Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Rationale: Higher social support is associated with a better quality of life and functioning in adults with chronic obstructive pulmonary disease (COPD). Objectives: To determine the association between structural and functional social support and self-care behaviors in adults with COPD. Methods: This was a longitudinal study using data from the CASCADE (COPD Activity: Serotonin Transporter, Cytokines, and Depression) study, which was focused on depression and functioning in COPD. Physical activity was measured with a validated accelerometer at baseline, year 1, and year 2. Additional self-care behaviors included pulmonary rehabilitation attendance, smoking status, receipt of influenza and/or pneumococcal vaccinations, and medication adherence. Structural social support indicators included living status, being partnered, number of close friends/relatives, and presence of a family caregiver. Functional social support was measured with the Medical Outcomes Social Support Survey (MOSSS). Mixed-effects and logistic regression models were used. Results: A total of 282 participants with Global Initiative for Chronic Obstructive Lung Disease stage II to IV COPD were included (age, 68 ± 9 yr; 80% men; FEV1% predicted, 45 ± 16). For physical activity, participants who lived with others accrued 903 more steps per day than those who lived alone (95% confidence interval [CI], 373–1,433; P = 0.001); increases in the MOSSS total score were associated with more steps per day (β = 10; 95% CI, 2–18; P = 0.02). The odds of pulmonary rehabilitation participation were more than 11 times higher if an individual had a spouse or partner caregiver compared with not having a caregiver (odds ratio [OR], 11.03; 95% CI, 1.93–62.97; P < 0.01). Higher functional social support (MOSSS total score) was associated with marginally lower odds of smoking (OR, 0.99; 95% CI, 0.98–1.00; P = 0.03) and higher odds of pneumococcal vaccination (OR, 1.02; 95% CI, 1.00–1.03; P = 0.02). Social support was not associated with influenza vaccination or medication adherence. Conclusions: Structural social support, which was measured by reports of living with others and having a caregiver, was respectively associated with higher levels of physical activity and greater participation in pulmonary rehabilitation in adults with COPD. Our findings reinforce the critical importance of the social environment in shaping patients’ success with self-care. Clinical Trial registered with clinicaltrials.gov (NCT01074515).

The independent relationship between physical inactivity and risk of death after an index chronic obstructive pulmonary disease (COPD) hospitalisation is unknown.We conducted a retrospective cohort study in a large integrated healthcare system. Patients were included if they were hospitalised for COPD between January 1, 2011 and December 31, 2011. All-cause mortality in the 12 months after discharge was the primary outcome. Physical activity, expressed as self-reported minutes of moderate to vigorous physical activity (MVPA), was routinely assessed at outpatient visits prior to hospitalisation. 1727 (73%) patients were inactive (0 min of MVPA per week), 412 (17%) were insufficiently active (1–149 min of MVPA per week) and 231 (10%) were active (≥150 min of MVPA per week). Adjusted Cox regression models assessed risk of death across the MVPA categories.Among 2370 patients (55% females and mean age 73±11 years), there were 464 (20%) deaths. Patients who were insufficiently active or active had a 28% (adjusted HR 0.72 (95% CI 0.54–0.97), p=0.03) and 47% (adjusted HR 0.53 (95% CI 0.34–0.84), p<0.01) lower risk of death, respectively, in the 12 months following an index COPD hospitalisation compared to inactive patients.Any level of MVPA is associated with lower risk of all-cause mortality after a COPD hospitalisation. Routine assessment of physical activity in clinical care would identify persons at high risk for dying after COPD hospitalisation.