Helplessness, self blame and faith may impact on self management in COPD: a qualitative study.

AIMS: To explore how patients with COPD experience helplessness. METHODS: In-depth interviews with 29 patients with moderate to very severe COPD. Data were analysed using a general inductive approach. RESULTS: All patients focused on acute symptoms and expressed feelings of helplessness in the management of their condition; little attention was paid to longer-term strategies. For one group of patients, mostly European, self blame appeared to intensify feelings of helplessness. For a second group, mostly Pacific, a focus on faith in God, Church and family provided a more positive affect and existed alongside helplessness. CONCLUSIONS: Clinicians seeking to support patients to include longer term strategies in their self management will need to coach patients to experiences of short-term success, and be aware of the ways that patients experience and interpret their helplessness. Clinicians need to address self blame, and recognise patients' priorities of faith and family.

Audit of acute exacerbations of chronic obstructive pulmonary disease at Waitemata District Health Board, New Zealand.

AIM: To examine management and outcome of patients admitted to Waitemata District Health Board (WDHB) with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and determine performance according to evidence-based guidelines. METHODS: Retrospective chart review of all patients admitted to WDHB hospitals with primary diagnosis of AECOPD during May and October 2010. 195 admissions (156 patients) were audited. RESULTS: Patients comprised 72 females and 84 males; mean age 73.1 years. 96% were ever-smokers. 10% of patients had BMI <18 kg/m2 and 40% of these received no dietician input. Spirometry was recorded in 72% within the previous 5 years. Chest X-ray was performed in 96% in the first 24 hours and 33% had arterial blood gas (ABG) performed. Twenty-three patients (29%) had acute respiratory acidosis. Continuous positive airways pressure (CPAP) was used in 11 but none received non-invasive ventilation (NIV). Systemic corticosteroids and antibiotics were prescribed to 87% and 84% respectively. Ten percent of patients were referred for pulmonary rehabilitation (PR). Overall 90-day mortality was 6.7% with 3.1% inpatient mortality. Mean length of stay was 5 days. 90-day re-admission rate was 44%. CONCLUSION: Areas of good adherence to best practice guidelines. Room for improvement in use of NIV, ABG and spirometry measurement, and PR referral.