The Lived Experiences of People With Chronic Obstructive Pulmonary Disease: A Phenomenological Study : People's Lived Experiences With COPD

This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone.

The current debate about the lower limit of normal (LLN) vs the 0.7 fixed ratio to diagnose COPD is not completely resolved, and little information about the clinical impact of these different criteria is available. We compared differences in health-related quality of life, exacerbations, exercise tolerance, physical activity, comorbidity, and systemic biomarkers of subjects with FEV(1)/FVC LLN (ratio-only group) vs subjects without COPD and those with mild or moderate to severe COPD. A population-based sample of 3,802 subjects aged 40 to 80 years from the Epidemiologic Study of COPD in Spain was selected. Subjects were evaluated with postbronchodilator spirometry, quality-of-life and physical activity questionnaires, and 6-min walk tests. Exacerbations within the previous year and comorbidities were recorded. Systemic biomarkers were measured after excluding subjects with conditions associated with systemic inflammatory processes. Fixed-ratio COPD overdiagnosis affects up to 4.6% of subjects aged 40 to 80 years, is more frequent in men, and increases with age. After adjusting for confounding factors, the ratio-only group had a worse health-related quality of life than the non-COPD group, with poorer scores in all questionnaire domains (P < .05). However, no differences between the two groups for respiratory exacerbations, 6-min walk distance, physical activity, or systemic biomarkers were observed. Ratio-only subjects did not present greater risk for cardiovascular disease (adjusted relative OR, 1.47; 95% CI, 0.81-2.64), whereas subjects with mild COPD did (adjusted relative OR, 2.32; 95% CI, 1.11-4.84). Subjects receiving a diagnosis of COPD by the fixed ratio present worse self-reported quality of life than subjects without COPD but had similar exercise, frequency of exacerbations, and indices of systemic effects.

Background Excluding the tropics, exacerbations of chronic obstructive pulmonary disease (COPD) are more frequent in winter. However, studies that directly relate hospitalizations for exacerbation of COPD to ambient temperature are lacking. The aim of this study was to assess the influence of temperature on the number of hospitalizations for COPD. Methods This was a population-based study in a metropolitan area. All hospital discharges for acute exacerbation of COPD during 2009 in Barcelona and its metropolitan area were analyzed. The relationship between the number of hospitalizations for COPD and the mean, minimum, and maximum temperatures alongside comorbidity, humidity, influenza rate, and environmental pollution were studied. Results A total of 9,804 hospitalization discharges coded with COPD exacerbation as a primary diagnosis were included; 75.4% of cases were male with a mean age of 74.9±10.5 years and an average length of stay of 6.5±6.1 days. The highest number of admissions (3,644 [37.2%]) occurred during winter, followed by autumn with 2,367 (24.1%), spring with 2,347 (23.9%), and summer with 1,446 (14.7%; P<0.001). The maximum, minimum, and mean temperatures were associated similarly with the number of hospitalizations. On average, we found that for each degree Celsius decrease in mean weekly temperature, hospital admissions increased by 5.04% (r 2=0.591; P<0.001). After adjustment for humidity, comorbidity, air pollution, and influenza-like illness, only mean temperatures retained statistical significance, with a mean increase of 4.7% in weekly admissions for each degree Celsius of temperature (r 2=0.599, P<0.001). Conclusion Mean temperatures are closely and independently related to the number of hospitalizations for COPD.