Written action plans in chronic obstructive pulmonary disease increase appropriate treatment for acute exacerbations
Article first published online: 3 AUG 2006
Volume 11, Issue 5, pages 619–626, September 2006
How to Cite
WOOD-BAKER, R., McGLONE, S., VENN, A. and WALTERS, E. H. (2006), Written action plans in chronic obstructive pulmonary disease increase appropriate treatment for acute exacerbations. Respirology, 11: 619–626. doi: 10.1111/j.1440-1843.2006.00902.x
- Issue published online: 3 AUG 2006
- Article first published online: 3 AUG 2006
- Received 12 August 2005; invited to revise 9 February 2006; revised 7 March 2006; accepted 23 March 2006 (Associate Editor: Toshihiro Nukiwa).
- chronic obstructive;
- motor activity;
- patient-care planning;
- pulmonary disease;
- quality of life;
- respiratory function test
Objective and background: COPD is a progressive disorder characterized by periodic exacerbations. While comprehensive self-management programmes decrease health-care resource utilization, the essential components are unclear. We performed a study of written action plans in the management of COPD.
Methodology: A randomized, controlled, prospective parallel-group study compared written action plans to usual practice.
Subjects: Recruited from general practices, received an educational intervention with or without an action plan, which usually emphasized prompt treatment with antibiotics and corticosteroids. Subjects were followed up 3-monthly for a year.
Results: One hundred and thirty-nine participants, mean FEV1 45 ± 16% predicted, were recruited, 81% completing the study. Both groups had a decline in lung function and physical activity, but increase in quality of life over the study period. Exacerbations were common. The intervention group was significantly more likely to have treatment with antibiotics (χ2 = 3.86; d.f. = 1; P = 0.05) or short course oral corticosteroids (χ2 = 14.25; d.f. = 1; P < 0.001). No differences were found between the number of general practitioner consultations, attendances at emergency departments or hospitalizations.
Conclusions: The use of a written action plan in COPD increased appropriate therapeutic interventions for exacerbations, but this effect was not associated with a decrease in the use of health-care resources.