Use of complementary and alternative medicines by patients with chronic obstructive pulmonary disease

During home visits, the pharmacists (L L I-D and J G) recorded baseline data on use of current prescription and non-prescription medications and CAM.

The pharmacists (L L I-D and J G) selected a subsample of patients for indepth interviews during home visits. Selection to give a suitable casemix was based on disease status, medications and management. One of us (J G), a trained interviewer, conducted indepth interviews (30–100 minutes) with patients in their homes. Patients decided whether or not their spouses would be included in the interviews. The interviewer explored patients’ health beliefs, experiences and attitudes towards medications (including CAM), as well as their attitudes towards disease conditions, their management and health professionals, using an interview guide based on a literature review.

Institutional ethics approval was obtained from The Alfred Human Research Ethics Committee and the Monash University Standing Committee on Ethics in Research Involving Humans, and the study participants provided written informed consent.

Of 30 patients approached for interview, two declined. The mean age (SD) of the interviewees (seven women; 21 men) was 70.1 (7.6) years. Five had never married, 15 were married, four were widowed and four divorced. Thirteen patients were living alone, two with family and 13 with spouses. All spoke fluent English. Multiple comorbidities were common among the interviewees, who were taking a mean (SD) of 9.57 (4.18) prescribed medications. Twelve patients self-reported using some form of CAM at the time of the interview.

Seven major themes relating to CAM use emerged from the interviews.

Advertisements in the media and friends or family members with prior experience of CAM or CAM practitioners were the major sources of information about CAM. Input from mainstream health professionals was meagre.

I just bought [CAM] listening to the wireless, and some health blokes get on and tell you how good they all are and I got out and bought them . . . I’m a sucker. (Man, 78 years, taking three vitamin preparations and marine lipid extracts.)

Our son had tennis elbow and he went up to this [traditional Chinese medicine practitioner] and he cured his tennis elbow . . . He suggested that we take dad up there and we’ve been going ever since. (Spouse of man, 77 years, uses herbal tea.)

[CAM users] must get to know about [CAM] independently of the medical profession, I think, because, going on my experience, no doctor has ever mentioned anything like that to me. (Woman, 60 years, not taking any CAM.)

Knowledge, attitudes and degree of faith were found to influence patient decisions to try CAM. Patients who totally relied on mainstream health professionals for guidance were less likely to try CAM.

I’ve yet to know of anybody who [CAM] has helped. (Woman, 83 years, not taking any CAM.)

I only believe in . . . 21st-century medical science; I don’t want to know about health food shops and the [traditional Chinese medicine] and whatever. They are all question mark things . . . No, I haven’t tried any and I won’t try any. (Man, 69 years, not taking any CAM.)

Not unless I’m told to go on [CAM] or try it, no . . . If [my GP] thought I would have to go on something else he would soon tell me. (Man, 67 years, not on any CAM.)

CAM users described their mainstream health professional as being too busy and having little time to discuss their health issues. In contrast, CAM practitioners were described as informative, thorough, available for longer discussions and receptive towards other therapies, which motivated some patients to try CAM as well as their existing treatment. CAM information provided by practitioners with qualifications in both CAM and Western medicine was considered more credible. Success stories of others with similar or even different medical conditions could generate faith in a particular CAM preparation or a CAM practitioner and become the motivation for trying CAM.

[Traditional Chinese medicine practitioner] will sit down . . . and talk to you for half an hour and go through everything concerning your problem. He will sit and he will explain this and explain that . . . more so than even the local GP or specialist; he covers much more than even they do. (Male, 77 years, uses herbal tea.)

My daughter has Crohn’s disease and she was advised by her specialist . . . he was also a naturopath . . . he suggested that she went on two fish oil [capsules] every day. She thought it was doing her good and I thought, well, it might do me good. (Woman, 77 years, taking fish oil capsules.)

CAM was used by the study participants for several reasons: as a preventive measure, for general wellbeing, to counteract side effects of prescribed medications, to compensate for dietary deficiencies due to restrictions or dislike of certain foods, and to help alleviate their disease condition.

[Garlic] might stop him from getting infections and whatever; anyway [he’s] been quite good this year. (Spouse of man, 77 years, taking garlic.)

I take a fantastic New Zealand herbal cough elixir. . . which is Manuka honey and a lot of natural things, which I think helps me . . .’cause you get this hoarseness from all your steroid. (Woman, 69 years, taking many herbal and vitamin preparations.)

Listening to the “smart alec” on the wireless, telling you how good it is, how we lack it in our meals and stuff . . . that’s the only reason why I did it. I thought . . . I might miss my meal, and then this would make up [for it]. (Man, 78 years, taking three vitamin preparations and marine lipid extract.)

While patients taking CAM sometimes expressed doubt about the efficacy of CAM, they were confident that they did not pose any health risks due to their “naturalness”.

I thought, oh well, fish oil, omega 3, and what I’ve read, I thought, well, it can’t do me any harm, I’m not taking a chemical . . . nothing’s ever come up in a blood test that it’s doing me any harm, so I feel I’ll benefit by them. (Woman, 77 years, taking fish oil capsules.)

Use of CAM raised a two-dimensional adherence issue — adherence to CAM and adherence to existing drug therapy. Physical properties such as the large size of the dosage form, unpleasant smell and taste were initial barriers to patients taking some CAM preparations. However, long-term adherence was determined by treatment response during the phase when the preparation was first tried, as well as perceived satisfaction. Reinforcement by CAM practitioners after the initiation of CAM was found to facilitate patients’ decision to adhere to their existing drug therapy.

I’ll spend the money but I won’t take them . . . because I can’t swallow the big tablets, all of these huge tablets. A lot of them won’t squash down in that pill cutter. (Woman, 69 years, taking many herbal and vitamin preparations.)

I feel that a lot of these things are not worth the paper they are printed on; I might give them away. (Man, 78 years, taking three vitamin preparations and marine lipid extract.)

The [traditional Chinese medicine practitioner] . . . appreciates both sides and I said to him one day . . . “I’m taking your stuff now, what about . . .?”. He said, “Don’t stop any of your tablets. You keep taking what they’ve given you, and I’ll give you this herbal medicine, but don’t stop what they’re giving you.” (Man, 77 years, uses herbal tea.)

The attitude of mainstream health professionals towards CAM and patients’ relationship with their health professional influenced patients’ decisions to discuss their CAM use with mainstream health professionals, especially during the initial phase of trying a CAM preparation. The reasons given by patients for not disclosing CAM use to their mainstream health professionals were anticipation of a negative response, belief that CAM use is a patient’s own healthcare issue, and a perception that disclosure of CAM use is not relevant.

A lot of doctors don’t believe in . . . Chinese stuff, to save any controversy or anything else, keep them apart . . . the right hand doesn’t know what the left hand is doing; leave it at that. (Man, 77 years, uses herbal tea.)