The Influence of COPD Awareness on Hospital Admissions: A Paradoxical Relationship?

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterised by frequent exacerbations, which contribute to increased healthcare utilisation and reduced quality of life. Knowledge about the disease is generally associated with better outcomes. This study examined the association between COPD knowledge levels and healthcare utilisation (including hospital readmissions) in patients hospitalised for acute exacerbations. Methods: This prospective observational study included 78 patients hospitalised for COPD exacerbations and classified as Group D according to the updated GOLD criteria 2021. The Bristol COPD Knowledge Questionnaire (BCKQ) was administered prior to discharge to evaluate patients' knowledge levels. Data were collected about emergency department visits, hospitalisations, and intensive care unit (ICU) admissions for a six-month follow-up period. Statistical analyses assessed the relationships between BCKQ scores, patient outcomes, and risk factors influencing hospital readmissions. Results: The median BCKQ total score was 23 (6-40). A strong correlation was found between higher BCKQ scores and more visits to the emergency room (p = 0.005), especially in the subdomains of epidemiology (p = 0.010), aetiology (p = 0.033), and dyspnoea (p = 0.042). Higher antibiotic knowledge scores were associated with ICU admissions (p = 0.019). Logistic regression analysis revealed that domiciliary NIV use (OR = 2.60, p = 0.041) and higher BCKQ scores (OR = 1.10, p = 0.010) were significant predictors of hospital readmissions. However, no significant relationship was found between survival and BCKQ or mCCI scores (p > 0.05). Conclusions: This study indicates that while increased COPD knowledge is associated with greater healthcare utilisation, it does not directly translate into improved clinical outcomes. These findings underscore the importance of integrating practical skills and behaviour management into educational programmes to help patients effectively apply their knowledge. Further research is needed to explore long-term implications and strategies to optimise knowledge-based interventions.

Keywords: Bristol COPD Knowledge Questionnaire; COPD knowledge; healthcare utilisation; hospital readmissions.

Figure 1

Receiver operating characteristic (ROC) curve for BCKQ score and emergency visits.