Post-discharge extended care contributes to the disease control of patients with COPD: a Chinese study

Figures & data

Table 1 Clinical information and general data of the included patients (140 cases)

Items	Classification	Usual care group (70), n (%)	Extended care group (70), n (%)
Gender
	Male	40 (57.1)	44 (62.9)
	Female	30 (42.9)	26 (37.1)
Smoking
	Yes	43 (61.4)	39 (55.7)
	No	27 (38.6)	31 (44.3)
Education level
	Junior high school and below	24 (34.3)	26 (37.1)
	Senior high school	28 (40)	24 (34.3)
	University and above	18 (25.7)	20 (28.6)
Monthly economic income
	<3,000 RMB	18 (25.7)	22 (31.4)
	≥3,000 and ≤5,000 RMB	28 (40)	24 (34.3)
	>5,000 RMB	24 (34.3)	24 (34.3)
Classification of lung dysfunction
	Moderate GOLD-2	38 (54.3)	36 (51.4)
	Severe GOLD-3	28 (40)	32 (45.7)
	Extremely severe-GOLD-4	4 (5.7)	2 (2.8)

Note: RMB, Chinese currency unit.

Figure 1 Patient flow diagram of this study.

Table 2 Nursing measurement for usual care group vs extended care group (M ± SD) (140 cases)

Interventions for care	Extended care (70)	Usual care (70)
Health guidancea	Yes	Yes
Helping to quit smokingb	Yes	No
Guiding medicationc	Yes	No
Respiratory exercised	Yes	No
Physical traininge	Yes	No
Long-term home oxygen therapyf	Yes	No
Psychological careg	Yes	No
Family visitsh	Yes	No
Social supporti	Yes	No
Nutritional supportj	Yes	No
Contact a doctor when the patient is not feeling well	Yes	Yes

Notes:

a Patient or family members are required to receive health guidance, including disease observation, medication, diet, activity, family rehabilitation training, referral time, self-care guidance, etc.

b Guide and help patients quit smoking.

c To guide patients to use drugs correctly such as bronchodilators or glucocorticoids.

d Patients are required to receive a respiratory exercise on COPD, including shrink lip breathing and abdominal breathing, which is to help the patients master the correct breathing skills (5 minutes/time, 2 times/day).

e Physical training is based on aerobic exercise: quantitative walking and upper limb movement (15 minutes/time, 2 times/day).

f Instruct patients to receive long-term home oxygen therapy; time ≥5 hours/day, oxygen flow 1–2 L/min.

g Psychological care: the researchers pay close attention to the patient’s mental state and give psychological counseling, encourage and care for patients.

h Family visits are performed for each patient (1 time/every week). The contents of follow-up include the inquiry of mental state, physical examination, the use of drugs and the situation of acute exacerbations.

i Providing effective social support (through psychologist).

j Providing scientific nutritional support to patients (through nutritionist).

Abbreviation: M, mean.

Table 3 Comparison of SGRQ scale score between before intervention and after intervention for usual care group vs extended care group (M ± SD, points)

Items	Usual care group (70 cases)		P-value	Extended care group (70 cases)		P-value
	Before intervention	After intervention		Before intervention	After intervention
Activity scores	76.46±5.12	72.38±4.57	>0.05	81.23±3.89	60.24±6.11a	<0.05
Symptom scores	70.73±4.33	67.26±3.78	>0.05	71.91±7.22	52.53±2.84b	<0.05
Impact scores	68.99±3.29	62.06±6.76	>0.05	69.92±9.56	55.83±7.22c	<0.05

Notes:

a After intervention, the comparison of extended care with usual care on activity score (P<0.05).

b After intervention, the comparison of extended care with usual care on activity score (P<0.05).

c After intervention, the comparison of extended care with usual care on activity score.

Abbreviations: M, mean; SGRQ, St George’s Respiratory Questionnaire.

Figure 2 Evaluation of efficacy of extended care and usual care patients with COPD after discharge.

