Efficacy of a self-management plan in exacerbations for patients with advanced COPD

Abstract

Background

Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD.

Methods

Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality.

Results

After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0.191).

Conclusion

The implementation of a self-management program for patients with advanced COPD reduced exacerbations that required hospital care.

Keywords:

• self-management
• COPD
• severe exacerbations

Acknowledgments

This study was made possible thanks to support and funding from the following companies: Gas Medi SA, Boehringer Ingelheim, Chiesi, Menarini. The role of these companies was limited to financing the project, with no intervention in the development of the material used in the self-management plan or in the writing of the article. Thanks are owed to the following nursing, administration, and IT staff from both the participating hospitals. Without their collaboration, conducting the study would not have been possible. María José Clemente La Serna, Ángela Dólera Martínez, Esperanza Pérez Navarro, Manuela Pérez Maiquez, Concepción Belmonte López, Maria Dolores Cervantes Pérez, Ana Bernal Gilar, Mari Carmen Navarro Leyva, Teresa Abellán Nogueira, Encarnación López López, Juana Maria Muñoz Martínez, Joaquin Moreno Hernandez Mᵃ Patricia Palacio Gaviria, Juan Manuel Moreno Hernández, Pablo Pérez Forca.

Disclosure

The authors report no conflicts of interest in this work.