[Effectiveness of a specific program for patients with chronic obstructive pulmonary disease and frequent exacerbations]. / Eficacia de un programa específico para pacientes con EPOC que presentan frecuentes agudizaciones.

OBJECTIVE: Patients with chronic obstructive pulmonary disease (COPD) and a history of frequent exacerbations are a target population of particular interest from both a clinical and an economic standpoint. The objective of this study was to evaluate the effectiveness of a program designed specifically to manage patients in this subgroup. PATIENTS AND METHODS: This was a 1-year randomized controlled trial designed to compare the effectiveness of a specific program (SP) with that of conventional management (CM) in a group of patients with a high frequency of exacerbations (3 or more per year). Within-group and between-group comparisons were carried out for a number of variables related to the patients medical care, dyspnea, health-related quality of life (HRQL), inhalation technique, and pulmonary function. RESULTS: A total of 26 patients were enrolled in the study (all men). The mean (SD) age was 73 (8) years, and mean forced expiratory volume in 1 second (FEV1) expressed as a percentage of the reference value was 43% (15%). Exacerbations requiring hospital care (emergency department visits and/or admission) decreased in both groups: by 24.4% (P not significant) in the CM group and 44.1% (P=.061) in the SP group. Hospital admissions decreased 73.3% in the SP group and increased 22% in the CM group (P< .001). While length of hospital stay decreased 77.3% in the SP group, this figure almost doubled in the CM group (P=.014). Dyspnea, HRQL, and inhalation technique improved in both groups. FEV1 fell by 46 mL/year in the CM group and increased 10 mL/year in the SP group (P not significant). CONCLUSIONS: The use of a simple program to manage selected patients with a history of frequent exacerbations produces a significant reduction in the number of hospital admissions, an improvement in HRQL, and may improve prognosis.

Eficacia de un programa específico para pacientes con EPOC que presentan frecuentes agudizaciones / Effectiveness of a specific program for patients with chronic obstructive pulmonary disease and frequent exacerbations

Objetivo: Los pacientes con enfermedad pulmonar obstructiva crónica que presentan frecuentes agudizaciones (AEPOC) constituyen una población diana de especial interés, tanto desde el punto de vista clínico como económico. El objetivo del estudio es evaluar la eficacia de un programa específico (PE) dirigido a este subgrupo de enfermos. Pacientes y métodos: Se ha realizado un estudio prospectivo, aleatorizado y controlado de un año de duración, en el que se ha comparado la eficacia del PE frente al tratamiento convencional (TC) en un grupo de pacientes con exacerbaciones frecuentes (3 o más AEPOC al año). Se efectuaron comparaciones intragrupo e intergrupo en diversos parámetros asistenciales, disnea, calidad de vida relacionada con la salud (CVRS), técnica inhalatoria y función pulmonar. Resultados: Se incluyó en el estudio a 26 pacientes (todos varones), con una edad media (± desviación estándar) de 73 ± 8 años y volumen espiratorio forzado en el primer segundo, en porcentaje del valor de referencia, del 43 ± 15%. Las exacerbaciones que precisaron atención hospitalaria (visitas a urgencias y/u hospitalizaciones) disminuyeron en ambos grupos: un 24,4% (p = no significativo) en el grupo TC y un 44,1% (p = 0,061) en el grupo PE. Las hospitalizaciones se redujeron un 73,3% en el grupo de intervención, mientras que se incrementaron un 22% en el TC (p < 0,001). Los días de hospitalización disminuyeron un 77,3% en el PE, mientras que aumentaron casi el doble para el TC (p = 0,014). La disnea, la CVRS y la técnica inhalatoria mejoraron en ambos grupos. El volumen espiratorio forzado en el primer segundo presentó un descenso de 46 ml/año en grupo TC, mientras que se incrementó 10 ml/año para el grupo PE (p = no significativo). Conclusiones: El empleo de un programa sencillo, dirigido a pacientes seleccionados con exacerbaciones frecuentes, comporta una reducción significativa del número de las hospitalizaciones, mayor CVRS y quizá mejor pronóstico

Objective: Patients with chronic obstructive pulmonary disease (COPD) and a history of frequent exacerbations are a target population of particular interest from both a clinical and an economic standpoint. The objective of this study was to evaluate the effectiveness of a program designed specifically to manage patients in this subgroup. Patients and methods: This was a 1-year randomized controlled trial designed to compare the effectiveness of a specific program (SP) with that of conventional management (CM) in a group of patients with a high frequency of exacerbations (3 or more per year). Within-group and between-group comparisons were carried out for a number of variables related to the patients´ medical care, dyspnea, health-related quality of life (HRQL), inhalation technique, and pulmonary function. Results: A total of 26 patients were enrolled in the study (all men). The mean (SD) age was 73 (8) years, and mean forced expiratory volume in 1 second (FEV1) expressed as a percentage of the reference value was 43% (15%). Exacerbations requiring hospital care (emergency department visits and/or admission) decreased in both groups: by 24.4% (P not significant) in the CM group and 44.1% (P=.061) in the SP group. Hospital admissions decreased 73.3% in the SP group and increased 22% in the CM group (P<.001). While length of hospital stay decreased 77.3% in the SP group, this figure almost doubled in the CM group (P=.014). Dyspnea, HRQL, and inhalation technique improved in both groups. FEV1 fell by 46 mL/year in the CM group and increased 10 mL/year in the SP group (P not significant). Conclusions: The use of a simple program to manage selected patients with a history of frequent exacerbations produces a significant reduction in the number of hospital admissions, an improvement in HRQL, and may improve prognosis