Effectiveness of non-pharmacological COPD management on health-related quality of life - a systematic review

ABSTRACT

Introduction

Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. The chronic progressive disease is accompanied by a high loss of health-related quality of life (HRQoL). The available drugs usually only have symptomatic effects; therefore, non-pharmacological therapies are essential too.

Areas covered

This systematic review examines non-pharmacological interventions consisting of pulmonary rehabilitation, physical activity, and training versus usual care or no intervention in COPD using at least one of the following HRQoL measuring instruments: St. George’s Respiratory Questionnaire, Clinical COPD Questionnaire, COPD Assessment Test, and EuroQol-5D. Of 1532 identified records from CENTRAL, MEDLINE, and EMBASE, 15 randomized controlled trials met the inclusion criteria. Pulmonary rehabilitation programs were investigated in nine studies, education and counseling-based training programs in three studies, and breathing exercises in three studies. Ten studies were found that investigated non-pharmacological treatment programs that led to a significant and clinically relevant improvement in HRQoL compared with usual care or no treatment.

Expert opinion

Non-pharmacological interventions consisting of pulmonary rehabilitation, education and counseling-based training programs, and breathing exercises can improve the HRQoL of COPD patients.

KEYWORDS:

• COPD
• non-pharmacological
• review
• lung disease
• quality of life

Article Highlights

• Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. The chronic progressive disease is associated with high loss of health-related quality of life (HRQoL).

• Drugs usually only have symptomatic effects; thus, non-pharmacological therapies are essential too.

• We examine non-pharmacological programs consisting of pulmonary rehabilitation, physical activity, education or counselling-based training programs, and breathing exercises compared with usual care.

• The following studies showed significant and clinically relevant improvements in HRQoL compared with usual care:

  • º five of nine studies with pulmonary rehabilitation as the main component,

  • º two of three studies with education and counselling-based training programs,

  • º three of three studies with breathing exercises as the main components.

• To improve COPD care, further measures are needed to increase the accessibility and applicability of non-pharmacological treatment programs. In addition, non-pharmacological treatments should be tailored to the needs of the patient to achieve high HRQoL.

Acknowledgments

The authors would like to thank Adriana König for carrying out the second quality assessment of the included studies and the subsequent check for consistency.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was funded by Federal Joint Committee (G-BA), Germany, under the program Innovation Fund (support code 01VSF16025).