PT  - JOURNAL ARTICLE
AU  - Julia Walters
AU  - Maxwell Howcroft
AU  - Richard Wood-Baker
AU  - E. Haydn Walters
TI  - Action plans with brief patient education only for exacerbations in COPD: A systematic review
AID  - 10.1183/13993003.congress-2016.PA3788
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA3788
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA3788.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA3788.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - Introduction: Exacerbations of COPD impair health status and impose high costs. Action plans help individuals recognise exacerbations to initiate early treatment.Aims: To assess effects of a COPD action plan and brief patient education input only on health outcomes and healthcare utilisation.Methods: Major databases were searched for trials comparing action plan use to usual care in COPD. An educational component of up to one hour and monthly support for action plan use were permitted but comprehensive self-management programmes were not. Data collection and analysis followed standard Cochrane Collaboration procedures; quality of evidence was graded.Results: Seven RCTs with 6-12 months follow up were included. Participant characteristics (n=1550) were: 66% male, 27% current smokers, mean age 68 years, mean post-bronchodilator FEV1 54% predicted. Action plan use reduced the combined rate of hospitalisations and emergency department visits for COPD over 12-months (1RCT, n=743) [rate ratio 0.59, 95% confidence interval (CI) 0.44 to 0.79; high quality], and decreased the likelihood of a hospital admission [odds ratio 0.69, 95% CI 0.49 to 0.97; n=897; 2 RCTs, moderate quality]. Over 12-months, 19 (95% CI 11 to 201) participants would need to be treated to prevent one hospital admission. All-cause mortality did not differ during 12-months. Use of oral corticosteroids over 12 months was increased, mean difference 0.74 courses 95% CI 0.12 to 1.35; n=200; 2 RCTs, moderate quality.Conclusions: Action plans with brief patient education only for management of COPD exacerbations can be safely used and reduce hospital healthcare utilisation.