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. 2024 Dec 2:18:2383-2393.
doi: 10.2147/PPA.S488165. eCollection 2024.

Association of Patients' Knowledge on the Disease and Its Management with Indicators of Disease Severity and Individual Characteristics in Patients with Chronic Obstructive Pulmonary Disease (COPD): Results from COSYCONET 2

Carolina Fischer  1   2 , Maria Siakavara  1 , Peter Alter  3 , Claus Franz Vogelmeier  3 , Tim Speicher  3 , Hendrik Pott  4 , Henrik Watz  5 , Robert Bals  6   7 , Franziska Trudzinski  8 , Felix Herth  8 , Joachim H Ficker  9 , Manfred Wagner  9 , Christoph Lange  10 , Krista Stoycheva  10 , Winfried Randerath  11 , Jürgen Behr  12   13 , Sebastian Fähndrich  14 , Tobias Welte  15 , Isabell Pink  15 , Kathrin Kahnert  12   16 , Werner Seeger  17 , Stefan Kuhnert  17 , Tobias Gessler  17 , Nina Adaskina  18 , Rudolf A Jörres  1
Affiliations

Association of Patients' Knowledge on the Disease and Its Management with Indicators of Disease Severity and Individual Characteristics in Patients with Chronic Obstructive Pulmonary Disease (COPD): Results from COSYCONET 2

Carolina Fischer et al. Patient Prefer Adherence. .

Abstract

Background: In patients with chronic diseases, including those with chronic obstructive pulmonary disease (COPD), knowledge on the disease and its self-management is considered as relevant for improving disease control and long-term outcome. We studied to which extent components of knowledge depended on potential predictors, such as participation in educational programs and disease severity. For example, the perception of exacerbations or GOLD grade might modulate the content and reliability of COPD understanding.

Methods: Data from the German COSYCONET 2 COPD cohort was used, and 13 questions addressing knowledge and self-management were analyzed.

Results: Overall, 310 patients with the diagnosis of COPD of GOLD grades 1/2/3/4 as well as the former grade 0 were included (39.7% female, median age 66.0 years). The answers to 3 questions (knowledge of term exacerbation, pursed lip breathing technique, criteria for contacting a doctor) were improved (p < 0.05 each) when patients had had moderate-to-severe exacerbations, and to one question (breathing exercise) when having COPD grade 3/4 versus 0/1/2. The other 9 responses did not depend on disease severity, but most of the knowledge was improved when having participated in an educational COPD program. This was particularly true for knowledge that also depended on exacerbations, or if the treating physician was a pulmonary specialist. In some responses, the proportion of correct answers was significantly reduced in males compared to females. The dependence on education level, existence of a treatment plan, self-reported level of risk aversion and low depression score was weak and heterogeneous.

Conclusion: These findings suggest that part of the disease-related knowledge in patients with COPD was reinforced by the experience of exacerbations, especially knowledge regarding criteria on contacting a physician. These observations might help in focusing education on those parts of knowledge that are considered as important by patients based on their own experience.

Keywords: COPD; education; knowledge; patient acuity; symptom exacerbation.

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Conflict of interest statement

Prof. Dr Claus Vogelmeier reports grants, personal fees from AstraZeneca, CSL Behring, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Grifols, Novartis, Sanofi; personal fees from Aerogen; Insmed, Menarini, Roche, outside the submitted work. Prof. Dr Robert Bals reports grants from German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET), during the conduct of the study; grants, personal fees from AstraZeneca GSK CSL; Regeneron, outside the submitted work. Prof. Dr Winfried Randerath reports personal fees from Boehringer Ingelheim, Novartis, Berlin Chemie, GlaxoSmithKline, outside the submitted work. Prof. Dr Kathrin Kahnert reports personal fees from Boehringer Ingelheim, Astra zeneca, GSK, Chiesie, Insmed, outside the submitted work. Prof. Dr Werner Seeger reports personal fees from United Therapeutics, Tiakis Biotech AG, Liquidia, Pieris Pharmaceuticals, Abivax, Pfizer, outside the submitted work. Dr Stefan Kuhnert reports personal fees from Sanofi, AstraZeneca, GSK, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Questions, answer options and shortcuts used in the text and the diagrams. By cutting the last column, the table could be used as a questionnaire.
Figure 2
Figure 2
Percentages of knowledge on questions 1 to 13 in terms of correct answers/high approval/Yes. The full questions and their answer options can be found in Figure 1. Non-categorical questions Q3, Q4, Q8, Q12 were rated positive for answers “Rather agree” or “Agree entirely”.
Figure 3
Figure 3
Heat map of the associations between the answers to each of the 13 questions (independent variable, columns) and the set of predictors (rows). P-values from logistic regression analyses (questions) and linear regression analyses (sum scores) are shown. P-values <0.1 are coloured in order to make potential patterns more clear. The intensity of the colouring shows the significance of the association, while the colour indicates the direction (blue coloured cells for negative regression coefficients, red for positive regression coefficients). The shortcuts for the questions are: Q1: Term Exacerbation; Q2: Pursed lip breathing technique, Q3: Criteria for contact with doctor; Q4: Breathing exercise; Q5: Term FEV1; Q6: High satisfaction with knowledge; Q7: Comorbidities in COPD patients; Q8: Which Medication for symptoms; Q9: Daily Exercise; Q10: Dyspnoea during exercise; Q11: Check of inhaler technique; Q12: Information about new Medication; Q13: Instructions for inhaler; S1-4: sum score first four questions; S5-13: sum score questions Q5-13. The full questions can be found in Figure 1.
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