The aim of this systematic review was to evaluate the efficacy of self-management interventions specifically designed for people with chronic obstructive pulmonary disease (COPD) that include a COPD exacerbation action plan compared with usual care for health-related quality of life, respiratory-related hospital admissions and other health outcomes. Twenty-two studies (n= 3,854 participants) were included in this review. There was a statistically significant effect of self-management interventions with action plans on health-related quality of life over 12 months (mean difference (MD) -2.69, 95% CI -4.49 to -0.90; 1,582 participants; 10 studies; high-quality evidence). Participants in the intervention group were at lower risk for having at least one respiratory-related hospital admission compared with those who received usual care (odds ratio (OR) 0.69, 95% CI 0.51 to 0.94; 3,157 participants; 14 studies; moderate-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over one year was 12 (95% CI 7 to 69) for participants with high baseline risk and 17 (95% CI 11 to 93) for participants with low baseline risk. There was no difference in the probability of at least one all-cause hospital admission, hospitalisation days, visits to the emergency department or general practitioner, number of COPD exacerbations, all-cause mortality, and dyspnoea scores. To conclude, self-management interventions with a COPD exacerbation action plan improve health-related quality of life and decrease the probability of respiratory-related hospital admissions.
Lenferink A et al. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2017;Issue 8