Self-management interventions that include COPD exacerbation action plans improve health-related quality of life – A Cochrane review

COPD self-management interventions usually have an action plan as a key component. Studies of these interventions show contradictory results. We have assessed the effectiveness of COPD self-management interventions that include COPD exacerbation action plans compared to usual care.

After a literature search, full-text articles were each independently assessed by two authors. Criteria for considering studies for this review were: randomised controlled trials published from 1995–May 2015; self-management interventions that included a written action plan for COPD exacerbations; and an iterative process between patient and healthcare provider.

From the 1,633 identified records, 22 studies were included, which had follow-up times between two and 24 months. A statistically significant effect of self-management on health-related quality of life (HRQoL) was found (St George's Respiratory Questionnaire total score, mean difference -2.55 (95% CI -4.22;-0.88), 10 studies, 1,799 participants, I2: 8%). Self-management also led to a statistically significant lower probability of respiratory-related hospitalisations (OR 0.69 (95% CI 0.50;0.95), 13 studies, 3,095 participants, I2: 60%) and a non-significant trend towards less all-cause hospitalisations (OR 0.74 (95% CI 0.54;1.03), 10 studies, 2,467 participants, I2: 62%). No effects on mortality were found (risk difference 0.00 (95% CI -0.03;0.03), 14 studies, 3,205 participants, I2: 55%).

Self-management interventions that include action plans for COPD exacerbations are associated with improved HRQoL and lower probability of respiratory-related hospitalisations. No effects were found on mortality.