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Exacerbation action plans for patients with COPD and comorbidities: a randomised controlled trial

Lenferink A, van der Palen J, van der Valk P, et al.

Eur Respir J. 2019;54:1802134

DOI: 10.1183/13993003.02134-2018

Chronic obstructive pulmonary disease (COPD) is caused by gradual destruction of the airways and alveoli, typically due to the inhalation of harmful gases and particles. Many patients do not experience COPD in isolation of other health problems and there is currently insufficient evidence concerning the implementation of self-management interventions.

COPD self-management aims to engage and support patients to independently manage their health through the use of individualised treatment plans. A critical part of self-management involves the implementation of COPD exacerbation action plans. These have been proven to improve the quality of life for patients experiencing COPD in isolation, by reducing the likelihood of future exacerbations and the risk of hospitalisation. This study compared the total number of COPD exacerbation days over 12 months in two groups of patients with one or more co-morbidities (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II–IV). The comorbidities considered were: ischaemic heart disease, heart failure, diabetes, anxiety and depression. Each group was either trained in using symptom-based exacerbation action plans (self-management group; n=102) or received usual care (UC; n=99).

No significant differences in the number of COPD exacerbation days per patient per year were observed between the self-management and usual care group (self-management: median 9.6; UC: median 15.6; p=0.546). Despite this, in the self-management group, significant reductions were found in the duration of exacerbations (Self-management: median 9.1 days; UC: median 9.5 days; p=0.348) and the probability of having a respiratory-related hospitalisation during follow-up (relative risk 0.55; p=0.008). No between-group differences were observed in the total number of hospitalisations (Incidence Rate Ratio (IRR) 1.07 (95% confidence interval 0.66; 1.72)) or in mortality rates (self-management: n=4 (3.9%); UC: n=7 (7.1%); relative risk 0.55). These results suggest using a patient-tailored approach including individual assessment of COPD and comorbidities, exacerbation action plans and motivational feedback from a supportive case manager may be beneficial to patients experiencing co-morbid COPD.

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