Self-treatment of acute exacerbations of chronic obstructive pulmonary disease requires more than symptom recognition – a qualitative study of COPD patients’ perspectives on self-treatment

摘要

Background: Self-treatment of acute exacerbations of COPD with antibiotics and/or oral corticosteroids has emerged asa promising strategy to reduce hospitalization rates, mortality and health costs. However, for reasons little understood, theeffect of self-treatment, particularly when not part of comprehensive self-management programs, remainsunclear. Therefore, this study aims to get insight into the patients’ perspective on self-treatment of acuteexacerbations of COPD, focusing specifically on how patients decide for the right moment to start treatment withantibiotics and/or oral corticosteroids, what they consider important when making this decision and aspects whichmight interfere with successful implementation. Methods: We interviewed 19 patients with chronic obstructive pulmonary disease using qualitative semi-structuredinterviews, and applied thematic analysis for data analysis.Results: Patients were well equipped with experiential knowledge to recognize and promptly respond to worseningCOPD symptoms. Worries regarding potential adverse effects of antibiotics and oral corticosteroids played animportant role in the decision to start treatment and could result in hesitation to start treatment. Although selftreatmentrepresented a practical and appreciated option for some patients with predictable symptom patternsand treatment effect, all patients favoured assistance from a medical professional when their perceived competencereached its limits. However, a feeling of obligation to succeed with self-treatment or distrust in their doctors or thehealth care system could keep patients from timely help seeking.Conclusion: COPD patients regard self-treatment of exacerbations with antibiotics and/or oral corticosteroidsas a valuable alternative. How they engage in self-treatment depends on their concerns regarding the medications’adverse effects as well as on their understanding of and preferences for self-treatment as a means of healthcare. Caregivers should address these perspectives in a collaborative approach when offering COPD patientsthe opportunity for self-treatment of exacerbations.