The effect of patient education in patients with asthma and Chronic Obstructive Pulmonary Disease (COPD) on health-related quality of life (HRQoL) is not previously investigated using the St. George's Respiratory Questionnaire (SGRQ). We randomly allocated at our out-patient clinic 78 asthmatics and 62 patients with COPD to either a control or an intervention group. Intervention consisted of two 2-h group sessions and one to two individual sessions each by a nurse and a physiotherapist. A self-management plan was developed. Baseline quality of life assessment showed comparable scores independent of treatment groups among asthmatics and patients with COPD, but statistically significantly better scores (p < 0.05) for the educated asthma group after 12 mo compared with the control group. This aligned with the 12-mo SGRQ assessment, which revealed better symptoms, activity, impact, and total scores by 11 (p < 0.02), 15 (p < 0.01), 19 (p < 0.001), and 16 (p < 0.001) units, respectively. Patient education among asthmatics increased the FEV1 by a mean value of 6.1% (SD, 12) compared with the control group (p < 0.05). Education among patients with COPD did not indicate a significant increase in HRQoL as measured by the SGRQ or increased FEV1. We conclude that patient education increased HRQoL and FEV1 among asthmatics, but not among patients with COPD.

The effect of patient education on steroid inhaler compliance and rescue medication utilization in patients with asthma or chronic obstructive pulmonary disease (COPD) has not been previously investigated in a single study. We randomized 78 asthmatics and 62 patients with COPD after ordinary outpatient management. Intervention consisted of two 2-h group sessions and 1 to 2 individual sessions by a trained nurse and physiotherapist. A self-management plan was developed. We registered for 12 mo medication dispensed from pharmacies according to the Anatomical Therapeutic Chemical (ATC) classification index. Steroid inhaler compliance (SIC) was defined as (dispensed/prescribed) x 100 and being compliant as SIC > 75%. Among asthmatics 32% and 57% were compliant (p = 0.04) with a median (25th/75th percentiles) SIC of 55% (27/96) and 82% (44/127) (p = 0.08) in the control and intervention groups, respectively. Patient education did not seem to change SIC in the COPD group. Uneducated patients with COPD were dispensed double the amount of short-acting inhaled beta(2)-agonists compared with the educated group (p = 0.03). We conclude that patient education can change medication habits by reducing the amount of short-acting inhaled beta(2)-agonists being dispensed among patients with COPD. Educated asthmatics showed improved steroid inhaler compliance compared with the uneducated patients, whereas this seemed unaffected by education in the COPD group.

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The effect of patient education on morbidity in asthmatics and COPD patients has not previously been investigated in a single study. We randomized 78 asthmatics and 62 COPD patients after ordinary outpatient management. Intervention consisted of educational group sessions and individual sessions administered by a trained nurse and physiotherapist. A self-management plan was developed. The utilization of health resources and absenteeism from work was self-reported monthly. During the 12-month follow-up, approximately two (P= 0.001) and three (P= 0.001) times as many uneducated asthmatics and COPD patients, respectively, visited their general practitioner (GP) compared with educated. The mean reduction in GP consultations for the educated were 73% (P<0.001) and 85% (P<0.0001) for the asthma and COPD group, respectively, compared with uneducated. Fifty percent of uneducated asthmatics reported absenteeism from work compared with 24% of the educated (P = 0.06). The mean reduction in days offwork for the educated was 69% (P = 0.03), compared with uneducated. A positive correlation was observed between St George's Respiratory Questionnaire total score and number of GP visits for both the asthma and COPD group (P < 0.001). We conclude that patient education in asthmatics and COPD patients reduced the need for GP visits and kept a greater proportion of patients independent of their GP. Patient education among asthmatics also reduced the number of days off work and appeared to increase the proportion of patients not reporting absenteeism from work at all. Increasing number of GP visits was correlated with decreased health-related quality of life as measured by the SGRQ for both the asthmatics and the COPD patients.

BackgroundSelf-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most.MethodsRandomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models.ResultsFourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes.ConclusionSelf-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.