Early symptom recognition and symptom management among exacerbation COPD patients: a qualitative study

An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most cause of deaths in the patient with COPD illness. It induces COPD patients often end in unexpected or unpredictable death. The purposes of this study were to explore the lived experiences of symptom recognition and to explain the pattern of symptom management successfully among exacerbation COPD patients. A Heideggerian hermeneutic phenomenology approach was used as the method to gain an understanding of living with AECOPD. The data were collected until saturation principles in 20 participants by using the semi-structured interview to capture breadth and depth detailed experiences verbatim. Data analysis proceeded based on a seven-stage hermeneutical process (Diekelmann et al, 1989). The results showed that two constitutive patterns with relational themes were identified. The first pattern, symptom recognition, consisted of four themes: meaning of AECOPD, pattern of AECOPD, warning signs and prodromal symptoms, and risk factors of AECOPD. Most participants described the meaning of AECOPD as acute breathing problem more than baseline by patient self-awareness that result in can’t breathe and can’t control/can’t manage by themselves until lead to the need of additional therapy. All participants described the pattern of AECOPD, recognized warning signs, and prodromal symptoms according to their individual experiences. Hot weather and rainy season were the most common aspects of weather which was a risk factor of AECOPD. The second pattern, symptom management, consisted of four themes: methods of symptom management (during AECOPD state), methods of symptom management (during stable COPD state for helping to prevent AECOPD state), knowledge source of symptom management, and factors influencing symptom recognition and symptom management. During AECOPD state, most participants used sitting and taking quick-relief inhaler to manage exacerbation state, but in the stable COPD state, used exercise, long-acting bronchodilators, and herbs for helping to prevent AECOPD state. Participants received the knowledge of symptom management through self-learning from their previous AECOPD experiences, sitting was the most common participant learning learned by themselves that helped to relieve dyspnea. The doctor recommended about how to use bronchodilators was the most common way participants could learn through others. Patient health behavior, psychological factors, and social support were factors influencing symptom recognition and symptom management. The findings provide that healthcare professionals should care, help, and provide the recommendation about early symptom recognition and symptom management to COPD patients in order to make it through illness with COPD in a period of time during with the patients can learn this knowledge on their own.