Self Management for COPD: A Randomized Controlled Trial

Rice KL, Dewan N, Bloomfield HE, Grill J, Schult TE, Nelson DB, Kumari S, Thomas M, Geist LJ, Beaner C, Caldwell M, Niewoehner DE. Self Management for COPD: A Randomized Controlled Trial. Presented at: American Thoracic Society Annual International Conference; 2008 May 21; Toronto, Canada.

Rationale: The aim of our study was to determine whether a limited case/self management program reduces hospital admissions and emergency department (ED) visits due to COPD exacerbations. Methods: This was a prospective multi-center, randomized, controlled, 1 yr study of case/self management (1hr educational and clinical assessment session, adjustment of respiratory medications according to guidelines, a written action plan with refillable prescriptions for antibiotics and prednisone bursts, and a monthly telephone call from the case manager) compared to usual care. Eligibility included a hospital admission, ED visit, systemic steroid use, or use of home O2 for COPD. Results: 743 patients were enrolled at 5 VA sites. Baseline characteristics were similar in both groups. The composite primary endpoint of hospitalizations and ED visits for COPD was 49.0/100 pt yr in the intervention group and 83.1 in the usual care group (p < 0.0001, 41% reduction; reduction in COPD hospitalizations 31%, ED visits 51%). The difference in St. Georges Respiratory Questionnaire scores at 1 yr was 4.9 in favor of case/self management (p < 0.001). Conclusions: A COPD case/self management program in a VA setting reduces hospital admissions and ED visits due to COPD exacerbation.