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Observational Study
. 2016 Nov 8;16(1):140.
doi: 10.1186/s12890-016-0304-3.

The evaluation of a remote support program on quality of life and evolution of disease in COPD patients with frequent exacerbations

Bernardino Alcazar  1 , Pilar de Lucas  2 , Joan B Soriano  3 , Alonso Fernández-Nistal  4 , Antonia Fuster  5 , Jose Miguel Rodríguez González-Moro  2 , Aurelio Arnedillo  6 , Patricia García Sidro  7 , María José Espinosa de Los Monteros  8
Affiliations
Observational Study

The evaluation of a remote support program on quality of life and evolution of disease in COPD patients with frequent exacerbations

Bernardino Alcazar et al. BMC Pulm Med. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) patients often present considerable individual medical burden in their symptoms, limitations, and well-being that complicate medical treatment. To improve their overall health status, while reducing the number of exacerbations, a multidisciplinary approach including different elements of care is needed. The aim of this study was to evaluate the effects of a remote support program on COPD patients at high risk of experiencing worsening of their disease and other health-related outcomes.

Methods: An observational, multicenter, prospective study aimed at evaluating the impact of a 7-month remote support program on COPD patients in exacerbations control and changes in health status measured with the COPD assessment test (CAT). Factors associated with a clinically relevant decrease in CAT were assessed using a logistic regression analysis.

Results: A total of 114 subjects started the program. The majority of the study population were males (81.6 %), retired (70.2 %), without academic qualifications or with a low level of education (68.4 %), and ex-smokers (79.8 %). The mean ± SD age was 69.6 ± 9.1 years and the BMI was 27.8 ± 5.5 Kg/m2. Overall, 41.9 % (95 % CI 31.9-52.0) patients, significantly improved health status (CAT decrease ≥ 2 points). Univariate analysis showed that significant improvement in CAT was associated with baseline CAT scores [high CAT score 19.2 (±7.5) vs. low CAT score 12.4 (±6.4); OR = 1.15, 95 % CI: 1.07-1.24; p < 0.001] and with being non-compliant [62.5 % (15/24) of non-compliant vs 34.7 % (24/69) of compliant patients significantly improved CAT scores; OR = 3.13, 95 % CI: 1.19-8.19; p = 0.021). After controlling for the effect of all variables in a multivariable logistic regression model, the only factor that remained significant was baseline CAT score. The proportion of smokers in the total population remained constant during the study. There was a significant reduction in the number of exacerbations after entering this remote support program with median -1 (IQR: -2, 0), (p < 0.001). The Morisky-Green questionnaire showed an increase of treatment compliance, namely at baseline, 25.8 % (24/93) of patients were noncompliant while in the end 66.7 % (16/24) of them became compliant) (p = 0.053).

Conclusions: A remote support program for high-risk COPD patients results in an improvement of the patients' health status, particularly in those with initially poor health status, and it helps to reduce COPD exacerbations.

Keywords: Chronic obstructive pulmonary disease; Education; Exacerbations; Management; Quality of life.

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Figures

Fig. 1
Fig. 1
Flow Diagram of the study
Fig. 2
Fig. 2
Flow-chart of the study
Fig. 3
Fig. 3
COPD assessment test (CAT) scores at baseline, at the first (V2) and second (V3) follow-up visits and at the end of the study (FV)
Fig. 4
Fig. 4
Difference in the number of exacerbation (12 months before starting the study and during the 12-months follow-up of the study)
See this image and copyright information in PMC

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