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15-05-2012 | Article

Warning over COPD self-care risk


Ann Intern Med 2012; 156: 673-683

A trial of education and self-management in patients with chronic obstructive pulmonary disease (COPD) has had to be stopped early because of excess deaths in the group receiving the intervention.

Three times as many patients were found to have died in the self-management group as in the usual care group after 8 months.

Although the authors could not fully explain the excess mortality, further investigation showed that deaths due to COPD accounted for the largest difference in mortality between the groups.

The research was conducted at 20 outpatient clinics in the USA by a team led by Dr Vincent Fan (Veterans Affairs Puget Sound Health Care System, Seattle, Washington). Only 426 patients, less than half of the planned total of 960, had been enrolled by the time the study was halted. However, the authors say that based on their analysis, "it is unlikely that a benefit would have been seen in COPD hospitalisations if the study had continued to its planned completion".

"Whatever the reasons for the high mortality, our findings suggest self-management may not be appropriate for all subsets of patients with COPD," they conclude in the Annals of Internal Medicine.

A recent UK study published in the BMJ by Dr Christine Bucknall and colleagues found no impact of a self-management programme on deaths or hospital admissions overall, but suggested that younger patients living with others may benefit (click here).

The Government' QIPP efficiency initiative has identified self-care as an important way to cut hospital admissions. National clinical lead for QIPP Sir John Oldham commented to Pulse magazine that the intervention in the US trial "increased self-efficacy, but not knowledge".

"You can't short-cut self-management, but done properly it works," he maintained.

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price