Inadequate Social Support in COPD Is Linked to Worse Clinical Outcomes

About one-fifth of patients with chronic obstructive pulmonary disease (COPD) who were living with a loved one reported inadequate social support, which was associated with worse clinical outcomes, according to study findings published in Respiratory Medicine.

Researchers assessed patients with COPD living with loved ones to determine their perceived level of support for their illness, using the Medical Outcome Study — Social Support Survey (MOS-SSS). The cross-sectional study is based on the Dutch Home Sweet Home study.

Patients with COPD were recruited from 7 hospitals or outpatient clinics in the Netherlands from July 2013 to December 2014. Patients with advanced COPD and a diagnosis of moderate to very severe COPD (Global initiative for chronic obstructive lung disease grades 2-4) without an exacerbation or hospitalization 4 weeks before enrollment were included. Participants also had a “resident loved one,” defined as a family member, friend, or other person living with them.

Clinical outcomes were based on home-administered assessments of lung function (forced expired volume in the first second [FEV₁]), body mass index (BMI), and the Timed Up and Go (TUG) test. Information on sex, age, smoking status, residential status, and other clinical outcomes were obtained from questionnaires.

A total of 191 patients were included; of those, 97.9% lived with their spouse or partner. Participants had a mean (SD) age of 65.6 (8.9) years and a mean FEV₁ of 47.3 (17.7) percent predicted; 53.4% were male and 54% had overweight or obesity.

The participants had a mean overall support index of 4.2 (0.8) points (out of a possible 5) on the MOS-SSS. Values were 4.1 for emotional/informational support, 4.3 for tangible support, 4.5 for positive social interaction, 4.3 for affectionate support, and 4.1 for additional item scores domains. The mean of the group indicated adequate social support, although multiple outliers (>18%) were observed.

About 18.3% of participants reported inadequate levels of social support, with a mean overall support index of 2.8 (0.7) points. Those with inadequate levels of support had consistent and significantly lower scores for all subscales and for the additional item domain compared with the group with adequate support levels. The affectionate support subscale was the only one in which the inadequate support group had a score above “some of the time.”

Patients who had inadequate levels of social support generally had worse outcomes vs those with adequate levels. The inadequately supported group had higher levels of dyspnea and a clinically and statistically significant greater effect of COPD. They had a 4-point higher score on the COPD Assessment Test (P =.004), which suggests a significantly greater effect of COPD on their daily lives.

The inadequately supported group had increased Hospital Anxiety and Depression Scale-Depression scores, as well as a score of 69 points on the Care Dependency Scale, which was lower than the adequately supported group, who scored 71 (P =.04). The groups had similar Instrumental Activities of Daily Living and TUG results.

Among several limitations, the participants were all living in their own homes with a resident loved one, and less than 50% of eligible patients volunteered to participate. In addition, the study authors said that a lower score on the MOS-SSS is not necessarily indicative support needs that are not met.

“This study underlines the importance of addressing social support in the care for patients with COPD, even if they have a resident loved one,” the study authors stated. “[A] low score of social support was linked with a worse clinical outcome in terms of symptom severity and impact of COPD, symptoms of depression and a higher degree of care dependency.”

This article originally appeared on Pulmonology Advisor