Gender difference on the knowledge, attitude, and practice of COPD diagnosis and treatment: a national, multicenter, cross-sectional survey in China

Figures & data

Table 1 Patient demographics

	Male (n=1,156)	Female (n=542)	P-value
Age, years (mean±SD)	67.6±10.9	64.9±11.2	<0.01
BMI (kg/m^2) (mean±SD)	22.2±3.7	23.2±4.2	<0.01
Smoking history, n (%)
Current smoker	298 (26.0%)	79 (14.6%)	<0.01
Never smoker	153 (13.4%)	344 (63.6%)	<0.01
Ex-smoker	693 (60.6%)	118 (21.8%)	<0.01
Pack-years (mean±SD)	36.5±25.9	26.0±23.2	<0.01
Education under elementary, n (%)	109 (9.5%)	155 (28.6%)	<0.01
Occupation, n (%)
Farmer	202 (17.5%)	172 (31.7%)	<0.01
No work	232 (20.1%)	250 (46.1%)	<0.01
No insurance, n (%)	299 (26.0%)	246 (45.5%)	<0.01
Monthly income ≤1,000 (RMB), n (%)	348 (30.4%)	333 (61.4%)	<0.01

Abbreviation: BMI, body mass index.

Figure 1 Flow of participants through the study.

Abbreviation: PFT, pulmonary function test.

Table 2 Gender difference on disease severity, comorbidities, exacerbation, and quality of life

	Male (n=1,156)	Female (n=542)	P-value
COPD stage, n (%)
Stage I	72 (6.3)	45 (8.4)	>0.05
Stage II	308 (27.1)	221 (41.1)	<0.01
Stage III	439 (38.7)	188 (34.9)	>0.05
Stage IV	316 (27.8)	84 (15.6)	<0.01
FEV1/FVC (mean±SD)	50.2±11.5	54.1±10.9	<0.01
FEV1% (mean±SD)	45.4±29.0	50.0±19.1	<0.01
VC% (mean±SD)	67.0±20.7	72.0±22.6	<0.01
RV/TLC% (mean±SD)	62.7±33.9	58.5±23.2	<0.05
DLco% (mean±SD)	61.5±28.5	64.2±26.0	>0.05
mMRC dyspnea score (mean±SD)	1.70±1.11	1.74±1.10	>0.05
Complication, n (%)
Hypertension	292 (56.3)	135 (56.0)	>0.05
CHD	159 (30.6)	73 (30.3)	>0.05
Diabetes	87 (16.8)	44 (18.3)	>0.05
Cerebrovascular disease	55 (10.6)	19 (7.9)	>0.05
Liver disease	21 (4.0)	10 (4.1)	>0.05
Kidney disease	20 (3.9)	7 (2.9)	>0.05
Hematology disease	4 (0.8)	2 (0.8)	>0.05
Exacerbation history
Number of exacerbations (mean±SD)	2.47±2.68	2.55±2.93	>0.05
One or more exacerbation n (%)	821 (87.0)	386 (84.3)	>0.05
Severe exacerbation, n (%)	441 (51.6)	185 (44.5)	<0.05
Quality of life
SF-36_PCS (mean±SD)	55.5±21.6	53.4±21.2	>0.05
SF-36_MCS (mean±SD)	61.3±25.0	57.5±26.8	<0.01

Abbreviations: CHD, coronary heart disease; DLco, carbon monoxide diffusing capacity; RV, residual volume; SF-36_MCS, the short form-36 mental component summary; SF-36_PCS, the short form-36 physical component summary; TLC, total lung capacity; VC, vital capacity.

Table 3 Patients’ knowledge, attitude, and practice on COPD diagnosis

	Male, n (%)	Female, n (%)	P-value
Never heard of COPD	682 (59.0)	363 (67.0)	<0.01
Risk factors of COPD
Unknown	431 (37.5)	288 (53.5)	<0.01
Active smoking	655 (57.0)	183 (34.0)	<0.01
Passive smoking	378 (32.9)	150 (27.9)	<0.05
Air pollution	349 (30.3)	119 (22.1)	<0.01
Biomass	176 (15.3)	64 (11.9)	>0.05
Respiratory infection	325 (28.3)	122 (22.7)	<0.05
Occupational exposure	178 (15.5)	52 (9.7)	<0.01
Regard themselves have COPD	957 (83.1)	434 (80.7)	>0.05
Ask physician about the severity of COPD	1,066 (92.6)	489 (90.6)	>0.05
Physician had to tell the patient that he/she has emphysema	694 (60.4)	272 (50.5)	<0.01
Physician had to tell the patient that he/she has chronic bronchitis	892 (77.6)	404 (74.8)	>0.05
Physician had to tell the patient that he/she has COPD	436 (37.9)	172 (31.9)	<0.05
Physician had to say about the severity of COPD	354 (30.8)	153 (28.2)	>0.05
Have done PFT before	812 (70.4)	353 (65.2)	<0.05
Not repeating PFT yearly	1,011 (87.6)	497 (91.7)	<0.05
Not knowing PFT results	843 (73.1)	426 (78.6)	<0.05

Abbreviation: PFT, pulmonary function test.

