O6.6 Education and self-management

There is limited evidence that education alone can improve self-management skills, mood and 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 (Effing 2007) concluded that self-management education is associated with a significant reduction in the probability of at least one hospital admission when compared with usual care , which translates into a one-year Number Needed to Treat ranging from 10 (6 to 35) for individuals with a 51% risk of exacerbation to a Number Needed to Treat of 24 (16 to 80) for patients with a 13% risk of exacerbation. This review also showed a small but significant reduction in dyspnoea measured using the Borg 0-10 dyspnoea scale. However, the magnitude of this difference (weighted mean difference -0.53, 95% CI -0.96 to -0.10) is unlikely to be clinically significant. No significant effects were found in the number of exacerbations, emergency room visits, lung function, exercise capacity and days lost from work. Inconclusive results were observed in doctor and nurse visits, symptoms (other than dyspnoea), the use of courses of corticosteroids and antibiotics and the use of rescue medication. 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). The differences may be related to differences in the study populations, study context and extent of self-management support provided.

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).