A number of effective strategies have been developed to improve the quality of life in patients with COPD. However, few have been implemented in patients with COPD at all stages in a community setting. This study evaluated the efficacy of a complex COPD health management intervention in rural communities in China.
METHODS:
A randomized controlled trial including 8,217 subjects with COPD was implemented from May 2008 to May 2012 in 14 community health-care centers. The control group of subjects received usual care, whereas the management group of subjects participated in a health management program that included assessing the subjects' health status, giving regular health lectures, smoking cessation counseling, encouraging regular exercise, providing rehabilitative training and psychological counseling, and regular follow-up. As a primary outcome, we examined the changes in the BODE index. Secondary outcomes included depression and anxiety rates, current smoking rate, awareness of COPD, mortality, risk factors, respiratory medication use, hospital admissions, and emergency department visits.
RESULTS:
After 4 y, the mean cumulative value of the BODE index increased by 0.7 per subject in the control group and decreased by 0.4 per subject in the health management group (difference of 1.1, 95% CI 0.2–2.0, P < .001). Health management reduced anxiety symptoms by 4.8%, depression symptoms by 6.6%, current smoking by 14.3%, mortality due to all causes by 9.0%, hospitalizations due to all causes by 16.1%, and emergency department visits due to all causes by 18.1% (P < .05 for all). However, it increased immunomodulator use by 58.9%, respiratory medication use by 14.1–21.9%, and awareness scores for COPD by 57.2% (P < .05 for all).
CONCLUSIONS:
The health management program is an effective community-based strategy for the prevention and management of COPD in China, increasing awareness and knowledge among patients and practitioners and improving management within the limitations of access to pharmacotherapy.
FabbriLM, RabeKF. From COPD to chronic systemic inflammatory syndrome?. Lancet, 2007; 370(9589):797–799.
2.
BaileyWC, TashkinDP. Pharmacologic therapy: novel approaches for chronic obstructive pulmonary disease. Proc Am Thorac Soc, 2007; 4(7):543–548.
3.
Nussbaumer-OchsnerY, RabeKF. Systemic manifestations of COPD. Chest, 2011; 139(1):165–173.
4.
LacasseY, MartinS, LassersonTJ, GoldsteinRS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. A Cochrane systematic review. Eura Medicophys, 2007; 43(4):475–485.
5.
van WeteringCR, HoogendoornM, MolSJ, Rutten-van MölkenMP, ScholsAM. Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial. Thorax, 2010; 65(1):7–13.
6.
BodenheimerT, WagnerEH, GrumbachK. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA, 2002; 288(15):1909–1914.
7.
RiesAL, BauldoffGS, CarlinBW, CasaburiR, EmeryCF, MahlerDA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest, 2007; 131(5 Suppl):4S–42S.
8.
ErgünP, KaymazD, GünayE, ErdoğanY, TurayUY, DemirN, et al. Comprehensive outpatient pulmonary rehabilitation: treatment outcomes in early and late stages of chronic obstructive pulmonary disease. Ann Thorac Med, 2011; 6(2):70–76.
9.
RiceKL, DewanN, BloomfieldHE, GrillJ, SchultTM, NelsonDB, et al. Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med, 2010; 182(7):890–896.
10.
TsuiEW, WangG, ZahlerA, SimoyanOM, WhiteMV, MckeeM. A multilingual population health management program. J Ambul Care Manage, 2013; 36(2):140–146.
11.
LouP, ZhuY, ChenP, ZhangP, YuJ, ZhangN, et al. Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study. BMC Public Health, 2012; 12:287.
CelliBR, CoteCG, MarinJM, CasanovaC, Montes de OcaM, MendezRA, et al. The body mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 2004; 350(10):1005–1012.
14.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002; 166(1):111–117.
15.
BestallJC, PaulEA, GarrodR, GarnhamR, JonesPW, WedzichaJA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 1999; 54(7):581–586.
16.
BjellandI, DahlAA, HaugTT, NeckelmannD. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res, 2002; 52(2):69–77.
17.
van WeteringCR, HoogendoornM, BroekhuizenR, Geraerts-KeerisGJ, De MunckDR, Rutten-van MölkenMP, ScholsAM. Effective and costs of nutritional rehabilitation in muscle-waste patients with chronic obstructive pulmonary disease in community-based setting: a prespecified subgroup analysis of the INTERCOM trail. J Am Med Dir Assoc, 2010; 11(3):179–187.
