Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease accompanied by acute exacerbations and chronic symptoms that lead to frequent hospitalizations and a reduced quality of life. Knowledge of the disease, its associated risk factors, symptoms and complications, as well as how to prevent them, is of utmost importance for patients. This allows them to control their disease, thereby prolonging and improving their quality of life.

In our country, specialists believe that the incidence of COPD is significantly above the European average and covers over 10% of the population over 40 years of age. The reason for this is the widespread prevalence of smoking in Bulgaria. It is on the rise as one of the five “deadliest” diseases [1].

Currently, COPD remains an incurable disease, and the corresponding treatment process – including measures such as repeated hospitalization – leads to high economic costs for the countries [1,2]. Hospitalization costs account for approximately 70% of COPD-related direct medical costs, which cumulatively exceed US$18 billion worldwide [3]. Thus, implementing effective disease management in patients with COPD is becoming increasingly important.

Objective

To determine the level of awareness of patients with Chronic Obstructive Pulmonary Disease regarding the nature of their disease and the need for additional training.

Sociological Methods

Documentary method – the available literature on the problem was studied;

Survey Method

• An anonymous survey was conducted, covering 75 hospitalized patients with COPD in 2 medical institutions in the city of Pleven;
• An anonymous survey was conducted with 13 nurses working in medical institutions where the study was conducted;
• An anonymous survey was conducted with 8 of the doctors - pulmonologists in the medical institutions where the study was conducted.

Statistical Methods

The data obtained were processed with MS Office Excel, SPSS Statistics Version 20 software products.

The anonymous survey was conducted in the period November 2022 - March 2024. At the Clinic of Pneumology and Phthisiology "Prof. Stefan Todorov" and the Clinical Hospital of Pulmonology at the University Hospital - Pleven. For the purposes of the study, an original questionnaire containing 24 closed and 2 open questions was developed. 75 hospitalized patients with COPD were included.

Table 1: Characteristics of the studied patients by age, gender, place of residence, education and social status.

The results show that patients over 60 years of age predominate (n=56; 74.67%), the proportion of patients in the age group 51-60 years is smaller (n=19; 25.33%). In the younger age groups, no participants in the study have been identified so far. The gender distribution shows a predominance of men 44 (58.67%), as was also established by the study of the available literature. Depending on the place of residence, patients from the city of Pleven predominate - 36 (48%) and from smaller towns 17 (22.67%), a small part of the patients also live-in villages 22 (29.33%). This fact can be explained by the demographic crisis process that has been taking place in our country in recent decades (Table 1).

The number of patients hospitalized due to exacerbation of the disease in the period up to 6 months after the previous hospitalization is 51 (68%), with 54 (72%) of them having to be admitted more than 3 times a year for treatment. This indicates poor control of the disease and incorrect implementation of drug treatment at home.

It is essential for patients with COPD to know the risk factors associated with the disease, which worsen their quality of life and lead to frequent exacerbations and the need for hospitalization.

Figure 1 presents the distribution of patients according to their awareness of the risk factors that influence the course of their disease.

Figure 1: Patient awareness of risk factors related to COPD.

It was found that a significant part n=35 (46, 67%) of the respondents are partially familiar with the factors that could have an adverse impact on their disease. Some of the surveyed patients (n=7, 11, 11%) also gave answers other than those listed, in the column "other" such as: self-medication, exposure to cold, irregular intake of medications, etc.

Along with the risk factors, patients with COPD should also be familiar with the specifics of the disease. With the entry into the digital age, people have access to a huge amount of information, which in most cases remains misunderstood or is unreliable. It is important to obtain it from a specialist in order to be complete and presented in an accessible manner (Figure 2).

Figure 2: Distribution of respondents according to the source of information related to the specifics of the disease.

A large part of the patients shared (n=63; 84.13%) that they received primary information about their disease from their treating pulmonologist, which proves that it is reliable and presented in the right way. The fact that 12 (15.87%) of the respondents received information about their disease from a relative with COPD is worrying. This fact speaks of gaps in the system of patient care and is an opportunity for its optimization.

