Department of Medicine, University of Otago, Wellington, New Zealand.
Medical Research Institute of New Zealand, Wellington, New Zealand.
Int J Chron Obstruct Pulmon Dis. 2023 Mar 15;18:317-325. doi: 10.2147/COPD.S393644. eCollection 2023.
Few interventions improve outcomes for people with Chronic Obstructive Pulmonary Disease (COPD), particularly higher risk groups such as those admitted to hospital with an acute exacerbation of COPD (AECOPD). The aim of the study was to test the feasibility and acceptability of a modified version of the Take Charge program in people after AECOPD and to determine the potential to improve self-reported limitations, health-related quality of life and reduce future hospitalizations.
A prospective, parallel group randomized trial with blinded endpoint assessment. Participants had been discharged from hospital with a diagnosis of AECOPD and were randomized to receive either a single 60-90 minute session of "Take Charge for COPD" from a trained facilitator in their own home or usual care. Take Charge is a "talking therapy" that encourages a sense of purpose, autonomy, mastery, and connectedness with others. The primary outcome was the rate of moderate or severe episodes of AECOPD in the subsequent 12 months.
Fifty-six people were randomized (study target 60): predominantly European (71%), female (61%), older (mean [SD] age 70 [11] years), and non-smokers (89%). Charlson Comorbidity Index mean (SD) score was 2.3 (1.6) indicating mild to moderate comorbidity severity. There were 85 moderate or severe AECOPD episodes in the 12 months after the index admission for the Take Charge participants and 84 episodes in the control group (relative rate 0.93; 95% confidence interval (CI) 0.69 to 1.26). COPD Clinical Questionnaire (CCQ) scores were significantly lower (better) in the Take Charge group (mean difference -1.26; 95% CI -2.06 to -0.45).
The Take Charge intervention proved feasible with a population of people recently discharged from hospital with AECOPD. The direction of change in the primary outcome and some secondary outcomes suggest that an adequately powered study is justified.
很少有干预措施能改善慢性阻塞性肺疾病（COPD）患者的结局，尤其是那些因 COPD 急性加重（AECOPD）而住院的高风险人群。本研究旨在检验经改良的“掌控 COPD”方案在 AECOPD 出院患者中的可行性和可接受性，并确定其改善自我报告受限、健康相关生活质量和减少未来住院的潜力。
前瞻性、平行组随机试验，终点评估设盲。参与者在因 AECOPD 住院后出院，被随机分配到在自己家中接受由训练有素的促进者进行的单次 60-90 分钟的“掌控 COPD”治疗，或接受常规护理。“掌控 COPD”是一种“谈话疗法”，鼓励患者有目标感、自主性、掌控感和与他人的联系感。主要结局为随后 12 个月内中重度 AECOPD 发作的发生率。
共有 56 人被随机分配（研究目标为 60 人）：主要为欧洲人（71%），女性（61%），年龄较大（平均[标准差]年龄 70[11]岁），非吸烟者（89%）。Charlson 合并症指数平均（标准差）评分 2.3（1.6），表明合并症严重程度为轻度至中度。在“掌控 COPD”组，索引住院后 12 个月内有 85 例中重度 AECOPD 发作，对照组有 84 例（相对风险 0.93；95%置信区间 0.69 至 1.26）。“掌控 COPD”组 COPD 临床问卷（CCQ）评分显著较低（更好）（平均差值-1.26；95%置信区间-2.06 至-0.45）。
“掌控 COPD”干预措施在近期因 AECOPD 住院的患者人群中具有可行性。主要结局和一些次要结局的变化方向表明，有必要进行充分的效能研究。
