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Chronic Obstructive Pulmonary Disease Self-Management in Three Low- and Middle-Income Countries: A Pilot Randomized Trial. | LitMetric

AI Article Synopsis

  • Chronic obstructive pulmonary disease (COPD) is a major health issue in low- and middle-income countries, with health systems not adequately prepared for its rising prevalence.
  • A study involving 239 participants in Nepal, Peru, and Uganda tested a community health worker-supported self-management program against standard care over one year, focusing on various health outcomes including the St. George's Respiratory Questionnaire (SGRQ) score.
  • Results showed no significant improvement in the SGRQ scores between the two groups after one year, with higher hospitalizations in the intervention group, suggesting the need for a reevaluation of strategies to effectively manage COPD in these settings.

Article Abstract

Chronic obstructive pulmonary disease (COPD) disproportionately affects low- and middle-income countries. Health systems are ill prepared to manage the increase in COPD cases. We performed a pilot effectiveness-implementation randomized field trial of a community health worker (CHW)-supported, 1-year self-management intervention in individuals with COPD grades B-D. The study took place in low-resource settings of Nepal, Peru, and Uganda. The primary outcome was the St. George's Respiratory Questionnaire (SGRQ) score at 1 year. We evaluated differences in moderate to severe exacerbations, all-cause hospitalizations, and the EuroQol score (EQ-5D-3 L) at 12 months. We randomly assigned 239 participants (119 control arm, 120 intervention arm) with grades B-D COPD to a multicomponent, CHW-supported intervention or standard of care and COPD education. Twenty-five participants (21%) died or were lost to follow-up in the control arm compared with 11 (9%) in the intervention arm. At 12 months, there was no difference in mean total SGRQ score between the intervention and control arms (34.7 vs. 34.0 points; adjusted mean difference, 1.0; 95% confidence interval, -4.2, 6.1;  = 0.71). The intervention arm had a higher proportion of hospitalizations than the control arm (10% vs. 5.2%; adjusted odds ratio, 2.2; 95% confidence interval, 0.8, 7.5;  = 0.15) at 12 months. A CHW-based intervention to support self-management of acute exacerbations of COPD in three resource-poor settings did not result in differences in SGRQ scores at 1 year. Fidelity was high, and intervention engagement was moderate. Although these results cannot differentiate between a failed intervention or implementation, they nonetheless suggest that we need to revisit our strategy. Clinical trial registered with www.clinicaltrials.gov (NCT03359915).

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867931PMC
http://dx.doi.org/10.1164/rccm.202303-0505OCDOI Listing

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