Primarily because of the increased number of smokers throughout the world in the past half-century, high rates of chronic obstructive pulmonary disease (COPD) are occurring. Attempts have been made to manage both the condition and the associated burden of the disease. One approach has been to apply self-management approaches to control the problem. The value of self-management education is not yet clear. As a result, a recent review assessed the settings, methods and efficacy of COPD self-management education programs on health outcomes and use of health care services. Appropriate sources of data were searched for information. Reviewers looked at group comparisons drawn from 14 trials, and assessed a broad-spectrum of interventions and health outcomes with different follow-up times. The studies showed a significant reduction in the probability of at least one hospital admission among patients receiving self-management education compared to those receiving usual care. A small but significant reduction was detected in dyspnea, but no significant effects were found in number of exacerbations, emergency department visits, lung function, exercise capacity, and days lost from work. Inconclusive results were observed in doctor and nurse visits, on symptoms other than dyspnea, the use of courses of oral corticosteroids and antibiotics, and the use of rescue medication.

VALUE OF STUDY TO READER: The authors concluded that the reduction in hospital admissions would in itself already be enough reason for recommending self-management education in COPD. However, because of heterogeneity in interventions, study populations, follow-up time, and outcome measures, data are still insufficient to formulate clear recommendations regarding the form and contents of self-management education programs in COPD. It was suggested that longer trials with randomized controlled trials (RCTs) be conducted. However, COPD does not fit well in the framework of RCTs as used in assessing other diseases and treatments such as medication use. Thus, the need for future studies is to more carefully look at their subject matter--COPD--in designing self-management programs for the conditions and insuring self-management skills are maintained over the remainder of patients’ lives. This simply has not been done to any extent.

T. Effing et al. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database System Review, 2007;4:CD002990.