Exacerbation action plans for patients with COPD and comorbidities: a randomised controlled trial

Anke Lenferink*, Job van der Palen, Paul D.L.P.M. van der Valk, Paul Cafarella, Anneke van Veen, Stephen Quinn, Catharina G.M. Groothuis-Oudshoorn, Morton G. Burt, Mary Young, Peter A. Frith, Tanja Effing

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)

Abstract

This international randomised controlled trial evaluated whether COPD patients with comorbidities, trained in using patient-tailored multidisease exacerbation action plans, had fewer COPD exacerbation days than usual care (UC).COPD patients (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II-IV) with ≥1 comorbidity (ischaemic heart disease, heart failure, diabetes, anxiety, depression) were randomised to a patient-tailored self-management intervention (n=102) or UC (n=99). Daily symptom diaries were completed for 12 months. The primary outcome "COPD exacerbation days per patient per year" was assessed using intention-to-treat analyses.No significant difference was observed in the number of COPD exacerbation days per patient per year (self-management: median 9.6 (interquartile range (IQR) 0.7-31.1); UC: median 15.6 (IQR 3.0-40.3); incidence rate ratio (IRR) 0.87 (95% CI 0.54; 1.39); p=0.546). There was a significantly shorter duration per COPD exacerbation for self-management (self-management: median 8.1 (IQR 4.8-10.1) days; UC: median 9.5 (IQR 7.0-15.1) days; p=0.021), with no between-group differences in the total number of respiratory hospitalisations (IRR 0.76 (95% CI 0.42; 1.35); p=0.348), but a lower probability of ≥1 for respiratory-related hospitalisation compared to UC (relative risk 0.55 (95% CI 0.35; 0.87); p=0.008). No between-group differences were observed in all-cause hospitalisations (IRR 1.07 (95% CI 0.66; 1.72)) or mortality (self-management: n=4 (3.9%); UC: n=7 (7.1%); relative risk 0.55 (95% CI 0.17; 1.84)).Patient-tailored exacerbation action plans for COPD patients with comorbidities did not significantly reduce exacerbation days, but reduced the duration per COPD exacerbation and the risk of having at least one respiratory-related hospitalisation during follow-up, without excess all-cause mortality.
Original languageEnglish
Article number1802134
JournalEuropean respiratory journal
Volume54
Issue number5
DOIs
Publication statusE-pub ahead of print/First online - 14 Aug 2019

Fingerprint

Chronic Obstructive Pulmonary Disease
Comorbidity
Randomized Controlled Trials
Self Care
Hospitalization
Incidence
Intention to Treat Analysis
Mortality
Myocardial Ischemia
Anxiety
Heart Failure
Depression

Keywords

  • Chronic obstructive pulmonary disease (COPD)
  • Comorbidity
  • Self-management
  • Symptom flare up
  • Hospitalisations
  • Randomised controlled trial

Cite this

Lenferink, Anke ; van der Palen, Job ; van der Valk, Paul D.L.P.M. ; Cafarella, Paul ; van Veen, Anneke ; Quinn, Stephen ; Groothuis-Oudshoorn, Catharina G.M. ; Burt, Morton G. ; Young, Mary ; Frith, Peter A. ; Effing, Tanja. / Exacerbation action plans for patients with COPD and comorbidities : a randomised controlled trial. In: European respiratory journal. 2019 ; Vol. 54, No. 5.
@article{e636d44171b943fe98ce3a26dbb46552,
title = "Exacerbation action plans for patients with COPD and comorbidities: a randomised controlled trial",
abstract = "This international randomised controlled trial evaluated whether COPD patients with comorbidities, trained in using patient-tailored multidisease exacerbation action plans, had fewer COPD exacerbation days than usual care (UC).COPD patients (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II-IV) with ≥1 comorbidity (ischaemic heart disease, heart failure, diabetes, anxiety, depression) were randomised to a patient-tailored self-management intervention (n=102) or UC (n=99). Daily symptom diaries were completed for 12 months. The primary outcome {"}COPD exacerbation days per patient per year{"} was assessed using intention-to-treat analyses.No significant difference was observed in the number of COPD exacerbation days per patient per year (self-management: median 9.6 (interquartile range (IQR) 0.7-31.1); UC: median 15.6 (IQR 3.0-40.3); incidence rate ratio (IRR) 0.87 (95{\%} CI 0.54; 1.39); p=0.546). There was a significantly shorter duration per COPD exacerbation for self-management (self-management: median 8.1 (IQR 4.8-10.1) days; UC: median 9.5 (IQR 7.0-15.1) days; p=0.021), with no between-group differences in the total number of respiratory hospitalisations (IRR 0.76 (95{\%} CI 0.42; 1.35); p=0.348), but a lower probability of ≥1 for respiratory-related hospitalisation compared to UC (relative risk 0.55 (95{\%} CI 0.35; 0.87); p=0.008). No between-group differences were observed in all-cause hospitalisations (IRR 1.07 (95{\%} CI 0.66; 1.72)) or mortality (self-management: n=4 (3.9{\%}); UC: n=7 (7.1{\%}); relative risk 0.55 (95{\%} CI 0.17; 1.84)).Patient-tailored exacerbation action plans for COPD patients with comorbidities did not significantly reduce exacerbation days, but reduced the duration per COPD exacerbation and the risk of having at least one respiratory-related hospitalisation during follow-up, without excess all-cause mortality.",
keywords = "Chronic obstructive pulmonary disease (COPD), Comorbidity, Self-management, Symptom flare up, Hospitalisations, Randomised controlled trial",
author = "Anke Lenferink and {van der Palen}, Job and {van der Valk}, {Paul D.L.P.M.} and Paul Cafarella and {van Veen}, Anneke and Stephen Quinn and Groothuis-Oudshoorn, {Catharina G.M.} and Burt, {Morton G.} and Mary Young and Frith, {Peter A.} and Tanja Effing",
year = "2019",
month = "8",
day = "14",
doi = "10.1183/13993003.02134-2018",
language = "English",
volume = "54",
journal = "European respiratory journal",
issn = "0903-1936",
publisher = "European Respiratory Society",
number = "5",

