Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial
- 1Department of Respiratory Medicine, Máxima Medical Centre, Veldhoven, The Netherlands
- 2institute for Medical Technology Assessment (iMTA), Erasmus MC, Rotterdam, The Netherlands
- 3Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Correspondence to Dr A Schols, Department of Respiratory Medicine, Maastricht University Medical Centre, P O Box 5800, 6202 AZ Maastricht, The Netherlands;
- Received 27 April 2009
- Accepted 4 August 2009
- Published Online First 23 August 2009
Background: The effectiveness of pulmonary rehabilitation in advanced COPD is well established, but few data are available in less advanced disease.
Methods: In a 2 year randomised controlled trial, 199 patients with an average moderate airflow obstruction but impaired exercise capacity (mean (SD) forced expiratory volume in 1 s (FEV1) 60 (16)%, peak work load (Wmax) <70%) were randomised to the INTERdisciplinary COMmunity-based COPD management programme (INTERCOM) or usual care. Intervention consisted of 4 months multidisciplinary rehabilitation followed by a 20-month maintenance phase. Outcomes (4, 12, 24 months): health-related quality of life (St George’s Respiratory Questionnaire (SGRQ)), exacerbation frequency, MRC dyspnoea score, cycle endurance time (CET), 6-minute walking distance (6MWD), skeletal muscle strength and patients’ and caregivers’ perceived effectiveness.
Results: Between-group comparison after 4 months revealed the following mean (SE) significant differences in favour of INTERCOM: SGRQ total score 4.06 (1.39), p = 0.004; activity and impact subscores, p<0.01; MRC score 0.33 (0.13), p = 0.01; Wmax 6.0 (2.3) Watt, p = 0.02; CET 221 (104) s, p = 0.04; 6MWD 13 (6) m, p = 0.02; hand grip force 4.3 (1.5) lb, p<0.01; and fat-free mass index 0.34 (0.13) kg/m2, p = 0.01. Between-group differences over 2 years were as follows: SGRQ 2.60 (1.3), p = 0.04; MRC score 0.21 (0.10), p = 0.048; CET 253 (104) s, p = 0.0156; 6MWD 18 (8) m, p = 0.0155. Exacerbation frequency was not different (RR 1.29 (95% CI 0.89 to 1.87)). Patients’ and caregivers’ perceived effectiveness significantly favoured the INTERCOM programme (p<0.01).
Conclusions: This study shows that a multidisciplinary community-based disease management programme is also effective in patients with COPD with exercise impairment but less advanced airflow obstruction.
Trial registration number: NCT00840892
See Editorial, p 4
▸ Additional details are published online only at http://thorax.bmj.com/content/vol65/issue1
Funding This study was financially supported by the Netherlands Asthma Foundation (NAF 3.4.01.63), the “Stichting Astma Bestrijding” (SAB), Nutricia Netherlands, Pfizer and Partners in Care Solutions (PICASSO) for COPD. The funding sources had no role in the design, conduct or reporting of the study or the decision to submit the manuscript for publication.
Competing interests CRvW has received previous research and travel grants from Nutricia Netherlands. MH and SJMM have no conflicts of interest. MPMHRvM has received previous research grants and speakers fees from Pfizer UK and Pfizer Netherlands and was a board member of the foundation “Stichting Astma Bestrijding” (SAB).
Ethics approval All patients gave written informed consent for participation in the study. Ethical approval was granted by the Medical Ethics Committee from Máxima Medical Centre.
Provenance and Peer review Not commissioned; externally peer reviewed.