Cochrane Summaries

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Integrated disease management for chronic obstructive pulmonary disease

Kruis AL, Smidt N, Assendelft WJJ, Gussekloo J, Boland MRS, Rutten-van Mölken M, Chavannes NH
Published Online: 
10 October 2013

Background

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory (lung), disabling disease which affects a lot of people worldwide and causes millions of deaths every year. People with COPD suffer differing levels of impairment, daily complaints/symptoms and number of exacerbations.

Different health care providers, such as doctors, nurses and physiotherapists, typically provide different components of care (for example medication, self management and education, exercise training) to people with COPD. The aim of an integrated disease management (IDM) program is to establish a program of different components of care in which different health care providers are co-operating and collaborating to provide efficient and good quality care.

Review question

We wished to determine the effect of such a program on quality of life, exercise tolerance and the number of exacerbations. We have chosen these outcomes as they are most important for people with COPD.

What we found

We evaluated 26 studies in 2997 people with COPD. Overall the evidence found was of high to moderate quality. The trials were conducted in 11 different countries. The average age of participants was 68 years, 68% of participants were men and the severity of COPD on average was severe (according to lung function measures). Some of the trials took place in GP clinics and some in hospitals. Overall, the studies were of good to moderate methodological quality.

People who participated in an IDM program had better quality of life and improved their exercise tolerance after 12 months. Furthermore, in participants treated with such a program, the number of hospital admissions related to exacerbations decreased and the total number of hospital days was reduced by three days. We found no evidence of an effect on mortality.

The results support an IDM program for people with COPD to optimize quality of life and exercise tolerance.

This plain language summary is up-to-date as of April 2012.