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Self-management in chronic obstructive pulmonary disease. Time for a paradigm shift?
Linda Nici1, Thomas D Bontly, Richard Zuwallack
11 Pulmonary and Critical Care, Providence Veterans Affairs Medical Center, Providence, Rhode Island.
Annals of the American Thoracic Society
|January 28, 2014
Summary
Self-management plans for chronic obstructive pulmonary disease (COPD) show mixed results. Some trials had increased mortality, suggesting a need for better implementation and patient selection for COPD self-care strategies.
Area of Science:
- Pulmonary Medicine
- Health Services Research
Background:
- Self-management plans, including exacerbation action plans and improved patient-provider communication, are clinically logical for chronic obstructive pulmonary disease (COPD).
- However, results from five large trials of COPD self-management have been inconsistent, with only two showing reduced healthcare utilization and one halted due to increased mortality.
Purpose of the Study:
- To analyze discordant findings in COPD self-management trials.
- To identify potential reasons for increased mortality in one trial and guide future research.
Main Methods:
- Review of data from multiple large clinical trials on COPD self-management interventions.
- Analysis of patient adherence and treatment initiation times in trials with negative outcomes.
Main Results:
- One trial was discontinued due to increased mortality, with patients showing poor adherence to self-management protocols (e.g., delayed treatment initiation).
- Patients in the high-mortality trial initiated antibiotics or steroids late and rarely contacted providers before starting treatment.
Conclusions:
- Current COPD self-management strategies may require refinement, particularly regarding implementation and patient selection.
- Further well-designed clinical trials are needed to optimize self-management interventions and identify high-risk patient groups who may benefit or be harmed.
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