title: Action plans and case manager support may hasten recovery of symptoms following an acute exacerbation in patients with chronic obstructive pulmonary disease (COPD).
abstract: OBJECTIVE
  In patients with COPD, does an action plan (AP) with support from a case manager lead to earlier contact with healthcare professionals and faster recovery from an exacerbation?
  
  
  METHODS
  Randomised, controlled trial with concealed allocation. Patients were unaware of the study aims.
  
  
  METHODS
  8 regional hospitals and 5 general practices in Europe.
  
  
  METHODS
  Adults with COPD, aged > 40 years, with a substantial smoking history, and using bronchodilators were eligible. Exclusion criteria were a primary diagnosis of asthma or cardiac disease, or presence of disease that would affect mortality or participation (eg, confusion). Randomisation of 233 patients allocated 111 to the intervention group and 122 to the control group.
  
  
  METHODS
  Both groups received usual care and brief nurse-led education about management of their disease. In addition, the intervention group received an individualised written AP, encouragement to contact the nurse for more information if needed, and two standardised telephone reinforcement sessions at 1 and 4 months following randomisation. The nurse, in consultation with physician, was able to provide a course of corticosteroids and antibiotics.
  
  
  METHODS
  Patients recorded their symptoms daily and completed the 24-hour Clinical COPD Questionnaire (CCQ) every 3 days, for 6 months. The primary outcome was time to recovery of health status following an exacerbation, defined as a return to pre-exacerbation CCQ scores. Secondary outcomes included the time delay between exacerbation onset and exacerbation-related healthcare contact and exacerbationrelated self-efficacy.
  
  
  RESULTS
  CCQ data were available for 216 patients. The mean symptom recovery time was shorter in the AP group by 3.68 days (95% CI 0.04 to 7.32). Patients in the AP group with an exacerbation sought treatment 2.9 days earlier (95% CI 2.4 to 3.5) than patients in the control group. The change in self-efficacy was higher in favour of the AP group. There were no differences in the number of exacerbations or healthcare contact between the groups.
  
  
  CONCLUSIONS
  An AP with case manager support enhanced early detection of exacerbations and expedited recovery from symptoms following these events.
authors.affiliation: Department of Respiratory Medicine, Repatriation Hospital, Adelaide, Australia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Effing