Patient education alone not enough to improve COPD

Among patients with Chronic obstructive pulmonary disease (COPD), increased education, improved self-management skills and enhanced follow-up components of pulmonary rehabilitation do not seem to lead to better health-related quality of life in compared with usual care without such extras, new research shows.

Instead, other aspects of pulmonary rehabilitation, such as peer interactions and exercise, may be more essential to improving health, the study authors speculate.

"In contrast to other chronic diseases such as asthma, enhanced patient education and follow-up by a nurse among patients with COPD does not lead to clinically relevant improvements in health outcomes compared to the ongoing care that they are getting from their regular physicians," said study author Dr. David Coultas, of the University of Texas Health Center at Tyler.

Coultas conducted the research while he was at the University of Florida Health Science Center in Jacksonville.

Chronic obstructive pulmonary disease (COPD) is a group of lung diseases involving limited airflow and varying degrees of air sac enlargement, airway inflammation, and lung tissue destruction. Emphysema and chronic bronchitis are the most common forms of COPD.
Most commonly caused by cigarette smoking, COPD includes the lung disease emphysema and chronic bronchitis, and is marked by progressively worsening shortness of breath and coughing. COPD is currently the fourth leading cause of death in the United States and worldwide.

To reduce the worldwide economic burden associated with the condition, various teams have published international guidelines on the best way to manage COPD patients. Those guidelines state that optimal management includes pulmonary rehabilitation, which consists of patient education, self-management training, psychosocial interventions and several other components. Many affected individuals do not have access to such rehabilitation services, however, as such care is usually provided at specialized centers.

Coultas and his team speculated that one way to improve patients' access is to offer the most integral components of pulmonary rehabilitation at other off-site locations. Since little is known about which components are most essential, they focused on providing study participants with nurse-assisted home care consisting of patient education, efforts to improve patient self-management skills and enhanced follow-up.

Their study group consisted of 151 adults ages 45 years or older, who were current or former smokers, had previously been diagnosed with COPD, had experienced cough, shortness of breath, or some other respiratory symptom during the previous year and had evidence of airflow obstruction.

The study participants were randomly divided into a group that received usual care, a group that received nurse-assisted medical management, which was particularly focused on patient education, or a group that received nurse-assisted collaborative management, which was an even more enhanced type of care.