Relationship of Knowledge about Disease, Illness Attitude, and Quality of Life for Patients with Chronic Obstructive Pulmonary Disease(COPD)

만성 폐쇄성 폐질환자의 질병관련 지식, 질병태도, 삶의 질에 관한 연구

  • 방윤이 (이화여자대학교 간호학과/강북삼성병원 간호본부) ;
  • 박효정 (이화여자대학교 간호학과)
  • Received : 2017.08.07
  • Accepted : 2017.09.07
  • Published : 2017.11.28


The purpose of this study was to investigate the correlation between knowledge related to disease(KRD), illness attitude, and quality of life(QOL) in relation to the Chronic Obstructive Pulmonary Disease(COPD). According to the study result, there were significant differences with regard to KRD in accordance with subjects' education, monthly income, mMRC(modified Medical Research Council) Dyspnea Scale, inhaled bronchodilator and antibiotic treatment. In addition, there were significant differences with respect to illness attitude according to monthly income and mMRC. In case of the QOL, there were significant differences in accordance with age, marital status, monthly income, inpatient status, history of hospital admission, oxygen use, comorbidity, mMRC, and inhaled steroid. It has shown that there was a significant correlation between KRD and QOL(r=-.438, p<.001), illness attitude and QOL(r=.279, p=.001). Thus, it is important to grasp monthly income and mMRC, which are correlated with the three elements in common. As per assessment about COPD patients in the clinical situation, it is necessary to develop a multi-disciplinary approach, health coaching program for improving KRD and having a positive attitude based on the low-income group with taking interest in the circumstances of mMRC as well as objective test results.


Patients with Chronic Pulmonary Disease;Illness Attitude;Knowledge;Quality of Life


  1. R. A. Pauwels, A. S. Buist, P. M. Calverley, C. R. Jenkins, and S. S. Hurd, "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary," Am J Respir Crit Care Med, Vol.163, No.5, pp.1256-1276, 2001.
  3. E. S. Ford, J. B. Croft, D. M. Mannino, A. G. Wheaton, X. Zhang, and W. H. Giles, "COPD surveillance--United States, 1999-2011," Chest, Vol.144, No.1, pp.284-305, 2013.
  4. R. Faner, N. Gonzalez, T. Cruz, S. G. Kalko, and A. Agusti, "Systemic inflammatory response to smoking in chronic obstructive pulmonary disease: evidence of a gender effect," PLoS One, Vol.9, No.5, p.e97491, 2014.
  5. R. E. Schane, L. C. Walter, A. Dinno, K. E. Covinsky, and P. G. Woodruff, "Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease," J Gen Intern Med, Vol.23, No.11, pp.1757-1762, 2008.
  6. R. P. Benzo, B. Abascal-Bolado, and M. M. Dulohery, "Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect," Patient Educ Couns, Vol.99, No.4, pp.617-623, 2016.
  7. Y. Nagatani, K. Murata, M. Takahashi, N. Nitta, Y. Nakano, A. Sonoda, H. Otani, H. Okabe, and E. Ogawa, "A new quantitative index of lobar air trapping in chronic obstructive pulmonary disease (COPD): comparison with conventional methods," Eur J Radiol, Vol.84, No.5, pp.963-974, 2015.
  8. Y. S. Punekar, S. H. Landis, K. Wurst, and H. Le, "Characteristics, disease burden and costs of COPD patients in the two years following initiation of long-acting bronchodilators in UK primary care," Respir Res, Vol.16, p.141, 2015.
  9. 남궁은하, "의료보장제도별 노인의료비 증가에 관한 연구," 보건사회연구, Vol.30, pp.519-556, 2010.
  10. T. N. Bonten, M. J. Kasteleyn, C. Taube, and N. H. Chavannes, "The clinical management of COPD exacerbations: an update," Expert Rev Clin Pharmacol, Vol.9, No.2, pp.165-167, 2016.
  11. P. Hernandez, M. Balter, J. Bourbeau, and R. Hodder, "Living with chronic obstructive pulmonary disease: a survey of patients' knowledge and attitudes," Respir Med, Vol.103, No.7, pp.1004-1012, 2009.
  12. 안민희, 최자윤, "만성폐쇄성폐질환의 지식, 태도, 정확한 정량식 분무기 사용 및 자가관리 이행," 성인간호학회지, Vol.24, No.2, pp.160-170, 2012.
  13. T. Reema, R. Adepu, and T. Sabin, "Impact of clinical pharmacist intervention on knowledge, attitude and practice (KAP) of patients with chronic obstructive pulmonary disease," Int J Pharm Pharm Sci, Vol.2, No.4, pp.54-57, 2010.
  14. A. C. Akinci, R. Pinar, and T. Demir, "The relation of the subjective dyspnoea perception with objective dyspnoea indicators, quality of life and functional capacity in patients with COPD," J Clin Nurs, Vol.22, No.7-8, pp.969-976, 2013.
  15. R. H. Lehto and K. F. Stein, "Death anxiety: an analysis of an evolving concept," Res Theory Nurs Pract, Vol.23, No.1, pp.23-41, 2009.
  16. S. Peruzza, G. Sergi, A. Vianello, C. Pisent, F. Tiozzo, A. Manzan, A. Coin, E. M. Inelmen, and G. Enzi, "Chronic obstructive pulmonary disease (COPD) in elderly subjects: impact on functional status and quality of life," Respir Med, Vol.97, No.6, pp.612-617, 2003.
  17. F. Faul, E. Erdfelder, A. Buchner, and A. G. Lang, "Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses," Behav Res Methods, Vol.41, No.4, pp.1149-1160, 2009.
  18. R. White, P. Walker, S. Roberts, S. Kalisky, and P. White, "Bristol COPD Knowledge Questionnaire (BCKQ): testing what we teach patients about COPD," Chron Respir Dis, Vol.3, No.3, pp.123-131, 2006.
  19. R. Kellner, "Hypochondriasis and somatization," Jama, Vol.258, No.19, pp.2718-2722, 1987.
  20. 이인혜, "질병태도 척도의 요인구조: 대학생을 중심으로," 한국심리학회지 : 건강, Vol.9, No.1, pp.203-216, 2004.
  21. P. W. Jones, F. H. Quirk, and C. M. Baveystock, "The St George's Respiratory Questionnaire," Respir Med, Vol.85, Suppl.B, pp.25-31, discussion 33-7, 1991.
  22. 김영삼, 변민광, 정우영, 정재희, 최상봉, 강신명, 문지애, 한숙정, 남정모, 박무석, 김세규, "한국어판 세인트조지 호흡기설문의 타당도와 신뢰도 검정," 대한결핵 및 호흡기학회지, Vol.61, No.2, pp.121-128, 2006.
  23. T. Hajiro, K. Nishimura, M. Tsukino, A. Ikeda, T. Oga, and T. Izumi, "A comparison of the level of dyspnea vs disease severity in indicating the health-related quality of life of patients with COPD," Chest, Vol.116, No.6, pp.1632-1637, 1999.
  24. J. Y. Choi, H. I. Chung, and G. Han, "Patient outcomes according to COPD action plan adherence," J Clin Nurs, Vol.23, No.5-6, pp.883-891, 2014.
