A self-management education program including an action plan for acute COPD exacerbations

Abstract

Exacerbations are an important cause of morbidity and mortality in COPD. We assessed treatment initiation and health care use at exacerbation in patients receiving a self-management education program including an action plan. COPD patients were randomly assigned to usual care or to a comprehensive self-management program "Living Well with COPD" including a written action plan and case manager support, and were followed-up for 12 months. Patients in the usual care were managed by their respective practitioners. Patients in the self-management program received, as part of a written action plan, a prescription of antibiotics and prednisone for self-initiation in case of aggravation of 2 or more symptoms (dyspnea, sputum volume, sputum purulence) for at least 24 hours, and they had the support of a case-manager for reinforcement and monthly telephone follow-ups. At 12 months, 166 patients presented with at least one exacerbation. Exacerbations (606) were confirmed by aggravation of at least one symptom; 403 (67.6%) presented 2 or more. Antibiotics were used in 61.6% of exacerbations and prednisone in 47.9%. In exacerbations presenting aggravation of 2 or more symptoms, antibiotics and prednisone were used together more often in the action plan than in the usual care group (54.4% vs. 34.8%, p < 0.001). In the action plan, compared to the usual care group, 17.2% vs. 36.3% exacerbations resulted in a hospitalization (p < 0.001). Self-management with the successful use of an action plan for acute exacerbation of COPD holds promise for reducing health care use.