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Effects of written action plan adherence on COPD exacerbation recovery
  1. Erik W M A Bischoff1,2,
  2. Dina H Hamd2,
  3. Maria Sedeno2,
  4. Andrea Benedetti2,3,4,
  5. Tjard R J Schermer1,
  6. Sarah Bernard5,
  7. François Maltais5,
  8. Jean Bourbeau2,3,4
  1. 1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montréal, Canada
  3. 3Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
  4. 4Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Québec, Canada
  5. 5Department of Medicine, McGill University, Montréal, Canada
  1. Correspondence to Jean Bourbeau, Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, 3650 St Urbain, Montréal H2X 2P4, Canada; jean.bourbeau{at}


Background The effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence.

Methods This was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan.

Results From the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV1) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (−5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV1 as percentage predicted.

Conclusions This study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.

  • Pulmonary disease
  • chronic obstructive
  • disease management
  • COPD exacerbations

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  • Funding This study was sponsored by the Canadian Institutes of Health Research (MCT-63162) and by the Respiratory Health Network of the Fonds de la Recherche en Santé du Québec. EWMAB is the recipient of a MD-clinical research trainee stipend of The Netherlands Organization for Health Research and Development (ZonMw).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the institutional research ethics board of each participating hospital and all subjects provided informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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