A Written Action Plan for Early Treatment of COPD Exacerbations: An Important Component to the Reduction of Hospitalizations

Background: This study explored the role of a written action plan in reducing hospitalizations as a component of a COPD self-management program in a recent multi-centre RCT. Methods: Patients were randomly allocated into 2 groups: intervention or usual care. The intervention group had access to a self-management education program Living Well with COPD, the support of a case manager, and a written action plan with a self-administered prescription of antibiotics and prednisone. Patients were instructed to start both antibiotics and prednisone in case of exacerbation with a change in 2 or more symptoms (increased dyspnea, increased sputum volume and/or purulent sputum) for at least 24 hr. Results: One hundred and sixty six patients with COPD presented with one exacerbation or more in the 12-month study period. Exacerbations (608) were confirmed by a change in at least one symptom; 429 (70.6%) by a change in 2 or more. Antibiotics were used in 61.3% of the exacerbations and prednisone in 47.7%. The combination of antibiotics and prednisone was used more often by the intervention group in exacerbations presenting changes in 2 or more symptoms (52.97% vs. 34.8%, P < 0.001). This difference was driven by a higher use of prednisone in the intervention group (55.7% vs. 44.3%, P < 0.001) consistent with dyspnea deterioration. In the intervention group, exacerbations treated with antibiotics and prednisone had less risk of requiring an hospitalization than those occurring in the control group (16.5% vs. 35.1%, P < 0.001). Conclusions: Improved access to treat exacerbations provided by the written action plan plays an important role in reducing hospitalization risk.