Effectiveness of a specific program for patients with chronic obstructive pulmonary disease and frequent exacerbations
Por:
Soler JJ, Martínez-García MA, Román P, Orero R, Terrazas S and Martínez-Pechuán A
Publicada:
1 oct 2006
Categoría:
Pulmonary and Respiratory Medicine
Resumen:
OBJECTIVE: Patients with chronic obstructive pulmonary disease (COPD) and a history of frequent exacerbations are a target population of particular interest from both a clinical and an economic standpoint. The objective of this study was to evaluate the effectiveness of a program designed specifically to manage patients in this subgroup.
PATIENTS AND METHODS: This was a 1-year randomized controlled trial designed to compare the effectiveness of a specific program (SP) with that of conventional management (CM) in a group of patients with a high frequency of exacerbations (3 or more per year). Within-group and between-group comparisons were carried out for a number of variables related to the patients' medical care, dyspnea, health-related quality of life (HRQL), inhalation technique, and pulmonary function.
RESULTS: A total of 26 patients were enrolled in the study (all men). The mean (SD) age was 73 (8) years, and mean forced expiratory volume in 1 second (FEV1) expressed as a percentage of the reference value was 43% (15%). Exacerbations requiring hospital care (emergency department visits and/or admission) decreased in both groups: by 24.4% (P not significant) in the CM group and 44.1% (P=.061) in the SP group. Hospital admissions decreased 73.3% in the SP group and increased 22% in the CM group (P <.001). While length of hospital stay decreased 77.3% in the SP group, this figure almost doubled in the CM group (P=.014). Dyspnea, HRQL, and inhalation technique improved in both groups. FEV1 fell by 46 mL/year in the CM group and increased 10 mL/year in the SP group (P not significant).
CONCLUSIONS: The use of a simple program to manage selected patients with a history of frequent exacerbations produces a significant reduction in the number of hospital admissions, an improvement in HRQL, and may improve prognosis.
Filiaciones:
:
Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, España.
Hosp Gen Requena, Unidad Neumol, Med Interna Serv, Valencia, Spain
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