title: Self-treatment of acute exacerbations of chronic obstructive pulmonary disease requires more than symptom recognition - a qualitative study of COPD patients' perspectives on self-treatment.
abstract: Self-treatment of acute exacerbations of COPD with antibiotics and/or oral corticosteroids has emerged as a promising strategy to reduce hospitalization rates, mortality and health costs. However, for reasons little understood, the effect of self-treatment, particularly when not part of comprehensive self-management programs, remains unclear. Therefore, this study aims to get insight into the patients' perspective on self-treatment of acute exacerbations of COPD, focusing specifically on how patients decide for the right moment to start treatment with antibiotics and/or oral corticosteroids, what they consider important when making this decision and aspects which might interfere with successful implementation.
  
  
  
  We interviewed 19 patients with chronic obstructive pulmonary disease using qualitative semi-structured interviews, and applied thematic analysis for data analysis.
  
  
  
  Patients were well equipped with experiential knowledge to recognize and promptly respond to worsening COPD symptoms. Worries regarding potential adverse effects of antibiotics and oral corticosteroids played an important role in the decision to start treatment and could result in hesitation to start treatment. Although self-treatment represented a practical and appreciated option for some patients with predictable symptom patterns and treatment effect, all patients favoured assistance from a medical professional when their perceived competence reached its limits. However, a feeling of obligation to succeed with self-treatment or distrust in their doctors or the health care system could keep patients from timely help seeking.
  
  
  
  COPD patients regard self-treatment of exacerbations with antibiotics and/or oral corticosteroids as a valuable alternative. How they engage in self-treatment depends on their concerns regarding the medications' adverse effects as well as on their understanding of and preferences for self-treatment as a means of health care. Caregivers should address these perspectives in a collaborative approach when offering COPD patients the opportunity for self-treatment of exacerbations.
authors.affiliation: General Practice Research Unit, UiT The Arctic University of Norway, 9037, Tromsø, Norway. johanna.laue@uit.no.
authors.forename: Johanna
authors.identifier: 0000-0003-1230-8777
authors.initials: J
authors.lastname: Laue
authors.affiliation: General Practice Research Unit, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
authors.forename: Hasse
authors.initials: H
authors.lastname: Melbye
authors.affiliation: General Practice Research Unit, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
authors.forename: Mette Bech
authors.initials: MB
authors.lastname: Risør
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D003657:Decision Making; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy*; D036301:Qualitative Research; D012648:Self Care
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
keywords: COPD; Exacerbations; Patient perspective; Primary care; Self-treatment