The role of coping resources and coping style in quality of life of patients with asthma or COPD.

OBJECTIVE: Sufficient psychosocial coping resources and an adequate coping style may have a beneficial influence on quality of life in patients with a chronic disease. Until now little research has been directed at these associations and particularly not among patients with asthma or chronic obstructive pulmonary disease (COPD). The objective of this study is to examine the association between psychosocial coping resources and coping style with HRQoL, for asthma and COPD separately. METHODS: Fourteen general practitioners in The Netherlands recruited 273 adult patients with asthma (n = 220) or COPD (n = 53). Data were collected by a pulmonary function assessment, a face-to-face interview and validated questionnaires about psychosocial coping resources (self-efficacy, mastery, self-esteem, and social support), coping style (avoidant, rational and emotional), and health related quality of life (HRQoL). RESULTS: A more emotional coping style (p < 0.01) was independently associated with poor HRQoL in both asthma and COPD patients. Furthermore, in asthma patients, less self-efficacy feelings (p < 0.01), less mastery feelings (p = 0.05), a more avoidant coping style (p = 0.04) and poor pulmonary function (p < 0.01) were independently associated with poor HRQoL. In COPD patients, a more rational coping style (p = 0.02) was independently associated with poor HRQoL. CONCLUSION: Our findings suggest that psychosocial coping resources and coping style are independently associated with HRQoL in patients with asthma or COPD. Further research should explore the possibilities of intervening on these factors, aiming to improve HRQoL in patients with asthma or COPD.

Effects of specialized community nursing care in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To investigate the effects of specialized respiratory home nursing care after discharge from a pulmonary rehabilitation center. DESIGN: Pretest-posttest control group design. Patients in the experimental group were visited by a nurse who specializes in respiratory care, whereas the control group received care from nurses who did not specialize in respiratory care. SETTING: Data were collected on admission, at program discharge, and 4 months and 9 months after discharge from a pulmonary rehabilitation center. PATIENTS: One hundred fifteen patients were included in the study and observed for 1 year. OUTCOME MEASURES: Health-related quality of life (HRQL), coping strategies, compliance, hospitalization, and satisfaction with the care provided. RESULTS: Complete data sets were obtained from 78 patients with severe airflow obstruction (FEV1 = 41%; predicted +/- SD = 15). Corrections were made for the selective nonresponse, but did not lead to adjustments in outcome scores. In both groups, HRQL scores improved between admission and discharge, but deteriorated 4 months and 9 months after discharge. The only statistically significant short-term effect was found on the "activities" component of HRQL in favor of the control group. No differences were found between groups regarding coping, compliance, and hospitalization. Patients in the experimental group, however, were more satisfied with the care provided by the specialized community nurses. CONCLUSIONS: The treatment intervention of specialized respiratory home nursing might not have been specific or intensive enough to result in outcome benefits. Secondly, the initial benefits from baseline pulmonary rehabilitation alone may have led to positive outcomes in both patient groups.

Long-term outcome of pulmonary rehabilitation in patients with COPD.

BACKGROUND: This study investigates the long-term benefits of pulmonary rehabilitation in terms of health-related quality of life (HRQL). Such information is of particular importance in developing strategies for aftercare at home which aim to maintain the initial improvements seen after rehabilitation. METHODS: Criteria for inclusion were diagnosis of COPD, age 40 to 80 years, and completion of an inpatient pulmonary rehabilitation program. HRQL was assessed by the St. George Respiratory Questionnaire, and the component "well-being" from the Medical Psychological Questionnaire for Lung Diseases. Patient characteristics included lung function parameters such as FEV1, the diffusion capacity for carbon monoxide and maximal inspiratory mouth pressure, age, socio-economic variables, and exercise tolerance evaluated by a 12-min walking test. To define patients in whom long-term benefits were sustained 9 months postdischarge, cases were clustered using hierarchical cluster analysis, based on the HRQL scores at discharge. RESULTS: Complete data sets were obtained from 77 patients. Two groups of cases were clustered. Patient characteristics were essentially the same in both groups. HRQL differed significantly between groups on admission, at discharge, and at follow-up. Within-group analysis revealed that patients in group 1 (n=44) had "moderate" scores on HRQL on admission, a significant improvement between admission and discharge, followed by a significant deterioration of HRQL at follow-up. Group 2 (n=33) had "severely" impaired HRQL on admission, little improvement after rehabilitation, and remained in fairly stable condition 9 months postdischarge. CONCLUSIONS: Results suggest that patients with COPD require a differentiated aftercare program of postdischarge pulmonary rehabilitation.

Determinants of health-related quality of life in patients with chronic obstructive pulmonary disease.

BACKGROUND: The consequences of chronic obstructive pulmonary disease (COPD) on daily life, encapsulated by the term "health-related quality of life" (HRQL), are important in determining appropriate home care. There is a need to understand the relative contribution of respiratory impairment, physical disability, coping, age, and socioeconomic variables on HRQL. METHODS: Patients with COPD were recruited on admission to a pulmonary rehabilitation centre. Respiratory impairment was assessed by lung function tests and physical disability was evaluated by a 12 minute walking test. HRQL was assessed by means of the St George's Respiratory Questionnaire (SGRQ) measuring "symptoms", "activity", and "impact". Because the SGRQ does not include a measure of "well being", this was taken from the medical psychological questionnaire for lung diseases. The COPD coping questionnaire and a questionnaire covering basic socioeconomic variables were also used. RESULTS: One hundred and twenty six patients of mean (SD) age 65 (9) years and mean (SD) forced expiratory volume in one second (FEV1) 39 (9)% predicted were included. The scores on the SGRQ indicated severe impairment. Correlations were found between lung function parameters, 12 minute walking test, and the HRQL "activity" and "impact" components. Coping strategies were correlated with the "activity", "impact", and "well being" components. No correlations were found between age, socioeconomic variables, and HRQL. FEV1, 12 minute walking test, and the coping strategies "avoidance" and "emotional reaction" were the best predictors of HRQL. CONCLUSION: In patients with COPD methods of improving physical performance and teaching adequate coping strategies should be considered in order to improve HRQL.

Influence of verbal ability on the expression of aggression in physically abused children.

The relationship between verbal ability and aggressive behavior in 53 physically abused children in a residential treatment center was examined. Characteristics differentiating aggressive children from their less aggressive peers were identified. Although general verbal ability was similar in aggressive and nonaggressive abused children, reading and expressive language deficits were more prevalent in the highly aggressive children. Highly aggressive children were significantly more deficient in reading ability and more often required speech-language services. Implications of these findings for treatment and future research are discussed.