The patient's burden: physical and psychological effects of acute exacerbations of chronic bronchitis

In this prospective qualitative study we evaluated the subjective perspecti ves of the quality of life of patients with chronic bronchitis, Individuals with diagnoses which fulfilled the clinical criteria of chronic bronchitis , i.e. daily production of sputum for at least three consecutive months in two consecutive years, were recruited into four focus groups from general p ractices in two industrial cities. Younger patients (those of pre-retiremen t age) of both sexes-a significant, but frequently 'invisible' minority in this patient population-were targeted. The groups were constituted with the aim of stimulating variation in the discussions. Twenty sufferers (10 male s and 10 females, ranging in age from 30 to 86 years) were eventually inclu ded in the study; there were five in each group. Group discussions were rec orded and transcribed verbatim and the data were analysed thematically. It was evident from the discussions that chronic bronchitis had led to a high degree of psychological distress in the participants, particularly in relat ion to dependency on medication, and disruption of social and family relati onships. Acute exacerbations of chronic bronchitis (AECB) were met with dre ad. They brought about further reductions in quality of life, increased anx ieties about breathlessness, fear of atmospheric pollution and of changes i n and extremes of temperature, embarrassment about coughing up phlegm in pu blic and suspicion of medical practitioners' motives if they were unwilling to prescribe antibiotics on request. Patients' health-related behaviour an d beliefs were often contradictory. For example, AECB in some patients led to increased smoking, There were also gender and age differences; for examp le, it was the perception of males that they received more support from the ir partners than did females. Younger participants appeared more distressed by AECB than older ones. The results of this study suggest that raising th e standard of care for patients with chronic bronchitis requires that great er attention be paid to patients' subjective experiences of the disease.