M40 ‘I know this is on my chest, let’s act’: a qualitative study exploring the (self) management of acute exacerbations in COPD using a sputum colour chart to reduce unnecessary antibiotic use

<h3>Introduction</h3> Reducing antimicrobial resistance is a recognised NHS and global sustainability priority. We report findings from a qualitative study exploring the acceptability of a sputum colour chart and self-management plan (SMP) to guide patient use of antibiotics and steroids in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). <h3>Methods</h3> Qualitative interviews were conducted with healthcare professionals (HCPs) and patients from the Colour COPD trial – a randomised controlled trial of usual care versus usual care plus the use of a sputum colour chart to manage AECOPD. Participants were from different parts of England, sampled to promote maximum variation of socio-demographic characteristics, trial arm and frequency of AECOPD. Some patients were invited to participate in follow up interviews. Interviews were audio-recorded, transcribed clean verbatim, then analysed thematically, using an adapted Framework approach. To help keep the patient voice central to our research, expert patients contributed to the patient data analysis. <h3>Results</h3> 14 HCPs and 39 patients were interviewed between July 2022 – Nov 2023, 8 of the HCPs and 20 patients were recruited from primary care. 4 patients were interviewed twice. Three overarching themes were identified related to the acceptability of the intervention: (1) handling tensions: the inherent tension between stewardship of antimicrobials and the need to reduce the risk of serious infection and illness in COPD required active negotiation by HCPs and patients (2) clinical and embodied legacies: introduction of the colour chart was broadly accepted as necessary by stakeholders, but disrupted the legacy of efforts to address the risk of exacerbations – for the patients, these efforts were focused around their experiential understandings of their condition, and for healthcare professionals, these efforts were focused around early intervention for AECOPD (3) changing self-management practices: opportunities for changing practices though negotiating change between HCP and patient. <h3>Conclusion</h3> Assessment of sputum colour was acceptable to participants, however the colour chart was more likely to be effective in patients new to AECOPD self-management. The legacy of strategies aimed at prescribing antibiotics early to reduce individual risk inhibited the intervention’s effectiveness in others, regular reiteration within clinical interactions could maximise the effectiveness of the intervention.