Self-management education for patients with chronic obstructive pulmonary disease

Self-management education programs for people with chronic obstructive pulmonary disorder (COPD) significantly decrease hospital admissions, researchers report in a new systematic review of studies.

Self-management education is also associated with a reduction in shortness of breath and a “positive trend” in improvement of quality of life.

However, researchers found no benefit in the total number of COPD-related exacerbations, emergency room visits, lung function, exercise capacity or days lost from work.

People with COPD suffer from abnormalities in the lungs that make it difficult for them to breathe. Generally, two distinct diseases are involved: emphysema and chronic bronchitis. According to the World Health Organization, 75 percent of deaths from COPD that occur in developed countries relate directly to smoking.

Those who develop COPD often must undergo major adjustments. They might have to “wear” oxygen — that is, carry supplemental oxygen tanks — wherever they go. They must cope with side effects from steroids – usually prednisone – used to treat the chronic disease and from antibiotics prescribed for infections to which COPD patients are prone.

Their roles at work and home can change dramatically, as they lose the stamina needed to perform their usual tasks and leisure activities requiring physical exertion leave them short of breath. In addition, COPD patients can find themselves becoming regular visitors to hospital emergency rooms.

“The most important finding in this review is that self-management education is associated with significant and clinically relevant reduction in hospital admissions,” said lead author Tanja Effing, an institutional researcher in the department of pulmonary medicine at the Medisch Spectrum Twente, a hospital in Enschede, the Netherlands.

“Self-management” describes any formal patient education program designed to teach skills required to follow medical regimens specific to COPD, guide behavioral changes and provide emotional support “for patients to control their disease and live functional lives.”

“The most exciting finding in the review is that there is at least preliminary evidence that the interventions are cost-effective, in that they lower hospitalizations. It is somewhat disappointing that there are not stronger findings in some other areas,” said Dr. Kate Lorig, professor of medicine and director of the Patient Education Research Center at Stanford University School of Medicine. Lorig was not involved with this review.

The review appears in the current issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The COPD review is a follow-up of another one undertaken in 2003 in which the outcomes were inconclusive. The latest version — comprising 14 studies and 2,239 patients — is more encouraging.

Patients who received self-management training saw their risk of hospitalization drop by one or more admissions in the 10 studies that measured this outcome. Self-management training was also associated with a small, but significant, reduction in shortness of breath, and improved quality of life.

There was no evidence of any harmful effects from such education, Effing said.
“Self-management education should be recommended in patients with COPD,” Effing said. She added, however, that because of variations among study designs, “data are still insufficient to formulate clear recommendations regarding the form and contents of self-management education programs in COPD.”

She said that large studies with a long-term follow-up of at least one year are needed for more accurate insights and “clear benchmarks need to be specified by authoritative bodies about the content of the intervention and the outcome measures of such studies.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Effing T, et al. Self-management education for patients with chronic obstructive pulmonary disease (Review). Cochrane Database of Systematic Reviews 2007, Issue 4.