How do acute worsening events influence daily life and healthcare-seeking behaviour in patients with COPD: an international multicountry qualitative study.

Abstract

To explore the impact of acute worsening events (AWEs), defined as clinically relevant deteriorations in peak expiratory flow, reliever use and/or symptoms, on patients' daily lives and identify behaviours linked to their recognition and management. A qualitative international substudy was conducted in the Netherlands, Spain, the USA, Canada and the UK (2023-2024). 19 patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) from a randomised clinical trial participated. Interviews, triggered by AWEs and repeated 6 weeks later, were audio-recorded, transcribed and analysed. Patients varied in identifying bad days, reporting inability to perform physical activities, symptom worsening or the need for add-on treatment. Recognition of AWEs depended on their duration: shorter events (<2 days) often went unnoticed, while longer events were typically recognised. Most patients indicated they would seek healthcare if needed. Barriers included difficulty obtaining timely appointments (external) and a reactive attitude to worsenings (internal). AWEs significantly impact daily life but vary widely in recognition and thresholds for seeking care. Limited awareness of daily disease variations may contribute to both under-reporting of worsening events to healthcare providers and suboptimal self-management in COPD. NCT05492877.