}

Exacerbation action plans for patients with COPD and comorbidities : a randomised controlled trial. / Lenferink, Anke ; van der Palen, Job; van der Valk, Paul D.L.P.M.; Cafarella, Paul; van Veen, Anneke; Quinn, Stephen; Groothuis-Oudshoorn, Catharina G.M.; Burt, Morton G.; Young, Mary; Frith, Peter A.; Effing, Tanja.

In: European respiratory journal, Vol. 54, No. 5, 1802134, 14.08.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Exacerbation action plans for patients with COPD and comorbidities

T2 - a randomised controlled trial

AU - Lenferink, Anke

AU - van der Palen, Job

AU - van der Valk, Paul D.L.P.M.

AU - Cafarella, Paul

AU - van Veen, Anneke

AU - Quinn, Stephen

AU - Groothuis-Oudshoorn, Catharina G.M.

AU - Burt, Morton G.

AU - Young, Mary

AU - Frith, Peter A.

AU - Effing, Tanja

PY - 2019/8/14

Y1 - 2019/8/14

N2 - This international randomised controlled trial evaluated whether COPD patients with comorbidities, trained in using patient-tailored multidisease exacerbation action plans, had fewer COPD exacerbation days than usual care (UC).COPD patients (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II-IV) with ≥1 comorbidity (ischaemic heart disease, heart failure, diabetes, anxiety, depression) were randomised to a patient-tailored self-management intervention (n=102) or UC (n=99). Daily symptom diaries were completed for 12 months. The primary outcome "COPD exacerbation days per patient per year" was assessed using intention-to-treat analyses.No significant difference was observed in the number of COPD exacerbation days per patient per year (self-management: median 9.6 (interquartile range (IQR) 0.7-31.1); UC: median 15.6 (IQR 3.0-40.3); incidence rate ratio (IRR) 0.87 (95% CI 0.54; 1.39); p=0.546). There was a significantly shorter duration per COPD exacerbation for self-management (self-management: median 8.1 (IQR 4.8-10.1) days; UC: median 9.5 (IQR 7.0-15.1) days; p=0.021), with no between-group differences in the total number of respiratory hospitalisations (IRR 0.76 (95% CI 0.42; 1.35); p=0.348), but a lower probability of ≥1 for respiratory-related hospitalisation compared to UC (relative risk 0.55 (95% CI 0.35; 0.87); p=0.008). No between-group differences were observed in all-cause hospitalisations (IRR 1.07 (95% CI 0.66; 1.72)) or mortality (self-management: n=4 (3.9%); UC: n=7 (7.1%); relative risk 0.55 (95% CI 0.17; 1.84)).Patient-tailored exacerbation action plans for COPD patients with comorbidities did not significantly reduce exacerbation days, but reduced the duration per COPD exacerbation and the risk of having at least one respiratory-related hospitalisation during follow-up, without excess all-cause mortality.

AB - This international randomised controlled trial evaluated whether COPD patients with comorbidities, trained in using patient-tailored multidisease exacerbation action plans, had fewer COPD exacerbation days than usual care (UC).COPD patients (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II-IV) with ≥1 comorbidity (ischaemic heart disease, heart failure, diabetes, anxiety, depression) were randomised to a patient-tailored self-management intervention (n=102) or UC (n=99). Daily symptom diaries were completed for 12 months. The primary outcome "COPD exacerbation days per patient per year" was assessed using intention-to-treat analyses.No significant difference was observed in the number of COPD exacerbation days per patient per year (self-management: median 9.6 (interquartile range (IQR) 0.7-31.1); UC: median 15.6 (IQR 3.0-40.3); incidence rate ratio (IRR) 0.87 (95% CI 0.54; 1.39); p=0.546). There was a significantly shorter duration per COPD exacerbation for self-management (self-management: median 8.1 (IQR 4.8-10.1) days; UC: median 9.5 (IQR 7.0-15.1) days; p=0.021), with no between-group differences in the total number of respiratory hospitalisations (IRR 0.76 (95% CI 0.42; 1.35); p=0.348), but a lower probability of ≥1 for respiratory-related hospitalisation compared to UC (relative risk 0.55 (95% CI 0.35; 0.87); p=0.008). No between-group differences were observed in all-cause hospitalisations (IRR 1.07 (95% CI 0.66; 1.72)) or mortality (self-management: n=4 (3.9%); UC: n=7 (7.1%); relative risk 0.55 (95% CI 0.17; 1.84)).Patient-tailored exacerbation action plans for COPD patients with comorbidities did not significantly reduce exacerbation days, but reduced the duration per COPD exacerbation and the risk of having at least one respiratory-related hospitalisation during follow-up, without excess all-cause mortality.

KW - Chronic obstructive pulmonary disease (COPD)

KW - Comorbidity

KW - Self-management

KW - Symptom flare up

KW - Hospitalisations

KW - Randomised controlled trial

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U2 - 10.1183/13993003.02134-2018

DO - 10.1183/13993003.02134-2018

M3 - Article

C2 - 31413163

VL - 54

JO - European respiratory journal

JF - European respiratory journal

SN - 0903-1936

IS - 5

M1 - 1802134

ER -