Table 4 Patients’ knowledge on the goal of COPD treatment

	Male, n (%)	Female, n (%)	P-value
Patients who did not know the side effects of COPD drug
Anticholinergic drugs	775 (81.6)	359 (80.1)	>0.05
Beta-receptor agonist	778 (82.2)	355 (79.4)	>0.05
ICS	766 (80.7)	357 (80.0)	>0.05
ICS/LABA	784 (82.7)	358 (80.3)	>0.05
Theophylline	773 (81.4)	352 (78.6)	>0.05
Single or combined therapy
Single therapy	44 (3.9)	30 (5.6)	>0.05
Combined therapy	508 (44.5)	205 (38.3)	<0.05
Do not know/does not matter	590 (51.7)	300 (56.1)	>0.05
Long-term treatment
Yes	593 (51.9)	247 (46.1)	<0.05
Goal of COPD treatment
Can be cured	258 (22.4)	124 (23.1)	>0.05
Reduced symptoms	601 (52.1)	296 (55.1)	>0.05
Improved quality of life	153 (13.3)	62 (11.5)	>0.05
No effective treatment	69 (6.0)	28 (5.2)	>0.05

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β2-agonist.

Table 5 Patients’ practice on current COPD treatment

	Male, n (%)	Female, n (%)	P-value
COPD treatments
Any medication	594 (87.5)	245 (84.8)	>0.05
Theophylline	402 (59.1)	157 (54.3)	>0.05
Salbutamol	265 (39.0)	106 (36.7)	>0.05
Ipratropium bromide	232 (34.2)	85 (29.4)	>0.05
Salmeterol/fluticasone	169 (24.9)	81 (28.0)	>0.05
Tiotropium	111 (16.3)	40 (13.8)	>0.05
Budesonide	77 (11.3)	29 (10.0)	>0.05
Oral beta agonist	42 (6.2)	20 (6.9)	>0.05
Formoterol/budesonide	36 (5.3)	11 (3.8)	>0.05
Formoterol	20 (2.9)	8 (2.8)	>0.05
Beclomethasone	19 (2.8)	5 (1.7)	>0.05
Fluticasone	8 (1.2)	5 (1.7)	>0.05
When the drugs are taken
According to prescription	749 (66.9)	325 (62.6)	>0.05
When I remember	105 (9.4)	45 (8.7)	>0.05
When needed	266 (23.8)	149 (28.7)	<0.05
Patient adjusts the drug frequency or doses
Never	496 (44.4)	219 (42.3)	>0.05
Seldom	325 (29.1)	136 (26.3)	>0.05
A few times	120 (10.8)	56 (10.8)	>0.05
Often	25 (2.2)	18 (3.5)	>0.05
Always	150 (13.4)	89 (17.2)	<0.05
Patients’ satisfaction with COPD drugs
Extremely dissatisfied	11 (1.0)	10 (2.0)	>0.05
Dissatisfied	223 (20.3)	116 (22.9)	>0.05
Satisfied somewhat	395 (35)	172 (34)	>0.05
Satisfied	380 (34.7)	166 (32.8)	>0.05
Extremely satisfied	87 (7.9)	42 (8.3)	>0.05
Worried about the side effects of ICSs	319 (28.0)	142 (26.7)	>0.05
Use antibiotics very often	473 (41.2)	237 (43.9)	>0.05
Oxygen supply at home	792 (68.8)	400 (73.9)	>0.05
Pulmonary rehabilitation	962 (83.6)	473 (87.8)	<0.05
Factors associated with the “ideal” COPD drug
Drug efficacy	805 (69.6)	381 (70.3)	>0.05
Side effects	416 (36.0)	193 (35.6)	>0.05
Attending patient education activity held by the hospital
Yes	34 (8.3)	95 (6.3)	>0.05
No	1,049 (91.7)	503 (93.7)	>0.05
Physician introduced the effect of prescribed drugs	531 (47.4)	242 (46.4)	>0.05

Abbreviation: ICSs, inhaled corticosteroids.

Table 6 Multivariable adjusted ORs for patients’ knowledge on COPD

	Male		Female
	OR (95% CI)	P-value	OR (95% CI)	P-value
Age	1.008 (0.994–1.022)	0.263	0.994 (0.954–1.036)	0.766
Smoking pack-years	1.003 (0.998–1.008)	0.284	1.001 (0.987–1.016)	0.838
FEV1%	1.025 (1.017–1.033)	0.000	1.016 (0.996–1.035)	0.112
Education level
Low education (under elementary level)	0.932 (0.688–1.262)	0.648	2.230 (0.992–5.013)	0.052
High education	1.0 (ref)	–	1.0 (ref)	–
Insurance
Have insurance	0.552 (0.375–0.811)	0.002	0.273 (0.123–0.604)	0.001
Self-paid	1.0 (ref)	–	1.0 (ref)	–
Income level
Monthly income ≤1,000 RMB	1.790 (1.279–2.505)	0.001	0.596 (0.266–1.333)	0.207
Monthly income >1,000 RMB	1.0 (ref)	–	1.0 (ref)	–
Dyspnea severity
mMRC <2	1.0 (ref)	–	1.0 (ref)	–
mMRC ≥2	1.006 (0.753–1.343)	0.970	1.562 (0.774–3.150)	0.213

Abbreviation: ref, reference.

