COPD disease knowledge, self-awareness and reasons for hospital presentations among a predominately Indigenous Australian cohort: a study to explore preventable hospitalisation

Abstract

BackgroundThe prevalence of chronic obstructive pulmonary disease (COPD) is higher among Indigenous Australians than that of non-Indigenous Australians. However, no studies have investigated COPD disease awareness and knowledge among Indigenous Australians. In this study, we assessed the COPD disease awareness among Indigenous and non-Indigenous patients in the Top End Health Service region of the Northern Territory of Australia.MethodsOf a total convenience sample of 100 adults, 86 patients consented to participate in this study over a 15-month period. A structured interview was conducted to identify participant’s level of knowledge about COPD, medications, self-management, healthcare interaction and utilisations.ResultsMost (69%) participants were Indigenous and men (52%). Indigenous patients were significantly younger (mean 56 vs 68 years p<0.001), with a higher proportion of remote residence and current smoking. COPD knowledge across the cohort was low, with 68% of Indigenous and 19% of non-Indigenous participants reporting they ‘know nothing/had never heard of COPD’. Most patients self-reported use of puffers/inhalers and were able to identify medication used; however, adherence to therapy was observed in only 18%. Shortness of breath was the most common symptom for hospital presentation (83%) and 69% of Indigenous patients reported seeking medical attention during an exacerbation. Self-management and COPD action plans were poorly implemented. A significant proportion (49%) reported ≥2 hospital admissions in the preceding 12 months. During exacerbation, although the majority of Indigenous patients were transferred to a tertiary centre from remote communities, patient’s preference was to be managed in their respective local communities.ConclusionsAwareness and understanding of COPD are low in this cohort on several domains. Tailored and culturally appropriate initiatives for both patients and health professionals alike are required to improve COPD disease management among Indigenous population. This will not only improve quality of life but also reduce recurrent hospitalisation, healthcare cost and utilisation.

The ‘ABC’ of respiratory disorders among adult Indigenous people: asthma, bronchiectasis and COPD among Aboriginal Australians – a systematic review

“…Of the 18 studies which reported on asthma (including the three studies which combined asthma and COPD),15 37 38 3 reported community cross-sectional data,35 36 39 2 reported on pregnant women,31 32 7 reported on patients from a hospital cohort,37 38 40–44 and 6 reported on patients referred to the respiratory health service (table 1). 7 14 15 30 45 46…”

“…Three studies used self-reported asthma to define prevalence,35 36 39 one used a combination of self-report and hospital admissions data,32 one used bronchodilator response (BDR),46 one used either BDR or electronic medical records (EMR) documentation for the presence of asthma44 and the remaining 12 used hospital admissions or entries on patients’ EMR 7 14 15 30 31 37 38 40–43 45. Excluding the three studies which combined COPD and asthma, and potentially overlapping studies, the average prevalence of asthma was 15.4% 30–32 35 36 39 42 46.…”

“…Among those patients with a significant BDR, percentage predicted values of FEV 1 and FVC were low, with a reduced FEV 1 /FVC ratio (51±13%, 62±12% and 0.65±0.13, respectively). Eight other studies reported on PFTs for the broader cohort,7 14 15 30 39 40 44 45 although only three of these reported BDR (prevalence of 29% in the NT, TEHS cohorts and 3.1% in the WA cohort),14 39 45 three reported diffusing capacity of carbon monoxide (NT, TEHS combined mean 62±26% and N. QLD mean 81±24%)14 15 30 and two reported total lung capacity (combined mean 73±22%) 14 15…”

“…Of the 21 studies which reported on bronchiectasis, one reported community cross-sectional data,42 one reported on patients receiving domiciliary oxygen therapy (DOT)47 while the remainder reported on referred populations, either to a respiratory service (n=11,7 14 15 30 45 46 48–52) or hospital (n=8,8 40 43 44 53–56) (table 2).…”

The Prevalence of Bronchodilator Responsiveness “Asthma” Among Adult Indigenous Australians Referred for Lung Function Testing in the Top End Northern Territory of Australia

“… 5 , 6 A recent study from our center found that only seven percent of Indigenous patients and 30% of non-Indigenous patients with COPD could accurately describe their respiratory condition, although 46 and 89%, respectively, were aware that “something” was wrong with their lungs. 69 In the same study, 80% of Indigenous patients described shortness of breath, 60% described a cough and 10% described wheezing – thus it is easy to see how Indigenous patients may self-report a previous diagnosis of “asthma” in the presence of another underlying respiratory condition. When excluding the presence of COPD in the present study (via either radiology or spirometry), the prevalence of BDR dropped from 17% to 5% among Indigenous patients and from 13% to 7% among non-Indigenous patients (using the usual/traditional ≥12% and ≥0.2L criteria).…”