  25. Q. Zhang, J. Liao, X. Liao, X. Wu, M. Wan, C. Wang, and Q. Ma, "Disease knowledge level is a noteworthy risk factor of anxiety and depression in patients with chronic obstructive pulmonary disease: a cross-sectional study," BMC pulmonary medicine, Vol.14, No.1, p.92, 2014.
  26. R. L. DiSantostefano, T. Sampson, H. V. Le, D. Hinds, K. J. Davis, and N. D. Bakerly, "Risk of pneumonia with inhaled corticosteroid versus long-acting bronchodilator regimens in chronic obstructive pulmonary disease: a new-user cohort study," PLoS One, Vol.9, No.5, p.e97149, 2014.
  27. 이종경, 양영희, "폐쇄성 폐질환자의 흡입기 사용 정확성 정도," 한국간호교육학회지, Vol.16, No.1, pp.111-120, 2010.
  28. G. S. Gaude, B. P. Rajesh, A. Chaudhury, and J. Hattiholi, "Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization," Lung India, Vol.32, No.5, pp.465-472, 2015.
  29. L. Dignani, A. Toccaceli, C. Lucertini, C. Petrucci, and L. Lancia, "Sleep and Quality of Life in People With COPD: A Descriptive-Correlational Study," Clin Nurs Res, Vol.25, No.4, pp.432-447, 2016.
  30. 김은진, 박재형, 윤석진, 이승준, 차승익, 박재용, 정태훈, 김창호, "만성폐쇄성폐질환자에서 질병중증도 및 삶의 질을 비롯한 사회적 요인과 호흡곤란과의 관계," 대한결핵 및 호흡기학회지, Vol.60, No.4, pp.397-403, 2006.
  31. C. Garvey, "Recent updates in chronic obstructive pulmonary disease," Postgrad Med, Vol.128, No.2, pp.231-238, 2016.
  32. 송현주, 김균희, "60대 고령자의 노후 인식 유형별독립적 경제력 유무에 미치는 영향 요인," 노인복지연구, Vol.61, pp.383-403, 2013.
  33. B. Huang, R. Willard-Grace, D. De Vore, J. Wolf, C. Chirinos, S. Tsao, D. Hessler, G. Su, and D. H. Thom, "Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial," BMC Pulm Med, Vol.17, No.1, p.90, 2017.
  34. K. L. Chou, I. Chi, and N. W. Chow, "Sources of income and depression in elderly Hong Kong Chinese: mediating and moderating effects of social support and financial strain," Aging Ment Health, Vol.8, No.3, pp.212-221, 2004.
  35. 이흥자, 김현실, 정영미, "일 지역 재가노인의 우울 및 삶의 질 영향요인," 지역사회간호학회지, Vol.20, No.1, pp.12-22, 2009.
  36. M. L. Moy, J. J. Reilly, A. L. Ries, Z. Mosenifar, R. M. Kaplan, R. Lew, and E. Garshick, "Multivariate models of determinants of health-related quality of life in severe chronic obstructive pulmonary disease," J Rehabil Res Dev, Vol.46, No.5, pp.643-654, 2009.
  37. K. Fitch, K. Iwasaki, B. Pyenson, C. Plauschinat, and J. Zhang, "Variation in adherence with Global Initiative for Chronic Obstructive Lung Disease (GOLD) drug therapy guidelines: a retrospective actuarial claims data analysis," Curr Med Res Opin, Vol.27, No.7, pp.1425-1429, 2011.
  38. 김동배, 김상범, 신수민, "무배우자 노인의 사회참여가 우울에 미치는 영향: 사회적 지지와 자아효능감의 매개효과," 한국노년학, Vol.32, No.1, pp.289-303, 2012.
  39. 김민희, 이주일, "노년기 활동 참여가 삶 만족과 자아통합감에 미치는 영향," 한국콘텐츠학회논문지, Vol.17, No.5, pp.100-113, 2017.
  40. 김제선, 한연주, "초고령사회 진입 지방자치단체 노인의 의료비부담과 가구 유형의 영향," 한국콘텐츠학회논문지, Vol.17, No.7, pp.610-621, 2017.
  41. 이해정, 임연정, 정희영, 박혜경, "만성폐쇄성폐질환자의 수면장애, 신체활동 및 건강관련 삶의 질," 한국노년학, Vol.31, No.3, pp.607-621, 2011.
  42. 강경숙, 나순옥, 유영법, 신준호, "제4기 국민건강영양조사에 기초한 만성 폐쇄성폐질환자의 성별에 따른 삶의 질 분석," 지역사회간호학회지, Vol.26, No.2, pp.61-68, 2015.
  43. S. K. Park and J. L. Larson, "Symptom cluster, healthcare use and mortality in patients with severe chronic obstructive pulmonary disease," J Clin Nurs, Vol.23, No.17-18, pp.2658-2671, 2014.
  44. P. M. Calverley, J. A. Anderson, B. Celli, G. T. Ferguson, C. Jenkins, P. W. Jones, J. C. Yates, J. Vestbo, and TORCH investigators, "Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease," N Engl J Med, Vol.356, No.8, pp.775-789, 2007.
  45. M. B. Drummond, E. C. Dasenbrook, M. W. Pitz, D. J. Murphy, and E. Fan, "Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis," Jama, Vol.300, No.20, pp.2407-2416, 2008.
  46. P. Ernst, A. V. Gonzalez, P. Brassard, and S. Suissa, "Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia," Am J Respir Crit Care Med, Vol.176, No.2, pp.162-166, 2007.
  47. E. O. Efraimsson, C. Hillervik, and A. Ehrenberg, "Effects of COPD self-care management education at a nurse-led primary health care clinic," Scand J Caring Sci, Vol.22, No.2, pp.178-185, 2008.
  48. F. Gallefoss, "The effects of patient education in COPD in a 1-year follow-up randomised, controlled trial," Patient Educ Couns, Vol.52, No.3, pp.259-266, 2004.