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Original Research: COPD |

Self-Management Following an Acute Exacerbation of COPDSelf-Management After an Acute COPD Exacerbation: A Systematic Review

Samantha L. Harrison, PhD; Tania Janaudis-Ferreira, PhD; Dina Brooks, PhD; Laura Desveaux, MSc; Roger S. Goldstein, MD, FCCP
Author and Funding Information

From the Department of Respiratory Medicine (Drs Harrison, Janaudis-Ferreira, Brooks, and Goldstein and Ms Desveaux), West Park Healthcare Centre; and Department of Physical Therapy (Drs Janaudis-Ferreira, Brooks, and Goldstein and Ms Desveaux) and Department of Medicine (Dr Goldstein), University of Toronto, Toronto, ON, Canada.

CORRESPONDENCE TO: Samantha L. Harrison, PhD, Department of Respiratory Medicine, West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON, M6M2J5, Canada; e-mail: samantha.harrison@westpark.org


Drs Harrison and Janaudis-Ferreira share joint first authorship.

FUNDING/SUPPORT: Dr Brooks holds a Canada research chair.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):646-661. doi:10.1378/chest.14-1658
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Published online

BACKGROUND:  Self-management (SM) reduces hospital admissions in patients with stable COPD. However, its role immediately post-acute exacerbation (AE) is unclear. The objectives of this review were to describe SM interventions delivered immediately following an AE of COPD (AECOPD) and to conduct a systematic review with meta-analysis of its impact on health-care utilization and health outcomes.

METHODS:  Randomized controlled trials reporting on SM interventions delivered during hospitalization for an AECOPD or within 1 month of hospital discharge were included. Seven articles were identified. Data were extracted and assessed for quality by two researchers.

RESULTS:  By definition, all interventions included action plans, education, and at least two SM skills. Nurses were responsible for providing all SM interventions. The delivery and follow-up periods varied widely. At 12 months, there were no significant differences between those who completed the SM intervention and control subjects in the number of patients readmitted to hospital (P = .38), or in health-related quality of life (P = .27). No effects were found on rate of mortality, depressive symptoms, primary care usage, or exercise capacity. Minimal effects were found on self-efficacy, anxiety symptoms, and health promoting behavior. SM was associated with positive effects on knowledge and management of an AECOPD.

CONCLUSIONS:  SM interventions delivered immediately post-AE vary widely and outcome measures are inconsistent, making it difficult to draw strong recommendations regarding its effectiveness. The evaluation of SM interventions, delivered by trained health-care professionals to selected patients and which offer structured follow-up, appears necessary.

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