scholarly journals Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review

2019 ◽  
Vol 25 (3) ◽  
pp. 195 ◽  
Author(s):  
Hassan Hosseinzadeh ◽  
Mahmmoud Shnaigat
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Self Efficacy ◽  
Randomised Controlled Trials ◽  
Self Management ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Primary Care Settings ◽  
Randomised Controlled

Chronic obstructive pulmonary disease (COPD) is one of the more disabling diseases and the third cause of mortality worldwide. Self-management is considered an effective strategy for controlling and managing COPD. This review aims to summarise the available evidence on the effectiveness of COPD self-management in primary care settings. Social Sciences, Citation Index, MEDLINE, CINAHL, Academic Search Complete and Scopus were searched for randomised controlled trials of COPD self-management in general practice between 2001 and 2018. Ten randomised controlled trials of COPD self-management trials conducted in primary care settings were included in this review. The identified trials have recruited stable patients; a majority having mild to moderate COPD. The trials implemented different types of interventions and measured improvements in knowledge, skills and behaviours of self-management, mental health, self-efficacy and endpoint outcomes such as hospitalisation and quality of life. The findings showed that COPD self-management trials had positive effects on COPD knowledge and improved self-management behaviours such as adherence to medication, physical activities and smoking cessation in some cases; however, the effect of trials on hospitalisation rate, quality of life and healthcare utilisation were not conclusive. There was also not enough evidence to suggest that the trials were efficient in improving self-efficacy, a major driver of self-management behaviours. Primary care COPD self-management trials are efficient in improving surrogate outcomes such as knowledge of and adherence to self-management behaviours; however, such improvements are less likely to be sustainable in the absence of self-efficacy. Future studies should also focus on improving endpoint self-management outcomes like hospitalisation rate and quality of life to benefit both patient and healthcare system.

scholarly journals Maintaining quality of life in patients with chronic obstructive pulmonary disease (COPD) by extending the maintenance phase of community-based pulmonary rehabilitation: protocol for a randomised controlled trial (ComEx3 Study)

2020 ◽  
Vol 7 (1) ◽  
pp. e000548
Author(s):  
Derrick Lopez ◽  
Nola Cecins ◽  
Joanne Cockram ◽  
Anna Collins ◽  
Holly Landers ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Randomised Controlled Trial ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Randomised Controlled ◽  
Maintenance Programme

IntroductionPulmonary rehabilitation is a core component of the treatment of people with chronic obstructive pulmonary disease (COPD); however, the benefits gained diminish in the ensuing months. The optimal strategy for maintaining the benefits is unclear with weekly supervised maintenance exercise programmes proposed as one strategy. However, the long-term future of maintenance programs is dependent on quality evidence.Methods and analysisThe ComEx3 randomised controlled trial will investigate the efficacy of extending a weekly supervised maintenance programme for an additional 6 months following an initial 10-week maintenance programme (intervention) by comparing with a control group who receive the same 10-week maintenance programme followed by 6 months of usual care. 120 participants with COPD will be recruited. Primary objective is to determine health-related quality of life over 12 months. Secondary objectives are to determine functional exercise capacity trajectory and to perform an economic evaluation of the intervention to the health system. Outcomes will be analysed for superiority according to intention-to-treat and per-protocol approaches.Ethics and disseminationApproval has been received from the relevant ethics committees. Findings will be disseminated in peer-reviewed journals and conferences, targeting those involved in managing people with COPD as well as those who develop policies and guidelines.Clinical trial registrationANZCTR 12618000933257

Chronic Obstructive Pulmonary Disease Discharge Education and Quality of Life Evaluation: A Feasibility Study

2018 ◽  
Vol 32 (3) ◽  
pp. 328-348 ◽  
Author(s):  
Patricia Conley ◽  
Teresa J. Kelechi ◽  
Lynne S. Nemeth ◽  
Martina Mueller
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Action Plan ◽  
Phone Call ◽  
Self Management ◽  
Chronic Obstructive ◽  
Secondary Diagnosis ◽  
Obstructive Pulmonary Disease

Background and Purpose:Discharge instructions provided to hospitalized participants with chronic obstructive pulmonary disease (COPD) are essential to promote improved health outcomes, reduce incidence of hospitalization, and enhance quality of life (QOL). This study evaluated the feasibility of implementing the American Lung Association’s COPD Action Plan and assessment of QOL among participants hospitalized for acute exacerbation of COPD or COPD as a primary or secondary diagnosis.Methods:The study was conducted on a cohort of critically ill participants hospitalized on a progressive care unit. The Principal Investigator administered the WHOQOL-BREF Questionnaire to assess QOL before discharge and 30 days after discharge via phone call. Reach, Effectiveness, Adoption, Implementation, and Maintenance was used to evaluate outcomes from the discharge study.Results:Among participants enrolled (n = 50), 13 completed the in-hospital and follow-up phone call. Participants scored (12; 92% answered “yes”) that they learned appropriate COPD self-management skills, such as change in respiratory symptoms and appropriate actions to take. At 30-day follow-up: number of rehospitalizations (12; 99%), no emergency department visits, and (1; 1%) emergency department visit for insulin reaction, not COPD. Most frequent principal admitted diagnosis was acute respiratory failure, and secondary diagnosis was COPD. There was no significant difference in QOL comparing scores at discharge to 30-day follow-up, using the Wilcoxon signed-rank test.Implications for Practice:COPD education can increase participant satisfaction in receiving self-management instructions from an action plan near the time of discharge based on a small sample.

scholarly journals Potential benefits of integrated COPD management in primary care

2016 ◽  
Vol 73 (3) ◽  
Author(s):  
A.L. Kruis ◽  
N.H. Chavannes
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Pulmonary Rehabilitation ◽  
Daily Practice ◽  
Management Program ◽  
Chronic Obstructive ◽  
Management Skills ◽  
Obstructive Pulmonary Disease ◽  
Healthy Life Style

Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable longterm effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis.

scholarly journals Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis

BMJ ◽  
2018 ◽  
pp. k4388 ◽  
Author(s):  
Yayuan Zheng ◽  
Jianhong Zhu ◽  
Yuyu Liu ◽  
Weiguang Lai ◽  
Chunyu Lin ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Dual Therapy ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
Randomised Controlled

AbstractObjectiveTo compare the rate of moderate to severe exacerbations between triple therapy and dual therapy or monotherapy in patients with chronic obstructive pulmonary disease (COPD).DesignSystematic review and meta-analysis of randomised controlled trials.Data sourcesPubMed, Embase, Cochrane databases, and clinical trial registries searched from inception to April 2018.Eligibility criteriaRandomised controlled trials comparing triple therapy with dual therapy or monotherapy in patients with COPD were eligible. Efficacy and safety outcomes of interest were also available.Data extraction and synthesisData were collected independently. Meta-analyses were conducted to calculate rate ratios, hazard ratios, risk ratios, and mean differences with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations assessment, development, and evaluation).Results21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy. The overall safety profile of triple therapy is reassuring, but pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).ConclusionsUse of triple therapy resulted in a lower rate of moderate or severe exacerbations of COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD.Study registrationProspero CRD42018077033.

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