Self‐management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease

Background Chronic Obstructive Pulmonary Disease (COPD) self‐management interventions should be structured but personalised and often multi‐component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self‐management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self‐management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. Objectives To evaluate the efficacy of COPD‐specific self‐management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health‐related quality of life, respiratory‐related hospital admissions and other health outcomes. Search methods We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. Selection criteria We included randomised controlled trials evaluating a self‐management intervention for people with COPD published since 1995. To be eligible for inclusion, the self‐management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community‐based setting to avoid overlap with pulmonary rehabilitation as much as possible. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random‐effects modelling meta‐analysis. The primary outcomes of the review were health‐related quality of life (HRQoL) and number of respiratory‐related hospital admissions. Main results We included 22 studies that involved 3,854 participants with COPD. The studies compared the effectiveness of COPD self‐management interventions that included an action plan for AECOPD with usual care. The follow‐up time ranged from two to 24 months and the content of the interventi