title: [Effectiveness of a specific program for patients with chronic obstructive pulmonary disease and frequent exacerbations].
abstract: OBJECTIVE
  Patients with chronic obstructive pulmonary disease (COPD) and a history of frequent exacerbations are a target population of particular interest from both a clinical and an economic standpoint. The objective of this study was to evaluate the effectiveness of a program designed specifically to manage patients in this subgroup.
  
  
  METHODS
  This was a 1-year randomized controlled trial designed to compare the effectiveness of a specific program (SP) with that of conventional management (CM) in a group of patients with a high frequency of exacerbations (3 or more per year). Within-group and between-group comparisons were carried out for a number of variables related to the patients medical care, dyspnea, health-related quality of life (HRQL), inhalation technique, and pulmonary function.
  
  
  RESULTS
  A total of 26 patients were enrolled in the study (all men). The mean (SD) age was 73 (8) years, and mean forced expiratory volume in 1 second (FEV1) expressed as a percentage of the reference value was 43% (15%). Exacerbations requiring hospital care (emergency department visits and/or admission) decreased in both groups: by 24.4% (P not significant) in the CM group and 44.1% (P=.061) in the SP group. Hospital admissions decreased 73.3% in the SP group and increased 22% in the CM group (P< .001). While length of hospital stay decreased 77.3% in the SP group, this figure almost doubled in the CM group (P=.014). Dyspnea, HRQL, and inhalation technique improved in both groups. FEV1 fell by 46 mL/year in the CM group and increased 10 mL/year in the SP group (P not significant).
  
  
  CONCLUSIONS
  The use of a simple program to manage selected patients with a history of frequent exacerbations produces a significant reduction in the number of hospital admissions, an improvement in HRQL, and may improve prognosis.
authors.affiliation: Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, España. jjsoler@telefónica.net
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Soler
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martínez-García
authors.forename: Pilar
authors.initials: P
authors.lastname: Román
authors.forename: Rosa
authors.initials: R
authors.lastname: Orero
authors.forename: Susana
authors.initials: S
authors.lastname: Terrazas
authors.forename: Amparo
authors.initials: A
authors.lastname: Martínez-Pechuán
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*