Unravelling self-management for patients with COPD: long-term effects of the COPE-II study

Chronic obstructive pulmonary disease (COPD) is a chronic and usually progressive disease. Besides symptoms of dyspnoea, sputum production and chronic cough, patients with COPD often have impaired exercise capacity and a decreased physical activity level. Despite optimal pharmacological treatment, patients still experience symptoms and may have difficulties to cope with their disease. In view of this, self-management is increasingly recognised to be important in the treatment of COPD. Scientific evidence on long-term effectiveness of self-management programmes remains scarce. Moreover, it is uncertain what the contribution of independent components of self-management is to its effectiveness. To assess the current state of evidence on the effectiveness of self-management for patients with COPD, we have updated the Cochrane review on this topic. Meta-analyses showed that self-management interventions in patients with COPD are associated with improved health-related quality of life and a reduction in hospital admission. Additionally, the long-term (i.e. after two years of follow-up) effectiveness of two frequently used self-management components, self-treatment of exacerbations and a community-based exercise programme, were evaluated using a randomised controlled trial. Data showed that patients with COPD clearly benefit from self-treatment of exacerbations guided by an action plan as regards the duration and severity of exacerbations. Also, self-treatment reduced healthcare utilisation leading to considerable cost savings. The community-based exercise programme was effective in achieving a behavioural change reflected by a sustained increase in daily physical activity level, but this was not accompanied by a sustained increase in maximal exercise capacity in patients with COPD after two years of follow-up. Based on these results, recommendations for current clinical practice and future research were made.