Action plans for chronic obstructive pulmonary disease
Evidence SummariesLevel of Evidence = C
Action plans helping people with COPD to recognise exacerbations may reduce hospitalisations and may increase self-initiation of antibiotics or steroids compared with usual care.
A Cochrane review 1 included 7 studies with a total of 1,550 subjects. Studies of an individual action plan with minimal or no self management education, compared to control in patients with moderate or severe COPD were included. 'Action plans' refer to encouragement of early intervention by providing guidelines on how to recognise an exacerbation via symptoms. In one trial an action plan with phone call follow-up non-significantly reduced the combined rate of hospitalisations and emergency department visits. Action plans reduced hospital admission (OR 0.69, 95% CI 0.49 to 0.97; 2 trials, n=897) and emergency department visits (OR 0.55, 95% CI 0.38 to 0.78; 2 trials, n=897). Action plans were associated with increased use of oral corticosteroids over 12 months (MD 0.74, 95% CI 0.14 to 1.35; 2 studies, n=200) and use of antibiotics (MD 2.3 courses, 95% CI 1.8 to 2.7; 3 trials, n=943). Health-related quality of life on St George’s Respiratory Questionnaire (SGRQ) showed a small improvement with action plans compared with usual care over 12 months (MD -2.8, 95% CI -0.8 to -4.8; 3 trials, n=1009; three RCTs).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and blinding), and by imprecise results (wide confidence intervals).
1. Walters JA, Turnock AC, Walters EH, Wood-Baker R. Action plans with limited patient education only for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2010;(5):CD005074 [Assessed as up-to-date: 21 November 2015]. [PMID:20464737]
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