Zhan Miao, Chen Jing, Zhang Hongying
The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing, China.
Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Med (Lausanne). 2025 Jun 9;12:1584316. doi: 10.3389/fmed.2025.1584316. eCollection 2025.
Chronic obstructive pulmonary disease (COPD) is a common fatal disease with high morbidity, disability, and economic burden, and it poses a major challenge to global public health. The limitations of the traditional hospital-based management models and the lack of continuous professional guidance and support for people with COPD after discharge have led to repeated acute exacerbations of the disease and high rates of rehospitalization. Community-based management models have received attention because of their convenience, affordability, and accessibility; however, their effectiveness has not been comprehensively and systematically evaluated.
This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and comprehensively searched for randomized controlled trials (RCTs) in the China National Knowledge Infrastructure, Wangfang Data, VIP Database, SinoMed, Cochrane Library, PubMed, and Web of Science from the inception to 6 May 2025. A control group received usual care, and an experimental group received community-based management models (community-based integrated management or telemedicine management, respectively) with an intervention period of >6 months. Two researchers independently used the NoteExpress software for literature management, the Cochrane Risk of Bias Assessment Tool for risk of bias assessment of the included studies, and RevMan5.4.1 for the meta-analysis of outcome indicators.
Thirty-three RTCs, encompassing a cohort of 12,288 people with COPD, were included in this study. The community-based management models demonstrated significant improvements in the 6-min walk test (mean difference [MD] = 39.73; 95% confidence interval [CI, 30.15, 49.32]; < 0.00001) and lung function parameters (forced expiratory volume in the first second/forced vital capacity [FEV1/FVC]: MD = 6.17; 95% CI [4.54, 7.79], < 0.00001; FEV1% predicted: MD = 4.91, 95% CI [3.96, 5.85], < 0.00001). Additionally, it was associated with decreased breathing difficulties (MD = -0.72, 95% CI [-1.23, -0.21], = 0.006) and COPD assessment test (CAT) scores (MD = -4.46, 95% CI [-5.67, -3 0.25], < 0.00001). Telemedicine management also significantly reduced the frequency of acute exacerbations of COPD (MD = -0 0.56; 95% CI [-0.79, -0.32], < 0.00001). Both management models showed comparable effects on the FEV1/FVC ratio, FEV1% predicted, and CAT scores. However, in terms of alleviating dyspnea symptoms-as measured by the modified Medical Research Council scale-community-based integrated management proved superior to telemedicine management ( = 0.007). Notably, neither approach demonstrated a statistically significant advantage in improving quality of life among COPD populations, as assessed by the St. George's Respiratory Questionnaire's total score (MD = -1.98, 95% CI [-5.02, 1.07], = 0.2).
Community-based management models were significantly better than the usual care in improving exercise tolerance, reducing symptoms, such as dyspnea, and improving lung function in people with COPD. Telemedicine management further reduced the number of acute exacerbations of COPD but did not improve exercise tolerance, and the effect of community-based integrated management on this indicator needs to be verified. Subgroup analyses revealed a significant difference between community-based integrated management and telemedicine management only in improving dyspnea; community-based integrated management was superior to telemedicine management alone. However, neither of the models showed a significant advantage in improving quality of life, suggesting that more comprehensive and precise intervention strategies should be explored in future studies and practice.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251046698, identifier CRD420251046698.
慢性阻塞性肺疾病（COPD）是一种常见的致命疾病，发病率、致残率和经济负担都很高，对全球公共卫生构成重大挑战。传统的基于医院的管理模式存在局限性，且COPD患者出院后缺乏持续的专业指导和支持，导致疾病反复急性加重和再住院率较高。基于社区的管理模式因其便利性、可负担性和可及性而受到关注；然而，其有效性尚未得到全面、系统的评估。
本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，并全面检索了中国知网、万方数据、维普数据库、中国生物医学文献数据库、考克兰图书馆、PubMed和Web of Science中从建库至2025年5月6日的随机对照试验（RCT）。对照组接受常规护理，试验组接受基于社区的管理模式（分别为社区综合管理或远程医疗管理），干预期>6个月。两名研究人员独立使用NoteExpress软件进行文献管理，使用考克兰偏倚风险评估工具对纳入研究进行偏倚风险评估，并使用RevMan5.4.1对结局指标进行荟萃分析。
本研究纳入了33项随机对照试验，共12288例COPD患者。基于社区的管理模式在6分钟步行试验（平均差值[MD]=39.73；95%置信区间[CI，30.15，49.32]；P<0.00001）和肺功能参数（第1秒用力呼气容积/用力肺活量[FEV1/FVC]：MD=6.17；95%CI[4.54，7.79]，P<0.00001；预测FEV1%：MD=4.91，95%CI[3.96，5.85]，P<0.00001）方面有显著改善。此外，它还与呼吸困难减轻（MD=-0.72，95%CI[-1.23，-0.21]，P=0.006）和COPD评估测试（CAT）评分降低（MD=-4.46，95%CI[-5.67，-3.25]，P<0.00001）相关。远程医疗管理还显著降低了COPD急性加重的频率（MD=-0.56；95%CI[-0.79，-0.32]，P<0.00001）。两种管理模式在FEV1/FVC比值、预测FEV1%和CAT评分方面显示出相似的效果。然而，在通过改良的医学研究委员会量表测量的缓解呼吸困难症状方面，社区综合管理优于远程医疗管理（P=0.007）。值得注意的是，根据圣乔治呼吸问卷总分评估，两种方法在改善COPD人群生活质量方面均未显示出统计学上的显著优势（MD=-1.98，95%CI[-5.02，1.07]，P=0.2）。
基于社区的管理模式在改善COPD患者的运动耐力、减轻呼吸困难等症状以及改善肺功能方面明显优于常规护理。远程医疗管理进一步减少了COPD急性加重的次数，但未改善运动耐力，社区综合管理对该指标的效果有待验证。亚组分析显示，社区综合管理和远程医疗管理仅在改善呼吸困难方面存在显著差异；社区综合管理优于单独的远程医疗管理。然而，两种模式在改善生活质量方面均未显示出显著优势，这表明未来的研究和实践中应探索更全面、精确的干预策略。
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251046698，标识符CRD420251046698
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