Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease

Abstract

Self-management interventions that include a COPD exacerbation action plan are associated with improvements in HRQoL, as measured with the SGRQ, and lower probability of respiratory-related hospital admissions. No excess all-cause mortality risk was observed, but exploratory analysis showed a small, but significantly higher respiratory-related mortality rate for self-management compared to usual care.For future studies, we would like to urge only using action plans together with self-management interventions that meet the requirements of the most recent COPD self-management intervention definition. To increase transparency, future study authors should provide more detailed information regarding interventions provided. This would help inform further subgroup analyses and increase the ability to provide stronger recommendations regarding effective self-management interventions that include action plans for AECOPD. For safety reasons, COPD self-management action plans should take into account comorbidities when used in the wider population of people with COPD who have comorbidities. Although we were unable to evaluate this strategy in this review, it can be expected to further increase the safety of self-management interventions. We also advise to involve Data and Safety Monitoring Boards for future COPD self-management studies.

Making sense of telemedicine in the management of COPD

“…Although treatment strategies to prevent COPD exacerbations and their subsequent hospital admissions are still largely based on pharmacological therapies, the Global Initiative for Chronic Obstructive Lung Disease 2017 also recommended non-pharmacological treatment, such as self-management interventions with communication with a healthcare professional [2]. The most recent Cochrane review reported that self-management interventions that include written action plans and coaching with a healthcare professional for a prompt treatment of worsening symptoms lead to a lower probability of both respiratory-related and all-cause hospitalisations, and also improve health status [3]. There remain problems with heterogeneity among interventions and consistency in their application that make generalisation difficult in real life.…”

“…Instead, we need to use telehealth technologies to our advantage to increase patient activation and empowerment and to facilitate collaboration between patients and healthcare professionals. There is a large volume of evidence that supports self-management programmes in COPD [3,4], but we clearly need a more effective way to implement it. We need to standardise the way symptoms are being monitored and recorded by patients and healthcare professionals.…”

Real‐world study of acute exacerbations of COPD reveals real gaps in care

“…Reasons for readmissions in this chronically ill population are multifactorial and multiple interventions are likely to be required to reduce ED presentations of this critically ill and often frail population. Early clinical follow‐up, nursing outreach visits, self‐management education and timely pulmonary rehabilitation are all likely to play a role …”

Effectiveness of self-management interventions for COPD

“…1 The review included randomised controlled trials that compared the effectiveness of COPD self-management interventions (that included an action plan for acute exacerbations of COPD) with usual care. Outcomes included health-related quality of life (HRQoL) and respiratory-related hospital admissions.…”

“…1 The content of the self-management interventions was described as diverse and could include components that were directed towards achieving behaviour change (e.g. smoking, exercise and diet).…”