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Study Identifies Direction for Improving Self-Management in Patients With COPD

Laura Joszt
A new study found that patients with chronic obstructive pulmonary disease with higher symptom burden are worse at self-management, which is an important part of managing the disease.
Chronic obstructive pulmonary disease (COPD) requires extensive and complex self-management, and a new study in the International Journal of COPD found an association between symptom burden, as well as sociodemographic characteristics, and self-management.

“Persons with COPD must, in addition to following complex medical regimes, monitor their disease, make lifestyle changes, manage its physical and psychosocial consequences, and decide when they need to seek professional care and when they can handle problems on their own,” the authors explained.

Researchers in Norway studied 225 participants diagnosed with COPD and examined the relationships of sociodemographic and clinical characteristics and symptom burden with the 8 self-management domains of the Health Education Impact Questionnaire (heiQ):
  1. Positive and active engagement in life
  2. Health-directed activities
  3. Skill and technique acquisition
  4. Constructive attitudes and approaches
  5. Self-monitoring and insight
  6. Health services navigation
  7. Social integration and support
  8. Emotional distress
There was a strong association between higher symptom burden and worse self-management scores. The researchers found that higher COPD symptom burden was associated with worse scores in all domains except self-monitoring and insight. Patients with a higher symptom burden had lower positive and active engagement in life and lower social integration and support. The findings indicate that “high symptom burden may influence health-directed activities, social functioning, and active engagement in life.”

Importantly, patients with higher symptom burden also reported less skill and technique acquisition, which impacts their ability to manage medication regimens and could lead to nonadherence.

Women reported higher positive and active engagement in life, which the researchers speculated could be because women are more motivated to participate in self-management and education programs or because they experience a higher level of psychological distress, which increases their motivation to improve their circumstances.

According to the authors, the findings indicate that in clinical practice, self-management support programs that focus on the 8 heiQ domains could improve symptom burden.

“…the knowledge produced by this study can serve as a first step toward improved the understanding of characteristics associated with the various self-management domains in persons with COPD and indicates that the heiQ domains could provide a direction for self-management support curriculums to support self-management in people with COPD,” the authors concluded.


Bringsvor HB, Skaug K, Langeland E, et al. Symptom burden and self-management in persons with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2018;13:365-373. doi: 10.2147/COPD.S151428.

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