Background: Self-managementinterventionsimprovevarious outcomes for many chronic diseases. The definite place of self-management in the care of chronic obstructive pulmonary disease (COPD) has not been established. We evaluated the effect of a continuum of self-management, specific to COPD, on the use of hospital services and health status among patients with moderate to severe disease.

The aim of the present study was to assess the long-term impact on hospitalisation of a self-management programme for chronic obstructive pulmonary disease (COPD) patients.A multicentre, randomised clinical trial was carried out involving 191 COPD patients from seven hospitals. Patients who had one or more hospitalisations in the year preceding study enrolment were assigned to a self-management programme ''Living Well with COPD TM '' or to standard care. Hospitalisations from all causes were the primary outcome and were documented from the provincial hospitalisation database; emergency visits were recorded from the provincial health insurance database.Most patients were elderly, not highly educated, had advanced COPD (reflected by a mean forced expiratory volume in one second of 1 L), and almost half reported a dyspnoea score of 5/5 (modified Medical Research Council). At 2 years, there was a statistically significant and clinically relevant reduction in all-cause hospitalisations of 26.9% and in all-cause emergency visits of 21.1% in the intervention group as compared to the standard-care group. After adjustment for the self-management intervention effect, the predictive factors for reduced hospitalisations included younger age, sex (female), higher education, increased health status and exercise capacity.In conclusion, in this study, patients with chronic obstructive pulmonary disease who received educational intervention with supervision and support based on disease-specific self-management maintained a significant reduction in hospitalisations after a 2-year period.

BACKGROUND:Approximately 10% of patients hospitalized with community-acquired pneumonia (CAP) are bacteremic. BacteremicStreptococcus pneumoniaepneumonia (BSPP) is the number one cause of mortality, representing up to 70% of all CAP deaths. In fact, all CAP guidelines have identified this issue as one of the most important issues when establishing their recommendations.OBJECTIVE:To assess the impact of dual antibiotic therapy in patients with BSPP.PATIENTS AND METHODS:All cases of BSPP in patients 18 years of age and older who were hospitalized from 1995 to 2000 were retrospectively analyzed. The standard initial therapeutic regimen used was cefuroxime with or without a macrolide from 1995 to 1997, and ceftriaxone and azithromycin or clarithromycin from 1998 to 2000. During the 1995 to 1997 period, only 16% of the patients initially received a macrolide, whereas all patients in the 1998 to 2000 period received a macrolide at admission.RESULTS:Ninety-five patients (49 men, 46 women) with a mean age of 63 years (range 20 to 98 years) were included in the present study. The mean pneumonia severity index at admission was 113 for the monotherapy cohort and 114 for the dual therapy group. At admission, 30.5% of patients had a leukocyte count greater than 20´109/L, 11.5% had a systolic blood pressure less than 90 mmHg, 44.2% had a respiratory rate greater than 30 breaths/min and 33.6% had nausea/vomiting, necessitating some form of therapy or preventing the patient from eating. In addition, 16.8% had no fever at admission. Overall, 72.5% became afebrile within 48 h. Fifteen (15.8%) patients died (four within the first 72 h). The mortality rate was significantly higher in the monotherapy group (11 of 42 patients; 25.6%) than in the dual therapy cohort (four of 53 patients; 7.5%) (OR 0.23; 95% CI 0.07 to 0.74). Antibiotic resistance was not associated with increased mortality.CONCLUSION:The combination of ceftriaxone plus a macrolide significantly reduced the mortality rate compared with monotherapy (cefuroxime) in patients with CAP that have the highest mortality rate.

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Mouth occlusion pressure at 0.1 s (P_0.1) and minute ventilation (VE) were measured at rest and during progressive hypercapnia in 32 patients. Under double-blind conditions and according to a 2 × 2 Latin-square design, half the patients received one oral dose of diazepam and its placebo. Using the same design, the other half received zopiclone and its placebo. Normocapnic and moderately hypoxemic patients between the ages of 21 and 69 with moderate to severe chronic obstructive pulmonary disease were included in the study. Diazepam produced a statistically significant decrease (p < 0.05) over its placebo in ΔP_0.1/ΔPE_ΤCO2 values following CO₂ rebreathing. Zopiclone did not influence either ΔP₀.₁/ΔP_ETCO2 or ΔVE/ΔP_ETCO2, but produced a significant increase in respiratory frequency. However, no statistically significant differences were observed between the two active treatments