O6.3 Education and self-management

There is limited evidence that education alone can improve self-management skills, mood and health-related quality of life. Education should be included with exercise training as part of a comprehensive pulmonary rehabilitation program (Ries et al., 2007) [evidence level III-2]. Delivering COPD-specific information in a didactic style is unlikely to be beneficial and therefore is not recommended.(Blackstock and Webster, 2007) Providing information and tools to enhance self-management in an interactive session is more effective than didactic teaching. (Lorig et al., 1999), (Blackstock and Webster, 2007)

A systematic review of self-management education for COPD (Effing et al., 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 glucocorticoids 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.

The single most important intervention is assistance with smoking cessation.(NHLBI/WHO Workshop Report, April 2001) 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.(NHLBI/WHO Workshop Report, April 2001),(Nici et al., 2006),(Morgan et al., 2001)