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      Disease awareness in patients with COPD: measurement and extent

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          Patient awareness of COPD refers to knowledge and acceptance of the disease and its treatment. Although it is relevant to management and outcomes, the disease awareness of patients is poorly investigated, and no validated questionnaires are currently available. We aimed to develop the novel Disease Awareness in COPD Questionnaire (DACQ), which was validated in relation to demographic and clinical features, in patients participating in the SATisfaction and Adherence to COPD Treatment (SAT) study.


          DACQ was developed according to a list of items regarding the patient’s knowledge, acceptance, and perception of COPD as well as of treatment needs. The questionnaire was validated by assessing internal structure and consistency, correlations with other patient-reported outcomes, and stability over time. Furthermore, the extent of disease awareness of patients enrolled in the SAT study was assessed by using DACQ, and correlations with demographic and clinical features were evaluated.


          DACQ was composed of four domains. Overall reliability and stability over time were adequate; correlations between DACQ and other tools measuring different constructs (ie, treatment satisfaction, illness perception, impact of COPD symptoms on daily life, and dyspnea severity) were, as expected, more limited. In the enrolled patient sample, a suboptimal level of disease awareness (<70%) was detected, especially in terms of disease acceptance and perception. Disease knowledge was positively associated with COPD severity, while the impact of symptoms on daily life was negatively associated with disease acceptance, awareness of treatment needs, and overall awareness.


          DACQ proved to be a reliable tool to assess awareness in COPD patients. Awareness of COPD patients need to be improved.

          Clinical trial registration

 ID# NCT02689492.

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          Most cited references 26

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          Coefficient alpha and the internal structure of tests

           Lee Cronbach (1951)
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            Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD.

            Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues. Copyright © 2013. Published by Elsevier Ltd.
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              Hierarchical construct validity of the treatment satisfaction questionnaire for medication (TSQM version II) among outpatient pharmacy consumers.

              The objectives of this study were twofold: 1) to evaluate the construct validity of the Treatment Satisfaction Questionnaire for Medication (TSQM v. II) using structural equation modeling (SEM); and 2) to assess its concurrent validity using medication adherence criteria. Pharmacy patients filling a new medication prescription (n = 342) were recruited from 14 Michigan pharmacies to participate in a 4-week treatment satisfaction study. The TSQM v. II was tested for model fit against an established theoretical model (the Decisional Balance Model of Treatment Satisfaction) using hierarchical confirmatory factor analysis (HCFA). Regression and discriminant analytic models were used to examine the criterion-related validity of the measure. An exploratory factor analysis, used for TSQM v. II item reduction, revealed a strongly dimensional instrument (Effectiveness, Side Effects, and Convenience) and explained 88% of total pooled variance. Results of an HCFA using the final TSQM v. II items suggested a good model fit with the data (P > 0.54). In support of concurrent validity, the TSQM scales explained between 9% and 20% of the variance in dosing adherence and 60% of the variance in the likelihood of future use. Discriminant analysis demonstrated the superior classification power of the hierarchical model of treatment satisfaction over the discrete attribute model when predicting medication discontinuation. The TSQM v. II has equivalent measurement characteristics as the TSQM v. I, yet uses four fewer items and more consistent wording. The value of the Decisional Balance Model for estimation of dosing adherence and medication persistence over time is discussed.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                17 December 2018
                : 14
                : 1-11
                [1 ]Department of Biomedical Sciences, Humanitas University, Milan, Italy
                [2 ]Respiratory Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy, paola.rogliani@
                [3 ]Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Milan, Italy
                [4 ]Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
                [5 ]Department of Medical Sciences, University of Ferrara, Ferrara, Italy
                [6 ]Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
                [7 ]Department of Health Sciences, University of Milan, Milan, Italy
                [8 ]Boehringer Ingelheim, Milan, Italy
                [9 ]Department of Psychology, University of Turin, Turin, Italy
                [10 ]MediNeos Observational Research, Modena, Italy
                [11 ]U.O. di Allergologia e Immunologia Clinica del Dipartimento delle Discipline Mediche, Battipaglia, Italy
                [12 ]U.O.C. Malattie, Fisiopatologia e Riabilitazione Respiratoria A.O. dei Colli, Naples, Italy
                [13 ]UOC Pneumologia, ICS Maugeri, IRCCS Cassano Murge, Murge, Italy
                [14 ]Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCS San Martino, Genoa, Italy
                Author notes
                Correspondence: Paola Rogliani, Respiratory Unit, Department of Experimental Medicine. University of Rome “Tor Vergata,” Via Montpellier 1, 00133 Rome, Italy, Tel +39 6 2090 3616, Email paola.rogliani@
                © 2019 Baiardini et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Clinical Trial Report

                Respiratory medicine

                patient satisfaction, awareness, copd, questionnaire


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