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Evidence summaries

Self-Management for Patients with Chronic Obstructive Pulmonary Disease

Self-management interventions appear to be associated with a reduction in respiratory-related hospital admissions, improved health-related quality of life, and improvement in dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Level of evidence: "B"

A Cochrane review [Abstract] 1 included 29 studies; 23 studies (n=3 189) compared self-management with usual care, and 6 studies (n=499) compared different components of self management head-to-head. In the 23 studies with a usual care control group, follow-up time ranged from 2 to 24 months. The content of the interventions was diverse. Self management improved quality of life as measured by the St George's Respiratory Questionnaire (SGRQ) total score (table T1) and decreased respiratory-related hospital admissions, but did not have any statistically significant effect on all-cause hospital admissions or mortality (table T2). Over one year of follow-up, 8 (95% CI 5 to 14) participants with a high baseline risk of respiratory-related hospital admission needed to be treated to prevent one participant with at least one hospital admission, and 20 (95% CI 15 to 35) participants with a low baseline risk of hospitalisation needed to be treated to prevent one participant with at least one respiratory-related hospital admission.

Self management compared with control for participants with chronic obstructive pulmonary disease

OutcomeControl groupSelf management groupParticipants(studies)
HRQoL: SGRQ total score(Scale 0-100; lower score indicates better HRQoL)Range of mean SGRQ total scores in the control group varied from 34.7 to 65.3 pointsMean SGRQ total score in the intervention group was 3.51 lower (5.37 to 1.65 lower)1 413 (10 studies)
Dyspnoea: (m)MRC scoreRange of mean (m)MRC scores in the control group varied from 2.4 to 3.6 pointsMean (m)MRC total score in the intervention group was 0.83 lower (1.36 to 0.3 lower)119 (3 studies)
Exercise capacity: 6MWDRange of mean 6MWD in the control group varied from 68.6 to 440.9 mMean 6MWD in the intervention group was 33.69 higher (9.12 lower to 76.50 higher)570 (6 studies)
HRQoL = Health related quality of life; SGRQ = St George's Respiratory Questionnaire; (m)MRC = (modified) Medical Research Council Scale; 6MWD = six-minute walking distance
Self management compared with control for participants with chronic obstructive pulmonary disease
OutcomeRelative effect(95% CI)Assumed risk - controlCorresponding risk - self managementParticipants(studies)
Respiratory-related hospital admissionsOR 0.57 (0.43 to 0.75 )293 per 1000190 per 1000(151 to 237)1 749(9 studies)
All-cause hospital admissionsOR 0.77 (0.45 to 1.30 )413 per 1000310 per 1000(241 to 478)1 365(6 studies)
Courses of oral steroidsOR 4.42 (0.39 to 50.10 )541 per 1000892 per 1000(315 to 983)901(3 studies)
MortalityOR 0.79 (0.58 to 1.07 )97 per 100079 per 1000(59 to 103)2 134(8 studies)

No effects of self management on lung function were found, but dyspnoea as measured by the (modified) Medical Research Council Scale ((m)MRC) was significantly reduced in participants assigned to self management. The difference in exercise capacity as measured by the six-minute walking test was not statistically significant (table T1). Subgroup analyses depending on the use of an exercise programme as part of the intervention revealed no statistically significant differences between studies with and without exercise programmes in the primary outcomes of HRQoL and respiratory-related hospital admissions.Head-to-head trials were not pooled because of heterogeneity among interventions and controls.

Comment: The quality of evidence is downgraded by inconsistency.