Several psychological factors, such as psychiatric morbidity and elevated psychological distress, have been associated with an increased risk of having a COPD exacerbation. One factor that has been consistently been shown to impact chronic disease outcomes is self–efficacy, which is an individual's confidence in their ability to manage or prevent disease-related symptoms and associated morbidity. The purpose of the current study was to assess the impact of COPD-specific self-efficacy on future COPD exacerbations.
COPD self-efficacy was evaluated using question 7 from the Seattle Obstructive Lung Disease Questionnaire (SOLDQ-7) in 110 patients (51% women, mean age ± SD: 66 ± 8 years) with stable COPD who had been hospitalized for an exacerbation in the past 12 months. Patients were followed for a mean of 2 years and both inpatient-treated (i.e., treated in the emergency department or hospital) and data on outpatient-treated (i.e., treated with medication in the patient's own environment) exacerbations was collected.
At baseline, the mean ± SD SOLDQ-7 score was 5.7 ± 1.3 (higher scores indicate better self-efficacy). Patients with higher levels self-efficacy at baseline were at significantly lower risk for future inpatient exacerbations (RR [for a 1 point increase] = 0.83, 95% CI, 0.69–0.99) exacerbations, but not outpatient exacerbations (RR = 1.11, 95% CI, 0.94–1.30).
Patients with better COPD self-efficacy were at a reduced risk of inpatient-treated exacerbations, with each 1 point increase in the SOLDQ-7 associated with a 13% reduction in risk. However, self-efficacy did not predict out-patient treated exacerbations.
Assessments of self-efficacy should be included as part of the evaluation of COPD patients. Interventions designed to improve patient self-efficacy (e.g. cognitive-behavioral therapy, CBT) should be offered to COPD patients, and future research should assess the efficacy of CBT on improving COPD outcomes.
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