[Effectiveness of a specific program for patients with chronic obstructive pulmonary disease and frequent exacerbations].
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.
Soler
Juan José
JJ
Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, España. jjsoler@telefónica.net
Martínez-García
Miguel Angel
MA
Román
Pilar
P
Orero
Rosa
R
Terrazas
Susana
S
Martínez-Pechuán
Amparo
A
D000368:Aged; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*