About Main Outcomes of Chronic Obstructive Airway Disease

January 19, 2016 Category: Chronic Obstructive Airway Disease

COAD patientsA total of 1,834 persons were assessed during a 16-month period (821 in Brattleboro and 1,013 in Laconia). A total of 518 COAD patients were found in Brattleboro. All Brattleboro patients were offered participation in a health education program (at no cost to the patient). Almost half (254) elected to participate in the program and 84 percent (213) of those entering completed it. Laconia had 405 COAD patients, of which 80 (20 percent) were lost to follow-up. Our analysis compares the Laconia patients (325) who were followed to the Brattleboro patients (213) who completed the education program organized with Canadian Health&Care Mall.

Comparison of Intervention and Control Patients At Baseline

The results of tests for comparability between intervention and comparison groups at baseline are summarized in Table 2 (continuous variables) and Table 3 (discrete variables).

Moderate and severe patients in the intervention and comparison groups were comparable; for unexplained reasons, the mild subgroup of control patients was less healthy than their intervention counterparts.

Impact of Health Education Program

Our analyses indicate that the health education program had no statistically significant impact on any measure of health status (Table 4). The only variable demonstrating a significant posttest difference between intervention and comparison patients was health locus of control (5.7 vs 5.9, p = 0.003), which was one of five measures used to assess general health perceptions. Health locus of control decreased slightly but significantly for each disease severity subgroup of intervention patients and increased for each disease severity subgroup of control patients. This suggests that the health education program helped patients become somewhat more likely to believe that they can control their own health.

There was no significant difference between groups at posttest on variables related to symptoms status, physical function, mental health, or social function. All of the variables which changed significantly within either group were found among the control patients. Within the Laconia group, mild control group patients improved significantly with respect to coughing (p = 0.05), phlegm production (p = 0.01); wheezing, both in the morning and at night, (p = 0.001); and shortness of breath when hurrying at SOB level 1 (p = 0.01). There were no significant changes for symptom variables among the severe patients.

Although changes were, for the most part, unremarkable among the symptom variables, it is noteworthy that most changes were in a positive direction for both groups of patients. The general direction of change was towards improvement or a decrease in the frequency of reported symptoms. When net change was summed by level of disease subgroup and by community, there was greater overall improvement in symptom status among the mild and moderate control group patients, and more improvement among the severe intervention group patients.

Table 2—Baseline Characteristics of Intervention and Comparison Groups; Continuous Variables (n=53S)

Variable Differences between groups Difference between groups by severity
Mild Moderate Severe
Int* Control p-value Int* Control p-value Int* Control p-value Int* Control p-value
Demographic and descriptive
Age 59.0 60.0 .33 56.0 58.0 .16 58.0 62.0 .03 66.0 67.0 .87
Years of education 11.9 11.4 .01 12.5 11.5 .001 11.5 11.3 .61 11.1 11.3 .77
Number of persons in household 2.4 2.4 .72 2.4 2.4 .98 2.3 2.4 .50 2.3 2.3 .94
Physical function
Ambulation 7.2 9.0 .01 4.2 7.4 .001 6.7 9.5 .04 13.5 15.0 .44
Body care and movement 2.1 3.0 .02 1.3 3.0 .001 2.0 2.5 .36 3.8 3.7 .99
Home management 8.9 11.6 .001 4.8 9.7 .001 9.4 11.8 .24 15.9 18.2 .45
Mobility 3.3 4.7 .02 1.4 4.1 .001 3.3 4.6 .23 6.6 7.4 .71
Mental health
Anxiety scale (25-100) t 42.3 41.8 .49 40.8 42.3 .11 42.4 40.9 .34 45.3 42.2 .09
Depression scale (25-100)t 45.9 45.7 .75 43.5 45.3 .05 46.6 45.8 .61 50.3 47.0 .12
Social (unction
Recreation and pastimes 10.9 12.8 .09 7.1 12.0 .001 10.7 12.3 .44 18.3 15.9 .44
Social interaction 6.6 7.7 .17 4.0 7.8 .001 8.1 7.5 .72 10.0 8.3 .46
General Health Perceptions
General health rating scale (1-10) 6.1 5.7 .06 6.7 6.1 .04 6.0 5.5 .05 4.8 4.3 .14
Health worry scale (1-10) 3.9 4.1 .27 3.7 3.9 .40 3.6 4.1 .17 4.5 4.8 .57
Health locus of control scale (0-10) 5.9 5.8 .35 5.7 5.7 .37 6.0 5.9 .37 6.1 6.0 .64

Table 3—Baseline Characteristics of Intervention and Comparison Groups; Discrete Variables (n=538)

Variable All groups Difference between groups by severity
Mild Moderate Severe
Int*(%) Control(%) P(x2) Int*(%) Control(%) P(x2) Int*(%) Control(%) P(x2) Int*(%) Control(%) P(x2)
Demographic and descriptive
Sex (% male) 54 51 .32 48 45 .53 53 51 .80 68 71 .77
Marital status (% married) 69 67 .81 70 66 .49 70 68 .50 66 71 .64
Currently employed 56 48 .03 68 52 .00 53 46 .35 32 31 1.00
Currently smoking 45 45 1.00 52 50 .75 47 42 .59 33 34 .99
Previously smoked 82 84 .59 77 83 .14 86 81 .39 91 96 .51
Occupational exposure to dust 48 49 .86 46 44 .81 44 49 .57 55 64 .34
Occupational exposure to fumes 29 33 .34 29 29 1.00 29 33 .60 32 43 .23
Symptom status
Usually cough 53 54 .93 50 53 .68 52 50 .84 62 65 .88
Usually produce phlegm 60 52 .02 53 49 .38 58 51 .33 73 64 .26
Wheeze apart from colds 66 68 .74 59 60 .96 69 74 .48 77 80 .72
Shortness of breath 80 80 1.00 69 78 .04 81 79 .77 99 93 .07
(hurry on level)

Table 4—Adjusted Posttest Mean Scores of Intervention and Comparison Groups; Continuous Variables (n=538)

Variables Adjusted means p-value for difference between adj X
Intervention Comparison
Physical (unction
Ambulation 8.3 8.7 0.903
Body care and movement 2.8 2.7 0.719
Home management 12.3 11.3 0.414
Mobility 4.1 4.1 0.638
Mental health
Anxiety scale (25-100)* 40.8 41.0 0.614
Depression scale (25-100)t 44.7 44.8 0.937
Social function
Recreation and pastimes 12.3 12.8 0.932
Social interactions 8.0 7.4 0.280
General health perceptions
General health rating scale (1-10) 6.0 5.8 0.800
Health worry scale (1-10) 3.7 3.9 0.150
Health locus of control (0-10) 5.7 5.9 0.003