Respiratory diseases, particularly asthma, have long been a target for self-management programs. Chronic obstructive pulmonary disease (COPD) is disabling, with symptoms such as chronic cough, phlegm, wheezing, shortness of breath, and increased infections of the respiratory passage. Efraimsson and coworkers examined the effects of a structured educational intervention program at a nurse-led primary health care clinic (PHCC) on quality of life (QoL), knowledge about COPD, and smoking cessation in patients with COPD. Fifty-two patients with COPD from a Swedish primary care setting were randomized into two groups (intervention or control). Both groups received standard care, but patients in the intervention group were also offered two visits to a nurse who specialized in COPD care. The purpose of the visits was to increase the patients' self-care ability and their knowledge about COPD. Data were collected using two questionnaires, one pertaining to knowledge about COPD and smoking habits, and the St. George's Respiratory Questionnaire that addresses how QoL was affected by the patients' respiratory symptoms. The intervention and control groups answered both questionnaires on their first and last visits to the PHCC. A statistically significant increase was noted in the intervention group on QoL, the number of patients who stopped smoking, and patients' knowledge about COPD at the follow-up, 3-5 months after intervention.

WHAT THE STUDY MAY MEAN TO YOU: The authors concluded that their findings showed that conventional care alone did not have an effect on patients' QoL and smoking habits. Instead, the evidence suggested that a structured program with self-care education is needed to motivate patients for life-style changes. The latter conclusion is a bit misleading: the subjects of the study not only needed motivation to increase the ongoing performance of self-management skills, but they first needed to learn and perform whatever skills they were taught. The acquisition of self-management skills is but one phase of the equation; the later successful performance is what not only improves outcomes, but enhances motivation. This construct, in turn, can be measured via the uses of valid self-efficacy paper-and-pencil instruments.

EO Efraimsson et al. Effects of COPD self-care management education at a nurse-led primary health care clinic. Scandinavian Journal of Caring Sciences, 2008;22:178-185.