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Meta-Analysis
. 2018 Feb 7;2(2):CD012528.
doi: 10.1002/14651858.CD012528.pub2.

Self-management for bronchiectasis

Carol Kelly  1 , Seamus Grundy, Dave Lynes, David Jw Evans, Sharada Gudur, Stephen J Milan, Sally Spencer
Affiliations
Meta-Analysis

Self-management for bronchiectasis

Carol Kelly et al. Cochrane Database Syst Rev. .

Abstract

Background: Bronchiectasis is a long term respiratory condition with an increasing rate of diagnosis. It is associated with persistent symptoms, repeated infective exacerbations, and reduced quality of life, imposing a burden on individuals and healthcare systems. The main aims of therapeutic management are to reduce exacerbations and improve quality of life. Self-management interventions are potentially important for empowering people with bronchiectasis to manage their condition more effectively and to seek care in a timely manner. Self-management interventions are beneficial in the management of other airways diseases such as asthma and COPD (chronic obstructive pulmonary disease) and have been identified as a research priority for bronchiectasis.

Objectives: To assess the efficacy, cost-effectiveness and adverse effects of self-management interventions for adults and children with non-cystic fibrosis bronchiectasis.

Search methods: We searched the Cochrane Airways Specialised Register of trials, clinical trials registers, reference lists of included studies and review articles, and relevant manufacturers' websites up to 13 December 2017.

Selection criteria: We included all randomised controlled trials of any duration that included adults or children with a diagnosis of non-cystic fibrosis bronchiectasis assessing self-management interventions delivered in any form. Self-management interventions included at least two of the following elements: patient education, airway clearance techniques, adherence to medication, exercise (including pulmonary rehabilitation) and action plans.

Data collection and analysis: Two review authors independently screened searches, extracted study characteristics and outcome data and assessed risk of bias for each included study. Primary outcomes were, health-related quality of life, exacerbation frequency and serious adverse events. Secondary outcomes were the number of participants admitted to hospital on at least one occasion, lung function, symptoms, self-efficacy and economic costs. We used a random effects model for analyses and standard Cochrane methods throughout.

Main results: Two studies with a total of 84 participants were included: a 12-month RCT of early rehabilitation in adults of mean age 72 years conducted in two centres in England (UK) and a six-month proof-of-concept RCT of an expert patient programme (EPP) in adults of mean age 60 years in a single regional respiratory centre in Northern Ireland (UK). The EPP was delivered in group format once a week for eight weeks using standardised EPP materials plus disease-specific education including airway clearance techniques, dealing with symptoms, exacerbations, health promotion and available support. We did not find any studies that included children. Data aggregation was not possible and findings are reported narratively in the review.For the primary outcomes, both studies reported health-related quality of life, as measured by the St George's Respiratory Questionnaire (SGRQ), but there was no clear evidence of benefit. In one study, the mean SGRQ total scores were not significantly different at 6 weeks', 3 months' and 12 months' follow-up (12 months mean difference (MD) -10.27, 95% confidence interval (CI) -45.15 to 24.61). In the second study there were no significant differences in SGRQ. Total scores were not significantly different between groups (six months, MD 3.20, 95% CI -6.64 to 13.04). We judged the evidence for this outcome as low or very low. Neither of the included studies reported data on exacerbations requiring antibiotics. For serious adverse events, one study reported more deaths in the intervention group compared to the control group, (intervention: 4 of 8, control: 2 of 12), though interpretation is limited by the low event rate and the small number of participants in each group.For our secondary outcomes, there was no evidence of benefit in terms of frequency of hospital admissions or FEV1 L, based on very low-quality evidence. One study reported self-efficacy using the Chronic Disease Self-Efficacy scale, which comprises 10 components. All scales showed significant benefit from the intervention but effects were only sustained to study endpoint on the Managing Depression scale. Further details are reported in the main review. Based on overall study quality, we judged this evidence as low quality. Neither study reported data on respiratory symptoms, economic costs or adverse events.

Authors' conclusions: There is insufficient evidence to determine whether self-management interventions benefit people with bronchiectasis. In the absence of high-quality evidence it is advisable that practitioners adhere to current international guidelines that advocate self-management for people with bronchiectasis.Future studies should aim to clearly define and justify the specific nature of self-management, measure clinically important outcomes and include children as well as adults.

PubMed Disclaimer

Conflict of interest statement

Sally Spencer – none known

Carol Kelly – none known

Dave Lynes – none known

Seamus Grundy – none known

David Evans – none known

Stephen Milan – none known

Sharada Gudur‐ none know

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Study flow diagram
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Early rehab versus usual care, Outcome 1 SGRQ Total: mean difference.
1.2
1.2. Analysis
Comparison 1 Early rehab versus usual care, Outcome 2 FEV1 L: mean difference.
1.3
1.3. Analysis
Comparison 1 Early rehab versus usual care, Outcome 3 Mortality.
2.1
2.1. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 1 SGRQ Total: mean difference.
2.2
2.2. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 2 Self‐efficacy: Exercise.
2.3
2.3. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 3 Self‐efficacy: Disease info.
2.4
2.4. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 4 Self‐efficacy: Obtain help.
2.5
2.5. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 5 Self‐efficacy: Communication.
2.6
2.6. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 6 Self‐efficacy: Manage disease.
2.7
2.7. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 7 Self‐efficacy: Do chores.
2.8
2.8. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 8 Self‐efficacy: Social activity.
2.9
2.9. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 9 Self‐efficacy: Manage symptoms.
2.10
2.10. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 10 Self‐efficacy: Manage breathlessness.
2.11
2.11. Analysis
Comparison 2 Expert patient programme versus usual care, Outcome 11 Self‐efficacy: Manage depression.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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NCT02179983 {published data only}
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