Predictors for adherence to action plans for self-treatment of COPD exacerbations

Abstract

Introduction/Aim: A minority of patients with chronic obstructive pulmonary disease (COPD) derives benefit fromself‐management interventions that include action plans for self‐treatment of COPD exacerbations. The aimof this studywas to identify predictors for adherence to action plans for self‐treatment of exacerbations in COPD patients. Methods: Self‐reported diary data from a subset of COPD patients who participated in a randomized controlled trial (COPE‐II study) in the Netherlands was used to assess adherence to COPD action plans within a self‐management intervention. Only patients with exacerbations were included. Successful self‐treatment was defined as self‐initiating a course of oral steroids/antibiotics within 2 days from the start of an exacerbation. A patient was defined as being adherent when in ≥75% of all exacerbations the self‐treatment action plan was followed. Patient‐level factors that showed a univariate association (P < 0.10) with adherence were included in a multivariate logistic regression model to identify the predictors for adherence toCOPD self‐treatment action plans (P < 0.05). Results: Data from 66 patients (mean age 63.6 ± 8.0;men 56.1%) showed 387 exacerbations within 2 years of follow‐up. Adherence to the action plans was observed in 37.9% of the patients and in 216 COPD exacerbations. Multivariate logistic regression analyses showed that being male (OR: 5.1; 95% CI: 1.5‐17.3) and having no walking problems (EQ5D mobility, OR: 4.9; 95%CI: 1.5‐16.4) were positively associatedwith being adherent to the action plan for self‐treatment of COPD exacerbations. Conclusion: Our study results indicate that being male and having no walking problems are predictors for better adherence to COPD exacerbation action plans. This implies that exploring patients' mobility and offering more support to femaleCOPDpatients who are lessmobilemay positively influence the adherence to COPD exacerbation self‐treatment action plans. More research is, however, required to confirm this.