The influence of adherence to COPD exacerbation action plans on health outcomes

Aim: We explored associations between various adherence categories to COPD exacerbation action plans, and health outcomes. Methods: Data came from self-treatment intervention groups of two COPD self-management trials, including patients that experienced ≥1 COPD exacerbation during one year follow up. Optimal treatment was defined as ‘self-initiating treatment <2 days from the COPD exacerbation start’. Regression models were built for the health outcomes COPD exacerbations, hospitalisations, health-related quality of life, anxiety, and depression. Results: Of the 101 patients (COPD exacerbations: mean 3.0 (SD 2.5)), 38 treated their exacerbation optimal, 17 sub-optimal, and 46 with significant delay or not at all. We observed a significantly lower number of COPD exacerbation days/patient/year for ‘optimal treatment’ (-32.8 (95% CI -54.9;-10.8) days) and ‘sub-optimal treatment’ (-33.8 (95% CI -62.1;-5.5) days), compared to ‘significant delay or no treatment’. Duration of COPD exacerbations was significantly shorter for ‘optimal treatment’ (-7.4 days) and ‘sub-optimal treatment’ (-6.7 days), compared to ‘significant delay or no treatment’. No associations were found between adherence categories and other health outcomes. Conclusion: Our results show that patients with ‘optimal or sub-optimal treatment9 adherence to exacerbation action plans had significantly fewer COPD exacerbation days/patient/year and a shorter COPD exacerbation duration, compared with those showing ‘significant delay or no treatment’. These findings highlight the importance of patients9 adherence in timely using COPD exacerbation action plans. Therefore, interventions should include strategies that aim to optimise adherence.