Effectiveness of community-based management models in chronic obstructive pulmonary disease: a systematic review and...

Chronic obstructive pulmonary disease (COPD) is a common fatal disease with high morbidity, disability, and economic burden, and it poses a major challenge to global public health. The limitations of the traditional hospital-based management models and the lack of continuous professional guidance and support for people with COPD after discharge have led to repeated acute exacerbations of the disease and high rates of rehospitalization. Community-based management models have received attention because of their convenience, affordability, and accessibility; however, their effectiveness has not been comprehensively and systematically evaluated.

This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and comprehensively searched for randomized controlled trials (RCTs) in the China National Knowledge Infrastructure, Wangfang Data, VIP Database, SinoMed, Cochrane Library, PubMed, and Web of Science from the inception to 6 May 2025. A control group received usual care, and an experimental group received community-based management models (community-based integrated management or telemedicine management, respectively) with an intervention period of >6 months. Two researchers independently used the NoteExpress software for literature management, the Cochrane Risk of Bias Assessment Tool for risk of bias assessment of the included studies, and RevMan5.4.1 for the meta-analysis of outcome indicators.

Thirty-three RTCs, encompassing a cohort of 12,288 people with COPD, were included in this study. The community-based management models demonstrated significant improvements in the 6-min walk test (mean difference [MD] = 39.73; 95% confidence interval [CI, 30.15, 49.32]; p < 0.00001) and lung function parameters (forced expiratory volume in the first second/forced vital capacity [FEV1/FVC]: MD = 6.17; 95% CI [4.54, 7.79], p < 0.00001; FEV1% predicted: MD = 4.91, 95% CI [3.96, 5.85], p < 0.00001). Additionally, it was associated with decreased breathing difficulties (MD = -0.72, 95% CI [-1.23, -0.21], p = 0.006) and COPD assessment test (CAT) scores (MD = -4.46, 95% CI [-5.67, -3 0.25], p < 0.00001). Telemedicine management also significantly reduced the frequency of acute exacerbations of COPD (MD = -0 0.56; 95% CI [-0.79, -0.32], p < 0.00001). Both management models showed comparable effects on the FEV1/FVC ratio, FEV1% predicted, and CAT scores. However, in terms of alleviating dyspnea symptoms-as measured by the modified Medical Research Council scale-community-based integrated management proved superior to telemedicine management (p = 0.007). Notably, neither approach demonstrated a statistically significant advantage in improving quality of life among COPD populations, as assessed by the St. George's Respiratory Questionnaire's total score (MD = -1.98, 95% CI [-5.02, 1.07], p = 0.2).

Community-based management models were significantly better than the usual care in improving exercise tolerance, reducing symptoms, such as dyspnea, and improving lung function in people with COPD. Telemedicine management further reduced the number of acute exacerbations of COPD but did not improve exercise tolerance, and the effect of community-based integrated management on this indicator needs to be verified. Subgroup analyses revealed a significant difference between community-based integrated management and telemedicine management only in improving dyspnea; community-based integrated management was superior to telemedicine management alone. However, neither of the models showed a significant advantage in improving quality of life, suggesting that more comprehensive and precise intervention strategies should be explored in future studies and practice.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251046698, identifier CRD420251046698.