Action plans for chronic obstructive pulmonary disease.
BACKGROUND
The effectiveness of action plans as treatment for chronic obstructive pulmonary disease (COPD) is not known.


OBJECTIVE
To assess the efficacy of action plans in the management of COPD.


METHODS
We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, CINAHL and the National Research Register of Ongoing Trials. We also searched reference lists of identified studies. The search was completed in August 2004.


METHODS
Randomised controlled trials of action plans in COPD. Studies with a primary diagnosis of asthma excluded.


METHODS
Two reviewers independently assessed trial quality and extracted data. Investigators were contacted for additional information when necessary. Study results were combined in meta-analyses using the Cochrane Collaboration software RevMan.


RESULTS
There was evidence of a positive effect of action plans on self-management knowledge. The mean difference (MD) for recognition of a severe exacerbation was 2.50; 95% confidence interval 1.04 to 3.96, for self-action in severe exacerbations MD 1.50; 95% confidence interval 0.62 to 2.38 and the use of antibiotics MD 6.00; 95% confidence interval 2.68 to 9.32. There was also evidence of a positive effect on the initiation of antibiotics (odds ratio (OR) 10.16; 95% confidence interval 2.02 to 51.09) and/or oral steroids (OR 6.58; 95% confidence interval 1.29 to 33.62). However, there was no evidence of significant effects on healthcare utilisation, health-related quality of life, lung function, functional capacity, symptom scores, mortality, anxiety, or depression. No trials used as outcomes: number of exacerbations, length of exacerbations, or days lost from work.


CONCLUSIONS
This review shows there is evidence that action plans aid people with COPD in recognising and reacting appropriately to an exacerbation of their symptoms via the self-initiation of antibiotics or steroids. Further research needs to be completed with more comprehensive outcomes measures in order to ascertain whether this results in significantly decreased morbidity and/or mortality.
Turnock
A C
AC
University of Tasmania Medical School, Discipline of Medicine, University of Tasmania, 43 Collins Street, Hobart, Tasmania, Australia 7001. aturnock@utas.edu.au
Walters
E H
EH
Walters
J A E
JA
Wood-Baker
R
R
D001521:Behavior Therapy; D006293:Health Promotion; D006801:Humans; D010347:Patient Care Planning; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012648:Self Care