Action plans with limited patient education only for exacerbations of chronic obstructive pulmonary disease
- 12 May 2010
- reference entry
- research article
- Published by Wiley
- No. 5,p. CD005074
- https://doi.org/10.1002/14651858.cd005074.pub3
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterised by exacerbations, usually infective in origin, which affect symptoms and quality of life. Action plans may help individuals recognise a deterioration in their symptoms and initiate changes to treatment early, thereby reducing the impact of the exacerbation. To assess the efficacy of action plans in the management of COPD. We searched the Cochrane Airways Group Specialised Register (7 July 2009), CENTRAL, MEDLINE , CINAHL and ongoing trials registers (last searched July 2009). Randomised controlled trials of an individual action plan with minimal or no self management education, compared to control in patients with COPD were included. Studies in asthma and in multi-faceted interventions in which an action plan was combined with other elements such as education programme, exercise programme or outreach visits were excluded. Two reviewers independently assessed trial quality and extracted data. We contacted investigators for additional information when necessary. Five studies enrolling 574 participants with moderate or severe COPD, with follow-up from six to twelve months, were included. There was no evidence that action plans reduced health care utilisation; assessed by hospital admission (mean difference (MD) 0.23; 95% CI -0.03 to 0.49), emergency department visits (MD 0.37; 95% CI -0.50 to 1.24) or GP visits (MD 0.53; -0.45, 1.50). Use of action plans was associated with increased initiation of treatment for acute exacerbations. Oral corticosteroid use was increased over 12 months (MD 0.74; 95% CI 0.14 to 1.35) with a significant increase in odds of being treated with antibiotics over 12 months (odds ratio 1.65; 95% CI 1.01 to 2.69). Self management knowledge and intention to initiate appropriate actions were improved in one study; recognition of a severe exacerbation (MD 2.50; 95% CI 1.04 to 3.96) and self initiating action in a severe exacerbation (MD 1.50; 95% CI 0.62 to 2.38). Health-related quality of life data were limited. There is evidence that action plans with limited COPD education aid recognition of, and response to, an exacerbation with initiation of antibiotics and corticosteroids. Only one study measured patients' self health appropriate behaviour (decision making and taking action). There is no evidence of reduced healthcare resources utilisation or improved health-related quality of life.The practice of giving patients an action plan and limited self-management education for the management of COPD exacerbations, without a multi-faceted self-management program or ongoing case management cannot be recommended as the standard of care in COPD.Keywords
This publication has 32 references indexed in Scilit:
- Effects of COPD self‐care management education at a nurse‐led primary health care clinicScandinavian Journal of Caring Sciences, 2008
- The effects of additional care by a pulmonary nurse for asthma and COPD patients at a respiratory outpatient clinic: Results from a double blind, randomized clinical trialPatient Education and Counseling, 2008
- A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary diseaseThorax, 2007
- Ambulante COPD-Patientenschulung (ATEM) und BODE-IndexPneumologie, 2007
- COPD-Schulung im Rahmen der stationären Rehabilitation verbessert Lebensqualität und MorbiditätPneumologie, 2007
- Defining COPD exacerbations: impact on estimation of incidence and burden in primary carePrimary Care Respiratory Journal, 2006
- Effectiveness of an education programme by a general practice assistant for asthma and COPD patients: results from a randomised controlled trialPatient Education and Counseling, 2004
- Care plans for acutely deteriorating COPD: a randomized controlled trialChronic Respiratory Disease, 2004
- Does patient education modify behaviour in the management of COPD?Patient Education and Counseling, 2004
- Disease-Specific Self-Management Programs in Patients with Advanced Chronic Obstructive Pulmonary DiseaseDisease Management and Health Outcomes, 2003