For patients with chronic diseases, and in particular for those with COPD, it is important to maintain a healthy style and lifestyle. Proper nutrition and physical activity lead to an improvement in the condition and reduce the risk of exacerbations (Figure 3).

Figure 3: Awareness of COPD patients about the correct nutritional and physical activity regimen.

It was found that slightly more than half of the respondents (n=42, 56%) were familiar with the dietary and exercise regimen that they should follow in order to maintain and improve their condition. More worrying is the fact that a large proportion of patients were not familiar with or had never heard of pulmonary rehabilitation (n=53, 70.67%). Pulmonary rehabilitation is a program designed for people with chronic lung diseases. Its main goal is to enable them to achieve and maintain their maximum level of independence and functioning. The most successful rehabilitation programs are those in which services are provided by a physiotherapist, nurse, physician, psychologist or social worker, and dietitian working as a team [4].

The cause of an acute exacerbation is usually unknown, although some exacerbations are the result of bacterial or viral infections. Tobacco smoking, irritant inhalation exposure, and high levels of air pollution also contribute to these conditions. The presence of frequent exacerbations indicates poor disease control (Figure 4).

Figure 4: Relative share of COPD patients who experienced exacerbations.

It can be seen that the share of respondents who had an exacerbation of COPD is very high – 74.67% (n=56). This corresponds to the high percentage of patients with more than 3 or 4 hospitalizations.

The share of patients who do not know how to cope in such a situation is also very high – 69.33% (n=52). This indicates insufficient awareness, as well as the inability of patients to react adequately and reduce the risk of incidents. Both results are confirmed by the opinions of the surveyed pulmonologists and nurses working in the clinic.

Very often, COPD patients need the care of family or relatives for taking medications, performing hygienic and physiological needs, as well as for everything related to daily activities. It is necessary for the persons who provide this care to be familiar with some of the features and specifics of the disease, the intake of medications and inhalers, physical activity and diet, and ways to provide assistance if necessary (Figure 5).

Figure 5: Awareness of patients' relatives about the risk factors and the specifics of the disease.

It can be seen that 76% (n=57) of the surveyed patients reported that their relatives are not familiar with the specifics of the disease, ways to deal with crisis situations and the possibilities for limiting risk factors leading to improvement of their condition.

A large part 77.33% (n=58) of the surveyed individuals shared that they need additional information about the nature of their disease, and its specifics are presented in Figure 6.

Figure 6: Opinion of patients on the type of additional information desired related to their disease.

The largest share of respondents (57.33%, n=43) wanted to receive information about everything related to their disease. The remaining patients wanted to receive information about working with inhalers and proper inhaler technique n=27 (36%), about the nature of the disease n=17 (22.67%) and behavior during a crisis n=13 (17.33%).

As the most preferred source of information (about COPD, the use of inhalers and proper inhaler technique, style and lifestyle related to the disease, etc.), patients chose their treating physician - pulmonologist n=38 (50.67%) and GP n=18 (24%), while the rest preferred using a brochure n=12 (16%) and the Internet n=7 (9.33%). The results obtained are also confirmed by the opinion of the surveyed pulmonologists and the nurses working with them.

From What Has Been Said So Far, The Following Conclusions Can Be Drawn:

• It is established that a significant part of the respondents n =35 (46.67%) are partially familiar with the factors that would have an adverse impact on their disease.
• A large part of the patients share n=63 (84.13%) that they received primary information about their disease from the pulmonologist treating them, which proves that it is reliable and presented in the right way.
• The share of patients who do not know how to cope in a crisis situation is particularly high n=52 (69.33%), which indicates insufficient information, as well as the inability of patients to react adequately and reduce the risk of incidents.

In conclusion, it can be said that the level of awareness of the patients participating in the study is satisfactory, but opportunities for optimizing their initial training are identified. The need for supportive training was categorically established in order to expand the knowledge of patients about:

• The nature of the disease;
• The style and way of life that they should follow;
• Coping with crisis situations;
• For the correct application of inhalation technique etc., tailored to the individual needs of each patient.

It would be good to include family members of patients with COPD in this training process.

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