Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute of the McGill University Health Centre, Montréal, Québec, Canada.
COPD. 2009 Oct;6(5):352-8. doi: 10.1080/15412550903150252.
Exacerbations are an important cause of morbidity and mortality in COPD. We assessed treatment initiation and health care use at exacerbation in patients receiving a self-management education program including an action plan. COPD patients were randomly assigned to usual care or to a comprehensive self-management program "Living Well with COPD" including a written action plan and case manager support, and were followed-up for 12 months. Patients in the usual care were managed by their respective practitioners. Patients in the self-management program received, as part of a written action plan, a prescription of antibiotics and prednisone for self-initiation in case of aggravation of 2 or more symptoms (dyspnea, sputum volume, sputum purulence) for at least 24 hours, and they had the support of a case-manager for reinforcement and monthly telephone follow-ups. At 12 months, 166 patients presented with at least one exacerbation. Exacerbations (606) were confirmed by aggravation of at least one symptom; 403 (67.6%) presented 2 or more. Antibiotics were used in 61.6% of exacerbations and prednisone in 47.9%. In exacerbations presenting aggravation of 2 or more symptoms, antibiotics and prednisone were used together more often in the action plan than in the usual care group (54.4% vs. 34.8%, p < 0.001). In the action plan, compared to the usual care group, 17.2% vs. 36.3% exacerbations resulted in a hospitalization (p < 0.001). Self-management with the successful use of an action plan for acute exacerbation of COPD holds promise for reducing health care use.
加重是 COPD 患者发病率和死亡率的重要原因。我们评估了接受自我管理教育计划（包括行动计划）的患者在加重时的治疗启动和医疗保健使用情况。将 COPD 患者随机分配到常规护理或综合自我管理计划“与 COPD 一起生活”中，包括书面行动计划和病例经理支持，并随访 12 个月。常规护理组的患者由各自的医生进行管理。自我管理计划组的患者作为书面行动计划的一部分，如果出现 2 个或更多症状（呼吸困难、痰量、痰脓性）加重至少 24 小时，他们会自行启动抗生素和泼尼松治疗，并得到病例经理的支持进行强化治疗和每月电话随访。在 12 个月时，有 166 名患者出现至少一次加重。加重（606 次）是通过至少一个症状的加重来确认的；403 次（67.6%）出现 2 次或更多次。在 61.6%的加重中使用了抗生素，在 47.9%的加重中使用了泼尼松。在出现 2 个或更多症状加重的加重中，行动计划中抗生素和泼尼松联合使用的比例高于常规护理组（54.4%比 34.8%，p<0.001）。在行动计划中，与常规护理组相比，17.2%的加重导致住院治疗，而常规护理组为 36.3%（p<0.001）。对于 COPD 急性加重的自我管理，成功使用行动计划有望减少医疗保健的使用。
