Adherence to action plan reduces COPD exacerbation recovery time
By Mark Cowen
13 January 2011Thorax 2011; 66: 26–31
MedWire News: Patients with chronic obstructive pulmonary disease (COPD) can minimize their recovery time after an exacerbation by sticking to a written action plan, research shows.
Writing in the journal Thorax, Jean Bourbeau (McGill University Health Centre, Montréal, Canada) and team explain: "Despite the huge impact [COPD] exacerbations may have, patients often have problems in recognising symptom deterioration and fail to report exacerbations. This causes a delay in treatment which has been associated with an increased symptom recovery time, a worsening of health status and an increased risk of hospitalization."
They add that written action plans have been developed to help COPD patients recognize symptom deterioration and react appropriately with prompt initiation of prednisone and/or antibiotics.
To investigate the effect of adherence to a written action plan on COPD exacerbation recovery time, the team studied 252 patients with the respiratory condition who were aged an average of 65 years.
All of the participants received a written action plan, with instructions for prompt treatment of exacerbations with antibiotics and prednisone within 3 days of exacerbation onset. They were followed-up for 1 year.
In total, 143 patients experienced 288 exacerbations during the study period. Of these, 119 patients reported start dates for antibiotic or prednisone treatment during 217 exacerbations.
The researchers found that patients adhered to their written action plan in 40.1% of these 217 exacerbations.
Mean exacerbation recovery time was 14.0 days. However, the average recovery time among patients who adhered to their written action plan was a significant 5.1 days shorter than for those who did not adhere to their plan, at 10.9 versus 16.0 days.
Factors associated with an increased likelihood of adherence to written action plans included influenza vaccination (odds ratio [OR]=4.83) and cardiac comorbidity (OR=2.44), as well as younger age and lower lung function measurements.
Bourbeau and team conclude: "This study shows that adherence to a written action plan with instructions for prompt and proper treatment of exacerbations is associated with a statistically and clinically significant reduction in exacerbation total recovery time."
They add that "the results of this study have significant implications for clinical practice" and suggest that "action plans deserve a more prominent role in exacerbation management."