Table

The KAP Questionnaire on COPD
I. Patients’ knowledge of COPD diagnosis and treatment
1. Have you ever heard of COPD before?	Yes ☐			No ☐
2. Which disease is associated with COPD?
Chronic bronchitis or emphysema	Yes ☐			No ☐		Don’t know ☐
3. Which item is a risk factor of COPD?
Active smoking	Yes ☐			No ☐
Passive smoking	Yes ☐			No ☐
Air pollution	Yes ☐			No ☐
Biomass	Yes ☐			No ☐
Respiratory infection	Yes ☐			No ☐
Occupational exposure	Yes ☐			No ☐		Don’t know ☐
4. What’s the clinical feature of COPD?
Cough	Yes ☐			No ☐
Expectoration	Yes ☐			No ☐
Dyspnea	Yes ☐			No ☐		Don’t know ☐
5. What’s the clinical feature of COPD exacerbation?
Upper respiratory infection	Yes ☐			No ☐
Increased dyspnea	Yes ☐			No ☐
Increased sputum volume	Yes ☐			No ☐
Sputum purulence	Yes ☐			No ☐
Increased cough	Yes ☐			No ☐
Fever	Yes ☐			No ☐		Don’t know ☐
6. What’s the warning sign of coming COPD exacerbation?
Wheeze	Yes ☐			No ☐
Lacking of strength	Yes ☐			No ☐
Upper respiratory infection	Yes ☐			No ☐
Increased cough	Yes ☐			No ☐
Increased sputum	Yes ☐			No ☐
No warning signs or don’t know	Yes ☐			No ☐
7. What’s the side effect of most used COPD drugs? Please list the side effect if you choose yes.
Anticholinergic drug	Yes ☐			No ☐
Beta receptor agonist	Yes ☐			No ☐
Inhaled corticosteroids	Yes ☐			No ☐
ICS/LABA	Yes ☐			No ☐
Theophylline	Yes ☐			No ☐
8. Do you think COPD should use combined treatment or single treatment?
Single treatment ☐		Combined treatment ☐			Don’t know ☐
9. Does COPD need long-term therapy?
Yes ☐		No ☐			Don’t know ☐
10. What’s the right description on goal of COPD treatment?
Can be cured			Yes ☐		No ☐
Alleviate symptoms			Yes ☐		No ☐
Improve quality of life			Yes ☐		No ☐
No effective treatment			Yes ☐		No ☐
II. Patients’ attitude of COPD diagnosis and treatment
1. Do you regard yourself have chronic bronchitis, emphysema or COPD?			Yes ☐	No ☐
2. Would you ask physician about the severity of COPD?			Yes ☐	No ☐
3. Which did you worry most in a COPD exacerbation?
Death ☐ The exacerbation of syndrome ☐ Hospitalization ☐ Decline of lung function ☐
4. Which item best describes your satisfaction with COPD drugs?
Extremely dissatisfied ☐ Dissatisfied ☐ Satisfied somewhat ☐ Satisfied ☐ Extremely satisfied ☐
5. These are factors associated with the “ideal” COPD drug, please rank them by importance?
A. Drug efficacy B. Type of dose C. Side effects D. The size and shape E. Price F. Frequency of dose
6. Do you worry about side effect of ICS?			Yes ☐	No ☐			Don’t know ☐
III. Patients’ practice of COPD diagnosis and treatment
1. What medicines do you take to treat your COPD?
Theophylline ☐ Salbutamol ☐ Ipratropium bromide ☐ Salmeterol/fluticasone ☐ Tiotropium ☐ Budesonide ☐
Oral beta agonist ☐ Formoterol/budesonide ☐ Formoterol ☐ Beclomethasone ☐
2. Had Physician told you that you have emphysema?			Yes ☐	No ☐
3. Had Physician told you that you have chronic bronchitis?			Yes ☐	No ☐
4. Had Physician told you that you have COPD?			Yes ☐	No ☐
5. Had Physician told you the severity of your COPD?			Yes ☐	No ☐
6. Had you ever done PFT before?			Yes ☐	No ☐
7. Do you repeat PFT yearly?			Yes ☐	No ☐
8. Do you know your PFT results?			Yes ☐	No ☐
9. Had physician introduce the effect of prescribed drugs?			Yes ☐	No ☐
10. When did you take drugs?
According to prescription ☐ When remember ☐ When needed ☐
11. How often do you adjust drug frequency or doses without doctors’ instructions?
Never ☐ Seldom ☐ A few ☐ Often ☐ Always ☐
12. Did you use antibiotics very often?			Yes ☐	No ☐
13. Do you have oxygen supply at home? If you have one, did you use it often or treat it as a standby?
Use it often ☐ Standby ☐ Don’t have one ☐
14. Had you attended a pulmonary rehabilitation program?			Yes ☐	No ☐
15. Did you attend patients’ education activity held by hospital?			Yes ☐	No ☐