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

摘要: Background Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging supporting the patients to positively adapt their behaviour(s) develop skills better manage disease. Exacerbation action plans are considered a key component COPD interventions. Studies assessing these show contradictory results. In this Cochrane Review, we compared effectiveness that include for acute exacerbations (AECOPD) usual care. Objectives To evaluate efficacy COPD-specific an plan care in terms health-related quality life, respiratory-related hospital admissions other health outcomes. Search methods We searched Airways Group Specialised Register trials, trials registries, reference lists included studies May 2016. Selection criteria We randomised controlled evaluating intervention people published since 1995. To eligible inclusion, written AECOPD iterative process between participant healthcare provider(s) which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered hospital, at centre, community-based setting avoid overlap much possible. Data collection analysis Two review authors independently assessed trial extracted data. resolved disagreements by reaching consensus involving third author. Study were contacted obtain additional information missing outcome data where possible. When appropriate, study results pooled using random-effects modelling meta-analysis. The primary outcomes life (HRQoL) number admissions. Main results We 22 involved 3,854 participants COPD. care. follow-up time ranged from two 24 months content diverse. Over 12 months, there statistically significant beneficial effect on HRQoL, measured St. George's Respiratory Questionnaire (SGRQ) total score, lower score represents HRQoL. found mean difference -2.69 points (95% CI -4.49 -0.90; 1,582 participants; 10 studies; high-quality evidence). Intervention risk least one admission who received (OR 0.69, 95% 0.51 0.94; 3,157 14 moderate-quality needed treat prevent over year 7 69) high baseline 17 11 93) low (based seven highest lowest respectively). There no probability all-cause group 0.74, 0.54 1.03; 2467 Furthermore, observed hospitalisation days, emergency department visits, General Practitioner dyspnoea scores (modified) Medical Research Council questionnaire participants. There mortality (RD 0.0019, -0.0225 0.0263; 3296 16 Exploratory analysis showed very small, significantly higher rate 0.028, 0.0049 0.0511; 1219 low-quality evidence). Subgroup analyses improvements HRQoL smoking cessation programme (MD -4.98, -7.17 -2.78) without -1.33, -2.94 0.27, test subgroup differences: Chi² = 6.89, df 1, P 0.009, I² 85.5%). behavioural change techniques clusters integrated intervention, duration adaptation maintenance medication part did not affect Subgroup detect any potential variables explain differences among studies. Authors' conclusions Self-management exacerbation associated SGRQ, admissions. No excess observed, exploratory care. For future studies, would like urge only together meet requirements most recent definition. increase transparency, provide more detailed regarding This help inform further ability stronger recommendations effective AECOPD. For safety reasons, take into account comorbidities when used wider population have comorbidities. Although unable strategy review, it can expected also advise involve Data Safety Monitoring Boards studies.