Introduction: The frequent exacerbator phenotype of COPD (fragile COPD) is associated with higher mortality, more exacerbations and greater resource consumption. A comprehensive care management program (CCMP) can be useful for the patient and the healthcare system. Objective: To evaluate the efficacy of a CCMP for patients with fragile COPD. Methods: Case-control study of patients with fragile COPD followed- up for at least 12 months. Cases were included in a CCMP consisting specialized medical evaluation, telephone and onsite monitoring by a case manager nurse and access to specialized care for early treatment of exacerbation. Controls received usual outpatient care. The number of admissions, emergency room (ER) visits, hospital days, number of treatments with steroids or antibiotics and survival rate were evaluated. Results: 36 cases and 36 controls matched for age and sex were studied. At baseline, cases had worse lung function and greater dyspnea than controls (FEV1 0.83 ± 0.26 vs 1.29 ± 0.54, p = 0.0001; mMRC 2.7 ± 0.88 vs 1.91 ± 0.85, p = 0.0018 respectively). However, during follow-up, cases had fewer hospital admissions (0.27 ± 0.57 vs 2.5 ± 1.96, p < 0.0001), fewer days of hospitalization (2.03 ± 4.64 vs 37.4 ± 35.9 , p < 0.0001) and required fewer trials of steroids and antibiotics than patients treated conventionally (1.1 ± 1.48 vs 2.9 ± 2.53, p = 0.0002; 1.4 ± 1.48 vs 3.1 ± 2.36, p = 0.0005, respectively) with no differences in mortality (11.8 vs 17.14 %, p = 0.70) or ER visits (0.21 ± 0.41 vs 0.66 ± 1.3, p = 0.325). Conclusion: A CCMP for fragile COPD patients is effective in the prevention of hospitalizations and reduction of moderate exacerbations compared to usual care.
Fiorentino et al. (Mon,) studied this question.