The evaluation of a remote support program on quality of life and evolution of disease in COPD patients with frequent exacerbations

BMC Pulmonary Medicine

Research Article

Alonso Fernández-Nistal¹  Antonia Fuster²  Jose Miguel Rodríguez González-Moro³  Pilar de Lucas³  Aurelio Arnedillo⁴  María José Espinosa de los Monteros⁵  Bernardino Alcazar⁶  Patricia García Sidro⁷  Joan B. Soriano⁸ 

[1] Departamento médico Takeda Farmacéutica España S.A., Madrid, Spain;Hospital Son Llàtzer, Mallorca, Spain;Hospital Universitario Gregorio Marañón, Madrid, Spain;Hospital Universitario Puerta del Mar, Cádiz, Spain;Hospital Universitario Virgen de la Salud, Toledo, Spain;Hospital de Alta Resolución de Loja, Agencia Sanitaria H. de Poniente, Avda Tierno Galván s/n., CP 18300, Loja, Granada, Spain;Hospital de la Plana, Castellón, Spain;Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain;

关键词: Chronic obstructive pulmonary disease;    Education;    Management;    Quality of life;    Exacerbations;   

DOI  :  10.1186/s12890-016-0304-3

 received in 2016-03-28, accepted in 2016-11-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundChronic obstructive pulmonary disease (COPD) patients often present considerable individual medical burden in their symptoms, limitations, and well-being that complicate medical treatment. To improve their overall health status, while reducing the number of exacerbations, a multidisciplinary approach including different elements of care is needed. The aim of this study was to evaluate the effects of a remote support program on COPD patients at high risk of experiencing worsening of their disease and other health-related outcomes.MethodsAn observational, multicenter, prospective study aimed at evaluating the impact of a 7-month remote support program on COPD patients in exacerbations control and changes in health status measured with the COPD assessment test (CAT). Factors associated with a clinically relevant decrease in CAT were assessed using a logistic regression analysis.ResultsA total of 114 subjects started the program. The majority of the study population were males (81.6 %), retired (70.2 %), without academic qualifications or with a low level of education (68.4 %), and ex-smokers (79.8 %). The mean ± SD age was 69.6 ± 9.1 years and the BMI was 27.8 ± 5.5 Kg/m2. Overall, 41.9 % (95 % CI 31.9–52.0) patients, significantly improved health status (CAT decrease ≥ 2 points). Univariate analysis showed that significant improvement in CAT was associated with baseline CAT scores [high CAT score 19.2 (±7.5) vs. low CAT score 12.4 (±6.4); OR = 1.15, 95 % CI: 1.07–1.24; p < 0.001] and with being non-compliant [62.5 % (15/24) of non-compliant vs 34.7 % (24/69) of compliant patients significantly improved CAT scores; OR = 3.13, 95 % CI: 1.19–8.19; p = 0.021). After controlling for the effect of all variables in a multivariable logistic regression model, the only factor that remained significant was baseline CAT score. The proportion of smokers in the total population remained constant during the study. There was a significant reduction in the number of exacerbations after entering this remote support program with median -1 (IQR: -2, 0), (p < 0.001). The Morisky-Green questionnaire showed an increase of treatment compliance, namely at baseline, 25.8 % (24/93) of patients were noncompliant while in the end 66.7 % (16/24) of them became compliant) (p = 0.053).ConclusionsA remote support program for high-risk COPD patients results in an improvement of the patients’ health status, particularly in those with initially poor health status, and it helps to reduce COPD exacerbations.

【 授权许可】

CC BY   
© The Author(s). 2016