This is not the most recent version of the article. View current version (12 MAY 2010)
Intervention Review
Action plans for chronic obstructive pulmonary disease
Editorial Group: Cochrane Airways Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 22 JUL 2005
DOI: 10.1002/14651858.CD005074.pub2
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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- Published Online: 21 JAN 2009
This is not the most recent version of the article.View current version (12 May 2010)
Abstract
Background
The effectiveness of action plans as treatment for chronic obstructive pulmonary disease (COPD) is not known.
Objectives
To assess the efficacy of action plans in the management of COPD.
Search strategy
We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, CINAHL and the National Research Register of Ongoing Trials. We also searched reference lists of identified studies. The search was completed in August 2004.
Selection criteria
Randomised controlled trials of action plans in COPD. Studies with a primary diagnosis of asthma excluded.
Data collection and analysis
Two reviewers independently assessed trial quality and extracted data. Investigators were contacted for additional information when necessary. Study results were combined in meta-analyses using the Cochrane Collaboration software RevMan.
Main results
There was evidence of a positive effect of action plans on self-management knowledge. The mean difference (MD) for recognition of a severe exacerbation was 2.50; 95% confidence interval 1.04 to 3.96, for self-action in severe exacerbations MD 1.50; 95% confidence interval 0.62 to 2.38 and the use of antibiotics MD 6.00; 95% confidence interval 2.68 to 9.32. There was also evidence of a positive effect on the initiation of antibiotics (odds ratio (OR) 10.16; 95% confidence interval 2.02 to 51.09) and/or oral steroids (OR 6.58; 95% confidence interval 1.29 to 33.62). However, there was no evidence of significant effects on healthcare utilisation, health-related quality of life, lung function, functional capacity, symptom scores, mortality, anxiety, or depression. No trials used as outcomes: number of exacerbations, length of exacerbations, or days lost from work.
Authors' conclusions
This review shows there is evidence that action plans aid people with COPD in recognising and reacting appropriately to an exacerbation of their symptoms via the self-initiation of antibiotics or steroids. Further research needs to be completed with more comprehensive outcomes measures in order to ascertain whether this results in significantly decreased morbidity and/or mortality.
Plain language summary
Action plans for chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterised by exacerbations of symptoms which decrease quality of life. Action plans are designed to help an individual recognise a deterioration in their symptoms and initiate changes to treatment early. This is designed to reduce the impact of the exacerbation.
This review found that the use of action plans results in an increased ability to recognise and react appropriately to an exacerbation by individuals. Unfortunately there was no evidence these behavioural changes alter health-care utilisation.