Integrated disease management improves one-year quality of life in primary care COPD patients: a controlled clinical trial

Chavannes, Niels H.; Grijsen, Marlous; van den Akker, Marjan; Schepers, Huub; Nijdam, Maddy; Tiep, Brian; Muris, Jean
September 2009
Primary Care Respiratory Journal;Sep2009, Vol. 18 Issue 3, p171
Academic Journal
Aim: To assess the long-term effectiveness of an integrated disease management (IDM) program (consisting of optimal medication, reactivation, education, and exacerbation management) in primary care patients with chronic obstructive pulmonary disease (COPD). Method: Controlled trial comparing the effects of IDM on quality of life - assessed by the St. George's Respiratory Questionnaire (SGRQ) - in primary care COPD patients. The minimal clinically important change on the SGRQ was accepted as being -4 points. Baseline and oneyear differences were compared using paired sample T-tests. The differential effects of an FEV1/FVC ratio <0.7 and dyspnoea as assessed by the Medical Research Council (MRC) Dyspnoea scale were investigated. Results: The average age of subjects was 63 years, with an average post-bronchodilator FEV1 of 67% predicted, average FEV1/FVC ratio of 0.65, a mean of 35 pack-years smoking, and 63% were male. No significant differences existed between groups at baseline. After one year of IDM, SGRQ had improved by -4.6 points (95% CI, -7.2 to -2.0; p=0.001) in the intervention group, versus -0.7 points (95% CI, - 3.0 to 1.6; p=0.6) in the usual care group. In patients with an FEV1/FVC ratio <0.7, SGRQ improved by -5.9 points (95% CI, -9.6 to -2.2; p=0.002) in the IDM group, while in the usual care group SGRQ improved by -0.8 points (95% CI, -4.1 to 2.4; p=0.6). In patients with an MRC Dyspnoea score >2 and FEV1/FVC <0.7, SGRQ improved by -13.4 points (95% CI, -20.8 to -6.1; p=0.002) in the IDM group, versus -0.3 points (95% CI, -5.5 to 4.9; p=0.9) in the usual care group. Conclusion: In this study, IDM improved one-year quality of life in primary care COPD patients, compared to usual care. The improvement in SGRQ was both clinically relevant and statistically significant, and was greatest in patients with FEV1/FVC <0.7 and MRC Dyspnoea score >2.


Related Articles

  • PILOTING AND EVALUATING POST-PULMONARY REHABILITATION (PR) LONG-TERM EXERCISE (LTE) FOR COPD PATIENTS. Roberts, S. E.; Kettle, G.; Rogers, S.; Segal, A.; Purcell, S.; Fabris, G.; Broomfield, H.; Calonge-Contreras, M.; Billet, J.; Restrick, L.; Stern, M. // Thorax;Dec2011 Supplement, pA127 

    Introduction There is evidence that regular exercise profoundly affects both the course and outcome of COPD. While PR is well established for COPD patients limited by breathlessness, there is currently no evidence-base for follow-on LTE, which takes into account expressed desires of patients to...

  • Nurse-led COPD project is cost-effective. Moberly, Tom // Independent Nurse;10/5/2009, p8 

    The article focuses on the programme of exercise and education led by primary care trust (PCT) nurses in the Isle of Wight which had been proven to improve the quality of life for patients suffering from chronic obstructive pulmonary diseases (COPD). The programme's first batch of participants...

  • Is hospitalisation for COPD an opportunity for advance care planning? A qualitative study. Seamark, David; Blake, Susan; Seamark, Clare; Hyland, Michael E.; Greaves, Colin; Pinnuck, Margaret; Ward, David; Hawkins, Adam; Halpin, David // Primary Care Respiratory Journal;Sep2012, Vol. 21 Issue 3, p261 

    BACKGROUND: It is recognised that patients with chronic obstructive pulmonary disease (COPD) should have the chance to discuss end-of-life care and advance care planning (ACP). Admission to hospital with an exacerbation may be a possible opportunity. AIMS: To examine whether an admission to...

  • The Dyspnoea, Obstruction, Smoking, Exacerbation (DOSE) index is predictive of mortality in COPD. Sundh, Josefin; Janson, Christer; Lisspers, Karin; Ställberg, Björn; Montgomery, Scott // Primary Care Respiratory Journal;Sep2012, Vol. 21 Issue 3, p295 

    BACKGROUND: The Dyspnoea, Obstruction, Smoking, Exacerbation (DOSE) index was designed to assess disease severity and for the clinical management of chronic obstructive pulmonary disease (COPD), but has not been evaluated as a prognostic instrument for mortality in a population including primary...

  • Self-management for COPD? Why does it generate negative connotations? Sohanpal, Ratna; Epiphaniou, Eleni; Taylor, Stephanie // British Journal of General Practice;Aug2014, Vol. 64 Issue 625, pe522 

    The article discusses the evidence that patients with obstructive pulmonary disease (COPD) want to understand their condition and manage breathlessness and exacerbation. The patchiness of of the evidence for the benefit of self-management of COPD is described. The article comments on the...

  • Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial. Zakrisson, Ann-Britt; Engfeldt, Peter; Hägglund, Doris; Odencrants, Sigrid; Hasselgren, Mikael; Arne, Mats; Theander, Kersti // Primary Care Respiratory Journal;Dec2011, Vol. 20 Issue 4, p427 

    Aim: To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD). Method: A 1-year...

  • Withdrawal of inhaled corticosteroids in individuals with COPD - a systematic review and comment on trial methodology. Nadeem, Nighat J.; Taylor, Stephanie J. C.; Eldridge, Sandra M. // Respiratory Research;Aug2011, Vol. 12 Issue 8, p1 

    Inhaled corticosteroids (ICS) reduce COPD exacerbation frequency and slow decline in health related quality of life but have little effect on lung function, do not reduce mortality, and increase the risk of pneumonia. We systematically reviewed trials in which ICS have been withdrawn from...

  • The Effects of Theophylline on Hospital Admissions and Exacerbations in COPD Patients. Fexer, Johannes; Donnachie, Ewan; Schneider, Antonius; Wagenpfeil, Stefan; Keller, Manfred; Hofmann, Frank; Mehring, Michael // Deutsches Aerzteblatt International;4/25/2014, Vol. 111 Issue 17, p293 

    Background: Theophylline is often used to treat chronic obstructive pulmonary disease (COPD). Current evidence leaves the effectiveness and safety of this drug open to question. Thus, we evaluated the effectiveness of theophylline on the rate of hospitalizations and disease exacerbations by...

  • A qualitative study of stakeholder views of a community-based anticipatory care service for patients with COPD. Cleland, Jennifer; Moffat, Mandy; Small, Iain // Primary Care Respiratory Journal;Sep2012, Vol. 21 Issue 3, p255 

    BACKGROUND: The need to consider anticipatory preventive care for people with chronic obstructive pulmonary disease (COPD) has been highlighted in UK guidelines and policy. AIMS: To explore stakeholder views of the utility and design of a community-based anticipatory care service (CBACS) for...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics