A self-treatment programme in patients with COPD: Effectiveness for the reduction of severe exacerbations

Abstract

Introduction: Non-pharmacological interventions in COPD can save care resources.

Material and Methods: A multicentre, randomized, single-blind, parallel-group clinical trial with a one-year follow-up of a self-treatment programme (STP) versus conventional management. The STP intervention group included a group education centre, training in inhaler technique and a written treatment plan. The control group received standard care. The main variable was the severe exacerbations rate. Secondary variables were number of admissions and mortality.

Results: Of the 250 patients recruited, 101 (40.4%) were included in the trial; 38 (37.62%) patients in the control group (CG) completed the trial and 47 (46.53%) in the intervention group (IG). There were no significant differences in the baseline characteristics of the patients. Twenty (52.6%) patients in the CG presented severe exacerbations vs 19 (40.4%) in the IG (P=0.262). Sixteen patients (42.1%) in the CG were hospitalised vs 12 (25.5%) in the IG (P=0.106). Two patients (5.26%) in the control group died vs none in the intervention group (P=0.383). The severe exacerbations rate was 1.37 (1.02–1.79) in the CG vs 0.89 (0.64-1.21) in the IG (P=0.049) (rate ratio, 1.53 [1.01-2.29]). The NNT (STP vs conventional treatment) to prevent one severe exacerbation per year was 6.25 (5.0-8.0).

Conclusions: 1. In the first year, the STP reduced the severe exacerbations rate in patients with COPD. 2. The STP reduced the number of hospitalizations and of severe exacerbations. 3. The STP could be used in less than half of the selected population.