O6.6 Education and self-management

There is limited evidence that education alone can improve self-management skills, mood or health-related quality of life (HRQoL). Education is often included with exercise training as part of a comprehensive pulmonary rehabilitation program (Ries 2007) [evidence level III-2]. Delivering COPD-specific information in a didactic style is unlikely to be beneficial and therefore is not recommended (Blackstock 2007). Providing information and tools to enhance self-management in an interactive session is more effective than didactic teaching (Lorig 1999, Blackstock 2007).

A systematic review of self-management education for COPD (Schrijver 2022) concluded that self-management education is associated with improvements in HRQoL measured by the SGRQ, compared to usual care (mean difference -2.86 95% CI -4.87 to -0.85).  This difference did not meet the MCID of 4 units however.  The intervention group was also at a lower risk of at least one respiratory hospital admission, albeit the difference was small (OR 0.75 95% CI 0.57 to 0.98).  This translates into a Number Needed to Treat of 15  (95% CI 8-399) to prevent one respiratory-related hospital admission over a follow-up period of 9.75 months. There were also improvements in exercise capacity (6MWD), anxiety and depression, and antibiotic courses. However, because of the heterogeneity in interventions, study populations, follow-up time and outcome measures, data are insufficient to formulate clear recommendations regarding the format and content of self-management education programs for individuals with COPD. Several more studies have not shown any benefit from self-management interventions (Bucknall 2012, Bischoff 2012). One study found excess mortality in the self-management group (Fan 2012). However, in the 2022 Cochrane review by Schrijver et al the mortality meta-analyses, which included Fan et al (2012), showed no difference in respiratory-related mortality risk (risk difference RD 0.01 95%CI -0.02 to 0.04), or all-cause mortality risk (risk difference RD 0.01 95%CI -0.03 to 0.01) between intervention and usual care.

The single most important intervention is assistance with smoking cessation. Good nutrition; task optimisation for more severely disabled patients; access to community resources; help with control of anxiety, panic or depression; instruction on effective use of medications and therapeutic devices (including oxygen where necessary); relationships; end-of-life issues; continence; safety for flying; and other issues may be addressed (Spruit 2013, Morgan 2001).