‘The COPD breathlessness manual’: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture. To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status. Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups. After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05–3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant. The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care. A cognitive-behavioural manual that helps patients manage their breathlessness significantly reduces visits to emergency departments. Up to 60% of patients with chronic obstructive pulmonary disease (COPD) also suffer from anxiety, panic and depression due to their shortness of breath. To assess the effect of a cognitive-behavioural therapy approach on health service use and the mental health of patients with COPD, Claire Howard at The Hillingdon Hospital in Uxbridge, UK, and colleague Simon Dupont, randomly allocated either information booklets about the disease or The COPD Breathlessness Manual (CM) to over 200 patients. The manual was developed by psychologists to help patients self-manage their condition. After 12 months, the researchers found a reduction in anxiety and depression in the CM group and a significant drop in visits to emergency departments, indicating that the manual represents a cost-effective intervention.