factors for exacerbation and mortality were identified. Therefore, clinicians should be aware of these risk factors and take them into account during interventions.
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Affiliation(s)
- Qing Song
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ling Lin
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Wei Cheng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Xue-Shan Li
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yu-Qin Zeng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Cong Liu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Min-Hua Deng
- Department of Respiratory, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Dan Liu
- Department of Respiratory, The Eighth Hospital in Changsha, Hunan, China
| | - Zhi-Ping Yu
- Department of Respiratory, Longshan Hospital of Traditional Chinese Medicine, Hunan, China
| | - Xin Li
- Division 4 of Occupational Disease, Hunan Occupational Disease Prevention and Treatment Hospital, Changsha, Hunan, China
| | - Li-Bing Ma
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Shan Cai
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
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Tung HY, Galloway J, Matcham F, Hotopf M, Norton S. High-frequency follow-up studies in musculoskeletal disorders: a scoping review. Rheumatology (Oxford) 2021; 60:48-59. [PMID: 33099639 DOI: 10.1093/rheumatology/keaa487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This scoping review identifies research in musculoskeletal disorders that uses high frequency follow-up of symptoms. The aim was to investigate whether symptom variability is investigated as a predictor of disease outcome and how intensive follow-up methods are used in musculoskeletal research. METHODS Embase, MEDLINE and PsycInfo were searched using OVID, and the Institute of Electrical and Electronic Engineers was also searched using the Institute of Electrical and Electronic Engineers Xplore search engine. Studies were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, but no meta-analysis was done because the priority in this study is to identify gaps in available literature. RESULTS Twenty-one papers were included. There was a mean of 54 patients per study (s.d. of 27.7). Two-thirds of the papers looked at how a symptom influences another in the short-term (subsequent assessment in the same day or next day), but none looked at the long-term. Only one study considered symptom variability investigating how higher variability in pain (defined by the s.d.) is associated with higher average pain severity and lower average sleep quality. CONCLUSION The methodology of musculoskeletal disorder research has changed from completing paper booklets to using electronic data capture (smartphones). There has also been a trend of collecting more intensive longitudinal data, but very little research utilizes these data to look at how symptom variability affects symptom outcomes. This demonstrates a gap in research where furthering understanding of this will help clinicians decide on the most important symptom to address in future patients.
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Affiliation(s)
- Hsiu Yen Tung
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience
| | - James Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences & Medicine
| | - Faith Matcham
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience.,Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences & Medicine
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Han W, Peng X, Qu D, Yang Y, Li K. Heavy shackles: The experience of symptom distress and coping behaviors of Chinese patients with chronic obstructive pulmonary disease. Nurs Health Sci 2020; 22:1177-1185. [PMID: 33118687 DOI: 10.1111/nhs.12790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
People with chronic obstructive pulmonary disease exhibit various symptoms, some of which can negatively affect their daily lives. Thus, they may adopt coping behaviors to improve their condition. This qualitative descriptive study investigated symptom distress and coping behaviors among 19 Chinese patients with chronic obstructive pulmonary disease using individual, semi-structured, face-to-face interviews. We identified the following three themes for the patients' symptom distress: distressing symptoms, inescapable imprisonment, and no choice other than being a burden to the family. The various coping behaviors of the patients were categorized into the following three themes: struggle during the medical treatment process, careful maintenance of daily life, and coping with negative emotions. Although all patients experienced physical and psychological distress, they displayed a strong desire to improve their lives and health. By recognizing the patients' symptom distress and coping behaviors, tailored interventions could be developed to improve the quality of their lives.
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Affiliation(s)
- Wenwen Han
- School of Nursing, Jilin University, Changchun, China.,The First Hospital of Jilin University, Changchun, China
| | - Xin Peng
- School of Nursing, Jilin University, Changchun, China
| | - Danhua Qu
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China.,The First Hospital of Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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