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26 September 2017

COPD action plan shortens exacerbation duration and reduces hospital admissions

The University of Twente and Medisch Spectrum Twente Enschede carried out the first study worldwide that shows patients with COPD (lung disease caused by smoking) and other diseases (heart disease, diabetes, anxiety and depression) have better outcomes if they follow a self-management programme with a customised action plan.

Anke Lenferink of UT recently obtained a doctoral degree on this subject. The study was awarded the Longfonds Publieksprijs in April 2017.

The goals of a self-management programme are to motivate, engage and provide support to patients to positively adapt their behaviours and to develop skills to better manage their disease. For example, quitting smoking, exercising, and better management of the disease through timely recognition and self-treatment of symptoms. The self-management programme with a patient-tailored action plan that focuses on COPD and other conmon diseases results in a shorter duration of COPD exacerbations  and reduced respiratory-related hospital admissions.

COPD

COPD (Chronic Obstructive Pulmonary Disease) is a chronic progressive lung disease caused primarily by smoking. COPD is also referred to as chronic bronchitis and emphysema. This lung disease is characterised by symptoms  of dyspnea, sputum purulence, wheezing, and coughing. Patients with COPD regularly experience acute worsening of symptoms, also referred to as a flare-up or exacerbation. These exacerbations reduce the quality of life and lead to more hospital admissions, increased costs and even an increased risk of death.

COPD and other Diseases

COPD is often accompanied by other diseases. Examples of these are heart failure, diabetes, anxiety and depression. These other diseases can result in even more hospital admissions and an increased risk of death. The other diseases often have the same risk factors as COPD (older age, smoking, being less active). In addition, COPD symptoms often overlap with the symptoms of the other diseases. For example, breathlessness or fatigue can be caused by COPD, as well as heart failure or anxiety.A treatment that focuses only on COPD will not be suitable for COPD patients who also have other diseases. This can lead to the initiation of delayed or inappropriate treatment, for example.


Approach of the study

“In the study, 145 Dutch (recruited from Medisch Spectrum Twente Enschede and Canisius-Wilhelmina Ziekenhuis Nijmegen) and 56 Australian COPD patients (recruited from three hospitals in Adelaide, Australia)  who also had other diseases were observed for a year. Half of the patients were offered a self-management programme with an action plan and the other half received standard care. We developed a patient-tailored action plan for both COPD and the other diseases (heart failure, anxiety, depression, diabetes) for each patient in the self-management programme. This personal action plan listed actions that patients could undertake themselves as soon as symptoms worsened (for example, taking medication, relaxation exercises, or contacting a healthcare provider for support). In addition, we provided a daily symptom diary so that all 201 patients could report changes in symptoms.” The self-management programme with the patient-tailored action plans resulted in reduced duration of COPD exacerbations, fewer hospital admissions for lung complaints and greater self-confidence, as well as more emotion.