Action plans for chronic obstructive pulmonary disease

Turnock AC, Walters EH, Walters JAE, Wood-Baker R

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Summary

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterised by exacerbations of symptoms which decrease quality of life. Action plans are designed to help an individual recognise a deterioration in their symptoms and initiate changes to treatment early. This is designed to reduce the impact of the exacerbation.
This review found that the use of action plans results in an increased ability to recognise and react appropriately to an exacerbation by individuals. Unfortunately there was no evidence these behavioural changes alter health-care utilisation.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Turnock AC, Walters EH, Walters JAE, Wood-Baker R. Action plans for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005074. DOI: 10.1002/14651858.CD005074.pub2.

This version first published online: October 19. 2005

Abstract

Background

The effectiveness of action plans as treatment for chronic obstructive pulmonary disease (COPD) is not known.

Objectives

To assess the efficacy of action plans in the management of COPD.

Search strategy

We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, CINAHL and the National Research Register of Ongoing Trials. We also searched reference lists of identified studies. The search was completed in August 2004.

Selection criteria

Randomised controlled trials of action plans in COPD. Studies with a primary diagnosis of asthma excluded.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data. Investigators were contacted for additional information when necessary. Study results were combined in meta-analyses using the Cochrane Collaboration software RevMan.

Main results

There was evidence of a positive effect of action plans on self-management knowledge. The mean difference (MD) for recognition of a severe exacerbation was 2.50; 95% confidence interval 1.04 to 3.96, for self-action in severe exacerbations MD 1.50; 95% confidence interval 0.62 to 2.38 and the use of antibiotics MD 6.00; 95% confidence interval 2.68 to 9.32. There was also evidence of a positive effect on the initiation of antibiotics (odds ratio (OR) 10.16; 95% confidence interval 2.02 to 51.09) and/or oral steroids (OR 6.58; 95% confidence interval 1.29 to 33.62). However, there was no evidence of significant effects on healthcare utilisation, health-related quality of life, lung function, functional capacity, symptom scores, mortality, anxiety, or depression. No trials used as outcomes: number of exacerbations, length of exacerbations, or days lost from work.

Authors' conclusions

This review shows there is evidence that action plans aid people with COPD in recognising and reacting appropriately to an exacerbation of their symptoms via the self-initiation of antibiotics or steroids. Further research needs to be completed with more comprehensive outcomes measures in order to ascertain whether this results in significantly decreased morbidity and/or mortality.

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