Determinants of poor chronic obstructive pulmonary disease control.

Abstract

Uncontrolled COPD has been associated with reduced health-related quality of life, activity impairment, and increased use of healthcare resources. However, limited research is available on the factors associated with poor disease control in COPD patients. This study aimed to explore the factors associated with poor disease control in patients with COPD. The current cross-sectional study was conducted on patients with COPD who attended outpatient respiratory clinics at two major hospitals in Jordan. Information about disease and medication-related characteristics was collected through patient interviews and medical files. Validated instruments, including the 4-item medication adherence scale and the hospital anxiety and depression scales, were used to assess medication adherence, anxiety, and depression among the study participants. COPD severity was assessed using the GOLD classification criteria. Ordinal regression analysis was conducted to explore the variables associated with poor COPD control. In total, 702 patients participated in the study, with a median (interquartile range) age of 68 years (58-77). According to the GOLD report, most of the participants were in the B group (low risk/high symptoms; 40.2%), followed by the D group (high risk/high symptoms; 28.2%). Older age, higher depression scores, and a higher number of prescribed medications were associated with poorer COPD control, while not receiving LAMA (long-acting muscarinic antagonists) was associated with better control. Future mental health care initiatives should address the prevalence of depression symptoms in COPD patients and manage them effectively to improve COPD control and prevent further complications, with special attention to older patients, those receiving multiple medications, and those using LAMA.