Notes: (A) Extended care promoted the activity ability, mitigated the clinical symptoms as well as reduced the impact degree of COPD to daily life in patients with COPD (P<0.05). (B) Extended care improved the psychological health of patients with GOLD-2 to -4 of COPD (P<0.05).
Abbreviations: GHQ-12, 12-item General Health Questionnaire; M, mean; SGRQ, St George’s Respiratory Questionnaire.

Table 4 Comparison of GHQ-12 score between before intervention and after intervention for usual care group vs extended care group (M ± SD)

Items	Cases (N)	Groups	M ± SD		P-value
			Before intervention	After intervention
GHQ-12 scores	70	Usual care group	7.99±1.09	6.81±0.95	>0.05
	70	Extended care group	9.36±1.33	2.73±0.59	<0.05
	70	T-value	0.49	11.55
	70	P-value	>0.05	<0.05a

Note:

a After intervention, the comparison of extended care with usual care on activity score (P<0.05).

Abbreviations: GHQ-12, 12-item General Health Questionnaire; M, mean.

Table 5 Comparison of pulmonary function between before intervention and after intervention for usual care group vs extended care group (M ± SD)

Group	Intervention	Usual care group (70 cases)	Extended care group (70 cases)	T-value	P-value
FEV1 % (M ± SD)	Before intervention	0.46±0.17	0.45±0.18	0.41	>0.05
	After intervention	0.48±0.15	0.57±0.09a	6.34	<0.05
FVC% (M ± SD)	Before intervention	0.47±0.12	0.48±0.13	0.41	>0.05
	After intervention	0.49±0.11	0.56±0.12b	8.56	<0.05
FEV1/FVC (M ± SD)	Before intervention	0.59±0.14	0.58±0.15	0.79	>0.05
	After intervention	0.62±0.13	0.69±0.14c	9.91	<0.05

Notes:

a After intervention, the comparison of the extended care group with the usual care group on FEV₁ (P<0.05).

b After intervention, the comparison of the extended care group with the usual care group on FVC (P<0.05).

c After intervention, the comparison of the extended care group with the usual care group on FEV₁/FVC (P<0.05).

Abbreviation: M, mean.

Figure 3 Effect of extended care and usual care on pulmonary function.

Notes: (A) After intervention, the value of FEV₁ in the extended care group was higher than that in the usual care group (P<0.05). (B) After intervention, the FVC in the extended care group was improved compared with the usual care group (P<0.05). (C) After intervention, the FEV₁/FVC of the extended care group showed an increasing trend compared with the usual care group (P<0.05).
Abbreviation: M, mean.

Table 6 Comparison of acute exacerbation rates and blood gas after intervention for usual care group vs extended care group (M ± SD)

Comparison of acute exacerbation rates in two groups
Groups	N (cases)	Acute exacerbation (%)	No acute exacerbation (%)	P-value
Usual care group Extended care group	70 70	18 (25.7) 4 (5.7)	52 (74.3) 66 (94.3)	0.001
Comparison of blood gas analysis in two groups
Groups	N (cases)	PaO2 (kPa)	PaCO2 (kPa)	P-value
Usual care group	70	6.3±1.05	7.59±1.05	0.001
Extended care group	70	7.8±1.08a	6.09±0.93b

Notes:

a After intervention, the comparison of extended care with usual care on activity score (P=0.001).

b After intervention, the comparison of extended care with usual care on activity score (P=0.001).

Abbreviations: M, mean; PaCO₂, carbon dioxide partial pressure; PaO₂, oxygen partial pressure.

Figure 4 Effect of extended care and usual care on acute exacerbation rate and blood gas levels of COPD patients.

Notes: (A) The acute exacerbation rate of COPD patients in the extended care group was lower than that in the usual care group (P<0.05). (B) The extended care elevated the level of PaO₂ and reduced the level of PaCO₂ of COPD patients compared with usual care (P<0.05).
Abbreviations: PaCO₂, carbon dioxide partial pressure; PaO₂, oxygen partial pressure.