Action plans and case manager support may hasten recovery of symptoms following an acute exacerbation in patients with chronic obstructive pulmonary disease (COPD).

In patients with COPD, does an action plan (AP) with support from a case manager lead to earlier contact with healthcare professionals and faster recovery from an exacerbation? Randomised, controlled trial with concealed allocation. Patients were unaware of the study aims. 8 regional hospitals and 5 general practices in Europe. Adults with COPD, aged > 40 years, with a substantial smoking history, and using bronchodilators were eligible. Exclusion criteria were a primary diagnosis of asthma or cardiac disease, or presence of disease that would affect mortality or participation (eg, confusion). Randomisation of 233 patients allocated 111 to the intervention group and 122 to the control group. Both groups received usual care and brief nurse-led education about management of their disease. In addition, the intervention group received an individualised written AP, encouragement to contact the nurse for more information if needed, and two standardised telephone reinforcement sessions at 1 and 4 months following randomisation. The nurse, in consultation with physician, was able to provide a course of corticosteroids and antibiotics. Patients recorded their symptoms daily and completed the 24-hour Clinical COPD Questionnaire (CCQ) every 3 days, for 6 months. The primary outcome was time to recovery of health status following an exacerbation, defined as a return to pre-exacerbation CCQ scores. Secondary outcomes included the time delay between exacerbation onset and exacerbation-related healthcare contact and exacerbationrelated self-efficacy. CCQ data were available for 216 patients. The mean symptom recovery time was shorter in the AP group by 3.68 days (95% CI 0.04 to 7.32). Patients in the AP group with an exacerbation sought treatment 2.9 days earlier (95% CI 2.4 to 3.5) than patients in the control group. The change in self-efficacy was higher in favour of the AP group. There were no differences in the number of exacerbations or healthcare contact between the groups. An AP with case manager support enhanced early detection of exacerbations and expedited recovery from symptoms following these events.

Effing T 《-》

Effect of an action plan with ongoing support by a case manager on exacerbation-related outcome in patients with COPD: a multicentre randomised controlled trial.

Trappenburg JC ，Monninkhof EM ，Bourbeau J ，Troosters T ，Schrijvers AJ ，Verheij TJ ，Lammers JW ... -  《-》

Effects of written action plan adherence on COPD exacerbation recovery.

Bischoff EW ，Hamd DH ，Sedeno M ，Benedetti A ，Schermer TR ，Bernard S ，Maltais F ，Bourbeau J ... -  《-》

Using titrated oxygen instead of high flow oxygen during an acute exacerbation of chronic obstructive pulmonary disease (COPD) saves lives.

In patients with a suspected acute exacerbation of COPD, does titrated oxygen in the pre-hospital setting change mortality, length of hospital stay and blood gas measurements? Cluster randomised controlled trial in which paramedics were allocated to deliver titrated or high flow oxygen. Randomisation sequence was concealed prior to allocation. Ambulance service and emergency department in Hobart, Australia. People who were: transported by ambulance to the emergency department, aged ≥35 years, breathless, and were thought to have COPD based on their acute symptoms, a patient-stated history of COPD, or a smoking history of > 10 pack-years. Randomisation of 64 paramedics allocated 32 to the titrated oxygen group and 30 to the high flow oxygen group. Over the study duration, 179 and 226 patients were allocated to the titrated and high flow oxygen groups, respectively. Patients in both groups received basic support, nebulised bronchodilators, intravenous dexamethasone and, if necessary, intravenous or intramuscular salbutamol. In addition, the intervention group received titrated oxygen via nasal prongs, with the aim of maintaining arterial oxygen saturation, measured via a pulse oximeter (SpO(2)) between 88% and 92%. Nebulised therapy was delivered by compressed air. The control group received high flow oxygen (8 to 10 L/min) via a non-rebreather face mask. Nebulised therapy was delivered by compressed oxygen at 6 to 8 L/min. The primary outcome was pre-and in-hospital mortality. Secondary outcomes were length of hospital stay and blood gas measurements. The primary outcome was captured for all enrolled patients. According to the intention to treat (ITT) analysis, mortality in the intervention and control groups was 4% (n = 7) and 9% (n = 21), respectively. The relative risk was 0.42 (95% CI 0.20 to 0.89). Similar results were demonstrated when only those patients who had a physician-confirmed diagnosis of COPD were included in the analyses (mortality of 2%, n = 2, vs 9%, n = 11, and relative risk of 0.22, 95% CI 0.05 to 0.9]). The ITT analysis did not demonstrate between-group differences in the secondary outcomes. In patients with a suspected acute exacerbation of COPD, using titrated oxygen to maintain SpO(2) between 88% and 92% reduced the risk of mortality by 58%. Physiotherapists working in acute care should strive to ensure that these patients are not treated with high-flow oxygen.

Ntoumenopoulos G 《-》

A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease.

Sridhar M ，Taylor R ，Dawson S ，Roberts NJ ，Partridge MR ... -  《-》