[Evaluation of a structured education programme for patients with COPD under outpatient conditions-- a pilot study]

In contrast to other chronic diseases, such as bronchial asthma, the role of patient education in the management of COPD still remains unclear. Therefore, we evaluated the efficacy of a structured education programme for COPD-patients under outpatient conditions in a prospective pilot study including 21 patients with mild to moderate COPD over a period of two years. The main teaching items of the programme are: self-control of the disease with regular peak flow measurements, the observation of typical symptoms and the patients diary, effects and side effects of the medication, correct inhalation technique and the patients' ability to change the medication with respect to the actual degree of airflow limitation. The frequency of episodes of dyspnoea per day was significantly reduced after the first year. Before the training course the patients had an average of 1.6 +/- 0.5 episodes of dyspnoea per day, after the first year 1.0 +/- 0.5 (p < 0.05). With respect to the year before the intervention, the total number of the exacerbations did not change significantly in the two years after the participation in the programme, but the number of self-managed exacerbations increased. Further effects were an improvement of the knowledge of the patients about the effects and side effects of the medication: before the education the number of correct answers in a multiple choice test was 9.1%, one year later 68.7% (p < 0.01) and after the second year 70.5% (p < 0.01). The self-control of the disease could be improved by regular observation of symptoms, peak flow measurements and patients' diary. The number of hospital days due to the diagnosis COPD decreased from 10.1 +/- 0.5 days per patient and year to 2.1 +/- 0.2 days (p < 0.01) in the first year after the education and remained constant with 2.4 +/- 0.6 days (p < 0.01) even in the second year after the course. The efficacy of the education programme is still evident two years after the training. In comparison to the results one year after the programme we found a loss of efficacy in some aspects, particularly in the self-control of the disease. In conclusion, structured education programmes under outpatient conditions could improve the self management abilities in patients with mild to moderate COPD. Randomized controlled trials with a larger sample size are needed to confirm the results of this pilot study.