Among patients with Chronic obstructive pulmonary disease (COPD), increased education, improved self-management skills and enhanced follow-up components of pulmonary rehabilitation do not seem to lead to better health-related quality of life in compared with usual care without such extras, new research shows.

Instead, other aspects of pulmonary rehabilitation, such as peer interactions and exercise, may be more essential to improving health, the study authors speculate.

“In contrast to other chronic diseases such as asthma, enhanced patient education and follow-up by a nurse among patients with COPD does not lead to clinically relevant improvements in health outcomes compared to the ongoing care that they are getting from their regular physicians,” said study author Dr. David Coultas, of the University of Texas Health Center at Tyler.

Coultas conducted the research while he was at the University of Florida Health Science Center in Jacksonville.

Most commonly caused by cigarette smoking, COPD includes the lung disease emphysema and chronic bronchitis, and is marked by progressively worsening shortness of breath and coughing. COPD is currently the fourth leading cause of death in the United States and worldwide.

To reduce the worldwide economic burden associated with the condition, various teams have published international guidelines on the best way to manage COPD patients. Those guidelines state that optimal management includes pulmonary rehabilitation, which consists of patient education, self-management training, psychosocial interventions and several other components. Many affected individuals do not have access to such rehabilitation services, however, as such care is usually provided at specialized centers.

Coultas and his team speculated that one way to improve patients’ access is to offer the most integral components of pulmonary rehabilitation at other off-site locations. Since little is known about which components are most essential, they focused on providing study participants with nurse-assisted home care consisting of patient education, efforts to improve patient self-management skills and enhanced follow-up.

Their study group consisted of 151 adults ages 45 years or older, who were current or former smokers, had previously been diagnosed with COPD, had experienced cough, shortness of breath, or some other respiratory symptom during the previous year and had evidence of airflow obstruction.

The study participants were randomly divided into a group that received usual care, a group that received nurse-assisted medical management, which was particularly focused on patient education, or a group that received nurse-assisted collaborative management, which was an even more enhanced type of care.

The usual care group received two COPD-related educational booklets from the American Lung Association and was advised to follow their physician’s recommendations.

At the end of the six-month study period, the researchers found that neither of the two nurse-assisted groups exhibited a marked improvement in their health-related quality of life compared with the usual care group, they report in the October issue of Chest.

Although visits to the emergency department and hospitalizations were infrequent, the intervention groups exhibited no decreases in emergency department visits or hospitalizations as a result of the pulmonary rehabilitation services, the researchers note.

In light of the current findings, “disease management programs that only address patient education and follow-up by a nurse should not be implemented,” Coultas told. “To improve health outcomes, patients with COPD need access to the other components of pulmonary rehabilitation, particularly regular physical activity/exercise.”

“In addition, there is a high level of distress (i.e., depressive and anxiety symptoms) that is not being adequately addressed” in COPD patients, Coultas added.

A grant from the Robert Wood Johnson Foundation funded this study.

SOURCE: Chest, October 2005.