Document Type : Original Article


1 Alberta Health Services, Edmonton, Alberta, Canada

2 Directions Physical Health, New York

3 Hamilton Grove Healthcare and Rehab Centre, NJ, USA,

4 Physiotherapists, Anand, Gujarat, India


BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a group of progressive lung
diseases; the most common are emphysema and chronic bronchitis. It is considered to be the major
cause of morbidity and mortality worldwide and is considered to be one of the leading causes of deaths
in India, the main reason being misconception/misinterpretation of the disease and unawareness
about the risk factors which hinder early diagnosis and its treatment effectively. Therefore, the
present study aimed to assess the knowledge, attitude and behavior about the disease process and
physiotherapy management in patients diagnosed with COPD.
MATERIALS AND METHODS: Ethical clearance was obtained before initiating the study. It was
a cross‑sectional, qualitative study. In total, 14 patients of COPD were recruited for the study by
convenience sampling. The total study duration was 6 months. Two focused groups (n = 14) were
conducted with seven COPD patients (diagnosed by chest physician on the basis of pulmonary
function testing) in each after obtaining the written informed consent. Focus group contents were
video graphed after obtaining the consent and a focus group discussion (FGD) guide comprising
of 15 questions was used for the study. Transcripts were prepared from the audio/video recordings
and were analyzed qualitatively by narrative analysis.
RESULTS:  The narration transcripted during both the sessions of FGD showed significant
negligence about the disease process, its precipitating factors, preventive measures, and
physiotherapy management among the patients suffering from COPD in the community. None
of the patients were aware even about the term “chronic obstructive pulmonary disease” and
only 35.71% of patients were aware of physiotherapy management as a mean of treatment for
CONCLUSIONS: The present study concludes that there is a lack of knowledge, incorrect attitudes,
and flawed behavioral changes which needs to be corrected among the patients with COPD. These
patients require correct, detailed, and broad‑based information about their condition and availability
of treatment options.


1. World Health Organization. Chronic Respiratory Diseases:
Chronic Obstructive Pulmonary Disease (COPD): Definition.
Available from:
en/. [Last accessed on 2018 Jun 20].
2. Chan‑Yeung M, Aït‑Khaled N, White N, Ip MS, Tan WC. The
burden and impact of COPD in Asia and Africa. Int J Tuberc Lung
Dis 2004;8:2‑14.
3. World Health Organization. COPD. Fact Sheet; November, 2017.
Available from:
fs315/en/. [Last accessed on 2018 Jun 20].
4. Koul PA. Chronic obstructive pulmonary disease: Indian guidelines and the road ahead. Lung India 2013;30:175‑7.
5. ICMR‑MRC Workshop. Building Indo‑UK collaboration in chronic
diseases. 2009:16.
6. Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding
to the threat of chronic diseases in India. Lancet 2005;366:1744‑9.
7. Fromer L. Implementing chronic care for COPD: Planned visits,
care coordination, and patient empowerment for improved
outcomes. Int J Chron Obstruct Pulmon Dis 2011;6:605‑14.
8. Keating A, Lee A, Holland AE. What prevents people with
chronic obstructive pulmonary disease from attending
pulmonary rehabilitation? A systematic review. Chron Respir
Dis 2011;8:89‑99.
9. Beniwal S, Sharma BB, Singh V. What we can say: Disease
illiteracy. J Assoc Physicians India 2011;59:360‑4.
10. Thakrar R, Alaparthi GK, Kumar SK, Vaishali K, Zulfeequer CP,
AanadR, et al. Awareness in patients with COPD about the disease
and pulmonary rehabilitation: A survey. Lung India 2014;31:134‑8.
11. Salvi S, Agrawal A. India needs a national COPD prevention and
control programme. J Assoc Physicians India 2012;60 Suppl: 5‑7.
12. Uzel FI, Karadağ P, Önür ST, Turan D, Yentürk E, Tuncay E, et al.
A basic question: Are patients with chronic obstructive pulmonary
disease aware of their disease? Turk Thorac J 2017;18:114‑8.
13. Kessler R, Ståhl E, Vogelmeier C, Haughney J, Trudeau E,
Löfdahl CG, et al. Patient understanding, detection, and experience
of COPD exacerbations: An observational, interview‑based study.
Chest 2006;130:133‑42.
14. Evans A. Nutrition screening in patients with COPD. Nurs Times
15. ScottAS, BaltzanMA, DajczmanE, Wolkove N. Patient knowledge
in chronic obstructive pulmonary disease: Back to basics. COPD
16. Bulley C, Donaghy M, Howden S, Salisbury L, Whiteford S,
Mackay E, et al. A prospective qualitative exploration of views
about attending pulmonary rehabilitation. Physiother Res Int
17. Taylor R, Dawson S, Roberts N, Sridhar M, Partridge MR. Why
do patients decline to take part in a research project involving
pulmonary rehabilitation? Respir Med 2007;101:1942‑6.
18. Roberts NJ, Ghiassi R, Partridge MR. Health literacy in COPD.
Int J Chron Obstruct Pulmon Dis 2008;3:499‑507.
19. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of
functional health literacy to patients’ knowledge of their chronic
disease. A study of patients with hypertension and diabetes. Arch
Intern Med 1998;158:166‑72.
20. Weiss BD, Hart G, McGee DL, D’Estelle S. Health status of illiterate
adults: Relation between literacy and health status among persons
with low literacy skills. J Am Board Fam Pract 1992;5:257‑64.
21. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C,
et al. Association of health literacy with diabetes outcomes. JAMA
22. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy
and the risk of hospital admission. J Gen Intern Med 1998;13:791‑8.