Abstract

Half of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are caused by bacterial infection, but self-management plans (SMPs) generally advocate use of antibiotics and steroids for all events. We report findings from a qualitative study exploring the acceptability of a sputum colour chart and SMP to guide patient use of antibiotics and steroids (commonly termed a ‘rescue pack’). Qualitative interviews were conducted with healthcare professionals (HCPs) and patients from the Colour COPD trial – a randomised controlled trial of usual care (SMP alone) versus usual care plus sputum colour chart to manage AECOPD across England and sampled to promote maximum variation. Interviews were audio-recorded, transcribed clean verbatim, then analysed thematically, using an adapted Framework approach. Expert patients contributed to the patient data analysis. Fourteen HCPs and 39 patients were interviewed from primary and secondary care. Three overarching themes were identified. (1) Handling tensions: the tension between stewardship of antimicrobials and need to reduce risk of serious illness. (2) Clinical and embodied legacies: established clinical practices of infection control and patient’s own experiences of managing their condition over time have focused on early intervention for AECOPD. (3) Changing self-management practices: opportunities for changing practices through negotiating change between HCP and patient. In conclusion, while, in principle, the assessment of sputum colour using a chart to manage AECOPD was acceptable to both patients and HCPs, in practice, it is unlikely to have significant impact on well-established clinical practices for infection control and patient habits of self-management.

Details

Title
“I know this is on my chest, let’s act”: a qualitative study exploring self-management of acute COPD exacerbations with a sputum colour chart to reduce unnecessary antibiotic use
Author
Adams, R. L. 1 ; McKenna, M. 1 ; Allsopp, K. 2 ; Saleem, S. 3 ; Le Mesurier, N. 1 ; Diar Bakerly, N. 4 ; Turner, A. M. 5 ; Gale, N. K. 1 

 University of Birmingham, Health Services Management Centre, School of Social Policy and Society, Birmingham, UK (GRID:grid.6572.6) (ISNI:0000 0004 1936 7486) 
 Independent Patient/Public Co-analyst, Birmingham, UK (GRID:grid.6572.6) 
 Independent Patient/Public Co-analyst, Birmingham, UK (GRID:grid.6572.6); University College London, Institute of Education, London, UK (GRID:grid.83440.3b) (ISNI:0000 0001 2190 1201) 
 Northern Care Alliance, Salford, UK (GRID:grid.6572.6); Manchester Metropolitan University, Manchester, UK (GRID:grid.25627.34) (ISNI:0000 0001 0790 5329) 
 University of Birmingham, Department of Applied Health Sciences, Birmingham, UK (GRID:grid.6572.6) (ISNI:0000 0004 1936 7486) 
Pages
41
Publication year
2024
Publication date
2024
Publisher
Nature Publishing Group
e-ISSN
20551010
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3134413845
Copyright
© The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.