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COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD

Romain Kessler, Pere Casan-Clara, Dieter Koehler, Silvia Tognella, Jose Luis Viejo, Roberto W. Dal Negro, Salvador Díaz-Lobato, Karina Reissig, José Miguel Rodríguez González-Moro, Gilles Devouassoux, Jean-Michel Chavaillon, Pierre Botrus, Jean-Michel Arnal, Julio Ancochea, Anne Bergeron-Lafaurie, Carlos De Abajo, Winfried J. Randerath, Andreas Bastian, Christian G. Cornelissen, Georg Nilius, Joëlle B. Texereau, Jean Bourbeau
European Respiratory Journal 2018 51: 1701612; DOI: 10.1183/13993003.01612-2017
Romain Kessler
Pneumologie, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
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Pere Casan-Clara
Asturias University Hospital, Oviedo, Spain
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Dieter Koehler
Kloster Grafschaft Specialized Hospital, Schmallenberg, Germany
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Silvia Tognella
Bussolengo General Hospital, Bussolengo, Italy
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Jose Luis Viejo
Burgos University Hospital, Burgos, Spain
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Roberto W. Dal Negro
Bussolengo Hospital, Bussolengo, Italy
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Salvador Díaz-Lobato
Ramón y Cajal University Hospital, Research Institute IRYCIS, Alcalá de Henares University, Madrid, Spain
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Karina Reissig
Kloster Grafschaft Specialized Hospital, Schmallenberg, Germany
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José Miguel Rodríguez González-Moro
Principe de Asturias University Hospital, Madrid, Spain
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Gilles Devouassoux
Croix Rousse Hospital, Lyon, France
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Jean-Michel Chavaillon
Antibes-Juan-les-Pins Hospital Center, Antibes, France
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Pierre Botrus
Metz-Thionville Hospital Center, Thionville, France
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Jean-Michel Arnal
Sainte Musse Hospital, Toulon, France
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Julio Ancochea
Pneumology Dept, La Princesa Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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Anne Bergeron-Lafaurie
Pneumology Dept, Saint-Louis Hospital, Paris, France
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Carlos De Abajo
Burgos University Hospital, Burgos, Spain
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Winfried J. Randerath
Dept of Pneumology, Bethanien C.V. Hospital, University of Cologne, Solingen, Germany
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Andreas Bastian
St Mary's Hospital Kassel GmbH, Kassel, Germany
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Christian G. Cornelissen
Section for Pneumology, University Hospital Aachen, Aachen, Germany
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Georg Nilius
Dept of Pneumology, HELIOS Klinik Hagen-Ambrock, University of Witten/Herdecke, Hagen, Germany
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Joëlle B. Texereau
AP-HP, Dept of Respiratory Physiology, Cochin Hospital, René Descartes University, Paris, FranceAir Liquide Healthcare, Medical Research and Development, Jouy-en-Josas, France
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Jean Bourbeau
FRCP Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
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  • For correspondence: jean.bourbeau@mcgill.ca
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Abstract

The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.

The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.

For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference −5.3, 95% CI −13.7 to −3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries.

The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients.

Abstract

Lower all-cause mortality in multicomponent home-based disease management programme vs routine care in severe COPD http://ow.ly/sykh30gS5XO

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • This study is registered at ClinicalTrials.gov with identifier NCT01241526.

  • Support statement: This study was funded by Air Liquide Healthcare. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

  • Received August 7, 2017.
  • Accepted October 13, 2017.
  • Copyright ©ERS 2018
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COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD
Romain Kessler, Pere Casan-Clara, Dieter Koehler, Silvia Tognella, Jose Luis Viejo, Roberto W. Dal Negro, Salvador Díaz-Lobato, Karina Reissig, José Miguel Rodríguez González-Moro, Gilles Devouassoux, Jean-Michel Chavaillon, Pierre Botrus, Jean-Michel Arnal, Julio Ancochea, Anne Bergeron-Lafaurie, Carlos De Abajo, Winfried J. Randerath, Andreas Bastian, Christian G. Cornelissen, Georg Nilius, Joëlle B. Texereau, Jean Bourbeau
European Respiratory Journal Jan 2018, 51 (1) 1701612; DOI: 10.1183/13993003.01612-2017

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COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD
Romain Kessler, Pere Casan-Clara, Dieter Koehler, Silvia Tognella, Jose Luis Viejo, Roberto W. Dal Negro, Salvador Díaz-Lobato, Karina Reissig, José Miguel Rodríguez González-Moro, Gilles Devouassoux, Jean-Michel Chavaillon, Pierre Botrus, Jean-Michel Arnal, Julio Ancochea, Anne Bergeron-Lafaurie, Carlos De Abajo, Winfried J. Randerath, Andreas Bastian, Christian G. Cornelissen, Georg Nilius, Joëlle B. Texereau, Jean Bourbeau
European Respiratory Journal Jan 2018, 51 (1) 1701612; DOI: 10.1183/13993003.01612-2017
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