18.
ZhouY, HuG, WangD, WangS, WangY, LiuZ, et al. Community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease (COPD) in Guangdong, China: cluster randomised controlled trial. BMJ, 2010; 341:c6387.
19.
BrownerWS, Du CheneAG, HulleySB. Effects of the Multiple Risk Factor Intervention Trial smoking cessation program on pulmonary function–a randomized controlled trial. West J Med, 1992; 157(5):534–538.
20.
AnthonisenNR, ConnettJE, KileyJP, AltoseMD, BaileyWC, BuistAS, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1 the lung health study. JAMA, 1994; 272(19):1497–1505.
21.
FerrariR, TanniSE, FaganelloMM, CaramLM, LuchetaPA, GodoyI. Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease. Braz J Med Biol Res, 2011; 44(1):46–52.
22.
CasanovaC, CoteCG, MarinJM, de TorresJP, Aguirre-JaimeA, MendezR, et al. The 6-min walking distance: long-term follow up in patients with COPD. Eur Respir J, 2007; 29(3):535–540.
23.
PauwelsRA, RabeKF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet, 2004; 364(9434):613–620.
24.
RennardS, DecramerM, CalverleyPM, PrideNB, SorianoJB, VermeirePA, VestboJ. Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey. Eur Respir J, 2002; 20(4):799–805.
25.
Di MarcoF, VergaM, ReggenteM, Maria CasanovaF, SantusP, BlasiF, et al. Anxiety and depression in COPD patients: the roles of gender and disease severity. Respir Med, 2006; 100(10):1767–1774.
26.
RabeKF, HurdS, AnzuetoA, BarnesPJ, BuistSA, CalverleyP, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2007; 176(6):532–555.
27.
ManninoDM, BuistAS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet, 2007; 370(9589):765–773.
28.
WillemseBW, ten HackenNH, RutgersB, Lesman-LeegteIG, PostmaDS, TimensW. Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers. Eur Respir J, 2005; 26(5):835–845.
29.
SimmonsMS, ConnettJE, NidesMA, LindgrenPG, KleerupEC, MurrayRP, et al. Smoking reduction and the rate of decline in FEV1: results from the Lung Health Study. Eur Respir J, 2005; 25(6):1011–1017.
30.
AuDH, BrysonCL, ChienJW, SunH, UdrisEM, EvansLE, BradleyKA. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med, 2009; 24(4):457–463.
31.
GodtfredsenNS, LamTH, HanselTT, LeonME, GrayN, DreslerC, et al. COPD-related morbidity and mortality after smoking cessation: status of the evidence. Eur Respir J, 2008; 32(4):844–853.
32.
CelliBR. Update on the management of COPD. Chest, 2008; 133(6):1451–1462.
33.
ZhouY, WangC, YaoW, ChenP, KangJ, HuangS, et al. COPD in Chinese nonsmokers. Eur Respir J, 2009; 33(3):509–518.
34.
HuG, ZhouY, TianJ, YaoW, LiJ, LiB, RanP. Risk of COPD from exposure to biomass smoke: a Metaanalysis. Chest, 2010; 138(1):20–31.
35.
MikkelsenRL, MiddelboeT, PisingerC, StageKB. Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD): a review. Nord J Psychiatry, 2004; 58(1):65–70.
36.
WilsonI. Depression in the patient with COPD. Int J Chron Obstruct Pulmon Dis, 2006; 1(1):61–64.
KunikME, BraunU, StanleyMA, WristersK, MolinariV, StoebnerD, OrengoCA. One session cognitive behavioral therapy for elderly patients with chronic obstructive pulmonary disease. Psychol Med, 2001; 31(4):717–723.
39.
KunikME, VeazeyC, CullyJA, SouchekJ, GrahamDP, HopkoD, et al. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Psychol Med, 2008; 38(3):385–396.
40.
WongsurakiatP, MaranetraKN, WasiC, KositanontU, DejsomritrutaiW, CharoenratanakulS. Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study. Chest, 2004; 125(6):2011–2020.
41.
YuWC, TaiEL, FuSN, KwongKC, YeungYC, ChangY, et al. Treatment of patients with chronic obstructive pulmonary disease as practised in a defined Hong Kong community: a cross-sectional pilot survey. Hong Kong Med J, 2011; 17(4):306–314.
