title: Efficacy of a self-management plan in exacerbations for patients with advanced COPD.
abstract: BACKGROUND
  Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD.
  
  
  METHODS
  Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality.
  
  
  RESULTS
  After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0.191).
  
  
  CONCLUSIONS
  The implementation of a self-management program for patients with advanced COPD reduced exacerbations that required hospital care.
authors: Division of Pneumology, Hospital Morales Meseguer; University of Murcia.
authors: Juan Miguel
authors: JM
authors: Sánchez-Nieto
authors: Division of Pneumology, Hospital Arrixaca, Murcia.
authors: Rubén
authors: R
authors: Andújar-Espinosa
authors: Division of Pneumology, Hospital Morales Meseguer; University of Murcia.
authors: Roberto
authors: R
authors: Bernabeu-Mora
authors: Division of Pneumology, Hospital Morales Meseguer.
authors: Chunshao
authors: C
authors: Hu
authors: Division of Pneumology, Hospital Morales Meseguer.
authors: Beatriz
authors: B
authors: Gálvez-Martínez
authors: Division of Pneumology, Hospital Morales Meseguer.
authors: Andrés
authors: A
authors: Carrillo-Alcaraz
authors: Division of Pneumology, Hospital Arrixaca, Murcia.
authors: Carlos Federico
authors: CF
authors: Álvarez-Miranda
authors: Division of Pneumology, Hospital Morales Meseguer.
authors: Olga
authors: O
authors: Meca-Birlanga
authors: Department of Professional Development Unit, Murcia, Spain.
authors: Eva
authors: E
authors: Abad-Corpa
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage; D018450:Disease Progression; D004636:Emergency Service, Hospital; D015444:Exercise; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010353:Patient Education as Topic; D010359:Patient Readmission; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012648:Self Care / Q000379:methods*; D016037:Single-Blind Method; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents
keywords: COPD; self-management; severe exacerbations