Community based integrated intervention for prevention and management of chronic obstructive pulmonary disease (COPD) in Guangdong, China: cluster randomised controlled trial.
OBJECTIVE
To evaluate the effects of a community based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China.


METHODS
Cluster randomised controlled trial.


METHODS
Eight healthcare units in two communities.


METHODS
Of 1062 people aged 40-89, 872 (101 with COPD and 771 without COPD) who fulfilled the inclusion and exclusion criteria were allocated to the intervention or the usual care programmes.


METHODS
Participants randomly assigned to integrated intervention (systematic health education, intensive and individualised intervention, treatment, and rehabilitation) or usual care.


METHODS
Annual rate of decline in forced expiratory rate in one second (FEV(1)) before use of bronchodilator.


RESULTS
Annual rate of decline in FEV(1) was significantly lower in the intervention community than the control community, with an adjusted difference of 19 ml/year (95% confidence interval 3 to 36) and 0.9% (0.1% to 1.8%) of predicted values (all P<0.05), as well as a lower annual rate of decline in FEV(1)/FVC (forced vital capacity) ratio (adjusted difference 0.6% (0.1% to 1.2%) P=0.029). There were also higher rates of smoking cessation (21% v 8%, P<0.004) and lower cumulative death rates from all causes (1% v 3%, P<0.009) in the intervention community than in the control community during the four year follow-up. Improvements in knowledge of COPD and smoking hazards, outdoor air quality, environmental tobacco smoke, and working conditions were also achieved (all P<0.05). The difference in cumulative incidence rate of COPD (both around 4%) and cumulative death rate from COPD (2% v 11%) did not reach significance between the two communities.


CONCLUSIONS
A community based integrated intervention can have a significant impact on the prevention and management of COPD, mainly reflected in the annual rate of decline in FEV(1).


BACKGROUND
Chinese Clinical Trials Registration (ChiCTR-TRC-00000532).
State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Yumin
Y
Zhou
Guoping
G
Hu
Dali
D
Wang
Shaoyi
S
Wang
Yujun
Y
Wang
Zhigang
Z
Liu
Jinxin
J
Hu
Zhe
Z
Shi
Gongyong
G
Peng
Shengming
S
Liu
Jiachun
J
Lu
Jingping
J
Zheng
Jian
J
Wang
Nanshan
N
Zhong
Pixin
P
Ran
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002681:China; D016000:Cluster Analysis; D003153:Community Health Services; D042241:Early Diagnosis; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D013458:Sulfur Dioxide / Q000032:analysis; D011795:Surveys and Questionnaires; D014797:Vital Capacity
D000393:Air Pollutants; D001993:Bronchodilator Agents; D013458:Sulfur Dioxide