Effectiveness of self-treatment of exacerbations in COPD patients: Two-year follow-up of the COPE-II study

Introduction Follow-up of most studies on action plans has been maximally 1 year. Long term effects are unclear. We report the effectiveness of self-treatment of exacerbations after 2 years of follow-up. Methods Self-management with or without self-treatment of exacerbations was randomly allocated to patients. All patients participated in 4 self-management sessions. Patients in the self-treatment group (STG) also learned to use an action plan to initiate a course of prednisolon and/or antibiotics in case of worsening of symptoms. Symptom diaries provided the number and severity of exacerbations. Healthcare utilisation was extracted from healthcare registries. Results Data of 70 patients in the STG and 72 patients in the control group (CG) were analysed. The number of exacerbations was not significantly different between study groups (STG: 5.4 ± 4.0 vs. CG: 5.6 ± 4.3). Preliminary analyses suggest that severity of exacerbations was not different between groups. The number of pulmonary physician consultations was significantly higher in the CG (9.0 ± 4.5) than in the STG (5.9 ± 3.2). Although total number of hospitalisations (STG: 31 vs. CG: 61) and emergency department (ED) visits (STG: 37 vs. CG: 80) was higher in the CG than in the STG, the % of patients with ≥ 1 hospitalisations (STG: 24.6% vs. CG: 31.5%) or ≥ 1 ED visits (STG: 27.1% vs. CG: 34.7%) was not significantly different between groups. Conclusions Self-treatment of exacerbations did not lead to fewer exacerbations or to a reduction in severity of exacerbation days after two years of follow-up. However, it did lead to fewer pulmonary physician consultations, with no increase in hospitalisations or ED visits.