Symptom burden and self-management in persons with chronic obstructive pulmonary disease

Figures & data

Table 1 Final models: associations between sociodemographic and clinical characteristics, symptom burden, and self-management domains

	1	2	3	4	5	6	7	8
	Positive and active engagement in life	Health-directed activities	Skill and technique acquisition	Constructive attitudes and approaches	Self-monitoring and insight	Health services navigation	Social integration and support	Emotional distress
	B (95% CI)	B (95% CI)	B (95% CI)	B (95% CI)	B (95% CI)	B (95% CI)	B (95% CI)	B (95% CI)
Agea	−0.00 (−0.01, 0.00)	−0.01 (−0.02, 0.00)	0.00 (−0.00, 0.01)	−0.00 (−0.01, 0.01)	0.00 (−0.00, 0.01)	0.00 (−0.01, 0.01)	0.01 (−0.00, 0.01)	−0.01 (−0.02, 0.00)
Sex	0.22 (0.10, 0.34)	0.04 (−0.14, 0.22)	0.10 (−0.02, 0.22)	0.10 (−0.03, 0.22)	0.02 (−0.08, 0.12)	−0.03 (−0.14, 0.08)	−0.03 (−0.16, 0.09)	0.11 (−0.05, 0.27)
Educationb
Cohabitationc	−0.11 (−0.24, 0.02)
Comorbidityd				−0.04 (−0.07, −0.00)			−0.02 (−0.05, 0.01)	0.07 (0.03, 0.12)
Disease severitye	−0.02 (−0.09, 0.05)	−0.11 (−0.22, −0.01)	0.10 (0.02, 0.18)	−0.04 (−0.12, 0.05)	0.04 (−0.02, 0.10)	0.01 (−0.06, 0.09)	0.08 (0.00, 0.167)	0.15 (0.05, 0.26)
Symptom burdenf	−0.03 (−0.04, −0.02)	−0.03 (−0.04, −0.02)	−0.02 (−0.03, −0.01)	−0.03 (−0.04, −0.02)	−0.01 (−0.01, −0.00)	−0.01 (−0.02, −0.00)	−0.02 (−0.03, −0.01)	0.03 (0.02, 0.04)
Pack-years smokingg		−0.01 (−0.01, −0.00)			−0.00 (−0.01, −0.00)
Daily use of ICS
PTh	0.16 (0.039, 0.271)	0.37 (0.20, 0.55)	0.15 (0.02, 0.28)		0.13 (0.02, 0.23)
PRi			0.10 (−0.03, 0.23)		0.12 (0.02, 0.22)	0.13 (0.01, 0.24)
R^2	0.337	0.268	0.203	0.240	0.201	0.061	0.141	0.243
Adjusted R^2	0.317	0.243	0.178	0.220	0.169	0.037	0.118	0.223
Bonferroni level	0.008	0.008	0.008	0.01	0.007	0.01	0.01	0.01

Notes: Significance at Bonferroni level is marked in gray and significance at 0.05 is in bold.

a Age in years,

b education: primary school, high school, or university,

c cohabitation: living alone and living with someone,

d comorbidity: rated between 0 (no comorbidities) and 16 based on a list of common comorbidities,

e disease severity: according to GOLD criteria: mild (I), moderate (II), severe (III), and very severe (IV) COPD, defined as FEV₁/FVC<0.7, and FEV₁%≥80% (I), FEV₁%=50%–79% (II), FEV₁%=30%–49% (III), and FEV₁%<30% (IV),

f symptom burden: COPD Assessment Test total score, 0–40 score range,

g pack-years smoking: number of cigarettes smoked per day multiplied by the number of years smoked and divided by 20,

h participates in organized PT,

i previous PR.

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; PR, pulmonary rehabilitation; PT, physical training.

Table 2 Characteristics of the participants

	n	Value
Agea	225	69.0 (8.4)
Sex, maleb	225	138 (61.3%)
GOLD gradeb	225
GOLD II		96 (42.7%)
GOLD III		90 (40.0%)
GOLD IV		39 (17.3%)
FEV1% predicteda	213	45.9 (14.9)
Educationb	219
Primary school		73 (33.3%)
High school		109 (49.8%)
University		37 (16.9%)
Cohabitationb,c	222	70 (31.1%)
Other chronic diseaseb	211	203 (96.2%)
Comorbiditya,d	210	2.6 (1.9)
Years diagnosed with COPD	177	8.5 (5.9)
BMIa	213	26.3 (5.8)
Current smokerb	219	51 (23.3%)
Previous smokerb	169	157 (69.8%)
Never-smokerb	167	12 (5.3%)
Pack-years,e ever-smokersa	186	30.2 (20.2)
CAT scorea,f	215	19.12 (7.5)
mMRC scorea,g	213	1.78 (1.1)
mMRC grade 0b		32 (15.0%)
mMRC grade 1b		57 (26.8%)
mMRC grade 2b		60 (28.2%)
mMRC grade 3b		53 (24.9%)
mMRC grade 4b		11 (5.2%)
PTb,h	225	79 (35.1%)
PRb,i	216	105 (48.6%)
Daily COPD medicationb	220	196 (89.1%)
Medicationb,j	225
LABAk		157 (69.8%)
LAMA		153 (68.0%)
ICS		125 (55.6%)
SABAk		125 (55.6%)
SAMA		11 (4.9%)
LTOTb	221	6 (2.7%)
BIPAPb,l	199	6 (2.7%)
Self-managementa,m
1. Positive and active engagement in life	219	2.9 (0.5)
2. Health-directed behavior	218	2.7 (0.6)
3. Skill and technique acquisition	217	2.7 (0.5)
4. Constructive attitudes and approaches	215	2.9 (0.5)
5. Self-monitoring and insight	220	3.0 (0.3)
6. Health services navigation	216	2.9 (0.5)
7. Social integration and support	218	2.8 (0.5)
8. Emotional distress	218	2.3 (0.6)

Notes:

a Mean (SD),

b n (%),

c cohabitation: living alone and living with someone,

d comorbidity: rated between 0 (no comorbidities) and 16 based on a list of common comorbidities,

e pack-years: number of cigarettes smoked per day multiplied by the number of years smoked and divided by 20,

f CAT score (0–40),

g mMRC dyspnea scale (0–4),

h participation in organized PT: participation and no participation in PT,

i previous PR: previous PR and no previous PR,

j use of medication and no use of medication,

k five participants reported the use of more than one LABA, and five participants reported the use of more than one SABA,

l ventilator assistance by BIPAP,

m domains of the Health Education Impact Questionnaire (1–4).

Abbreviations: BIPAP, biphasic positive airway pressure; BMI, body mass index; CAT, COPD Assessment Test; FEV₁, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β₂-agonist; LAMA, long-acting anticholinergic; LTOT, long-term oxygen therapy; mMRC, modified Medical Research Council; SABA, short-acting β₂-agonist; SAMA, short-acting anticholinergic; PR, pulmonary rehabilitation; PT, physical training.