A model of care for mild chronic obstructive pulmonary disease (COPD) consisting of an 8-week home-based pulmonary rehabilitation program (HomeBase), home medicines review, and support for smoking cessation has not demonstrated superiority over traditional care, according to a study published in the European Respiratory Journal.
The RADICALS cluster randomized controlled trial (Review of Airway Dysfunction and Interdisciplinary Community-Based Care in Adult Long-Term Smokers; Australia and New Zealand Clinical Trials Registry: ACTRN12614001155684) included 272 individuals with COPD, 157 of whom were treated with intervention and 115 of whom were treated with traditional care. Care was provided in 43 Australian general practice facilities. Participants were ≥40 years old, were current or previous smokers, and had spirometrically confirmed COPD with ≥2 visits to the clinic within the past year. Traditional care consisted of routine care practices administered by general practitioners, whereas interventional care included HomeBase, a home-based interview assessing medication use, and individual support for smoking cessation.
The study’s primary outcome was change in St George’s Respiratory Questionnaire (SGRQ) at the 6-month mark, and secondary outcomes included 6- and 12-month changes in lung function, smoking cessation, dyspnea, and COPD Assessment Test scores. In regression analyses, adjustments were made for prior COPD diagnosis, current smoking status, income, education, age, and clustering.
In the intervention group, 31% (n=49) followed through with both home medicines review and HomeBase. The 6-month change in SGRQ for the intervention group was 3.07 (95% CI, 0.73-5.42), which was statistically significant; however, the adjusted mean difference between groups of 2.45 (95% CI, –0.89 to 5.79; P =.15) while in favor of intervention, was not. In the participants who received intervention as intended, per protocol analysis revealed a statistically significant SGRQ difference in interventional vs traditional care (5.22; 95% CI, 0.19-10.25; P =.042). Secondary outcomes did not show statistically significant differences, and no statistically significant results were found at the 12-month mark.
Limitations of this study included low uptake of intervention, difficult recruitment, and a slightly higher rate of attrition than expected.
“In primary care, uptake of and adherence to healthy behaviors (smoking cessation, increased physical activity) and self-management skills (optimal use of inhaled medications, and early recognition and treatment of worsening of symptoms) may be better predictors of longer-term outcomes in patients with mild disease,” the researchers concluded. “Patient needs, preferences, and personal goals should be carefully assessed and considered to inform subsequent intervention program tailoring.”
Disclosures: This study received funding from Eastern Melbourne PHN, Boehringer Ingelheim, National Health and Medical Research Council, and Lung Foundation Australia. Several authors report financial associations with pharmaceutical companies. For a full list of author disclosures, please see the reference.
Liang J, Abramson MJ, Russell G, et al. Interdisciplinary COPD intervention in primary care: a cluster randomised controlled trial [published online February 20, 2019]. Eur Respir J. doi:10.1183/13993003.01530-2018