title: 'The COPD breathlessness manual': a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture.
  
  
  OBJECTIVE
  To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status.
  
  
  METHODS
  Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups.
  
  
  RESULTS
  After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05-3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant.
  
  
  CONCLUSIONS
  The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care.
authors.affiliation: Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Howard
authors.affiliation: Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Dupont
mesh_terms: D000339:Affect; D000368:Aged; D015928:Cognitive Behavioral Therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010174:Pamphlets; D010353:Patient Education as Topic; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D016037:Single-Blind Method