Emergency Department Return Visits in Chronic Obstructive Pulmonary Disease: the Importance of Psychosocial Factors

Study Objectives: Relapses are common after treatment of decompensated chronic obstructive pulmonary disease (COPD) in the emergency department. The purpose of this study was to identify psychosocial and pulmonary function variables that distinguish patients who relapse from those who do not.

Design: Retrospective case analysis. A relapse was defined as an unscheduled return to the ED within two weeks of treatment.

Setting: 475-bed Veterans Administration Medical Center.

Type Of Participants: 33 male veterans with COPD who used the ED.

Measurements: Demographic profile, a Likert-scaled questionnaire about illness beliefs, and physiologic data obtained by chart review.

Main Results: Patients who relapsed at least once (R patients) were more likely to be widowed, separated, or divorced than patients who did not relapse at any time (N patients) (52.4% vs 8.3%; P = .011). R patients were more likely to have lost a first-order relative within three years (57.1% vs 8.3% P = .006). Stepwise logistic regression showed that the loss of a first-order relative, a negative attitude about prognosis, and a higher forced vital capacity distinguished R from N patients. Stepwise linear regression showed that six specific illness beliefs, distance of the home from the hospital, and baseline bronchodilator response correlated with the number of relapses (multiple r2 = 0.82; P less than .001).

Conclusion: Social and psychological parameters are closely correlated with relapse in patients with decompensated COPD.