Community based integrated intervention for prevention and management of chronic obstructive pulmonary disease (COPD) in Guangdong, China: cluster randomised controlled trial

Abstract

Objective To evaluate the effects of a community based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. Design Cluster randomised controlled trial. Setting Eight healthcare units in two communities. Participants Of 1062 people aged 40-89, 872 (101 with COPD and 771 without COPD) who fulfilled the inclusion and exclusion criteria were allocated to the intervention or the usual care programmes. Intervention Participants randomly assigned to integrated intervention (systematic health education, intensive and individualised intervention, treatment, and rehabilitation) or usual care. Main outcome measures Annual rate of decline in forced expiratory rate in one second (FEV 1 ) before use of bronchodilator.Results Annual rate of decline in FEV 1 was significantly lower in the intervention community than the control community, with an adjusted difference of 19 ml/year (95% confidence interval 3 to 36) and 0.9% (0.1% to 1.8%) of predicted values (all P<0.05), as well as a lower annual rate of decline in FEV 1 /FVC (forced vital capacity) ratio (adjusted difference 0.6% (0.1% to 1.2%) P=0.029). There were also higher rates of smoking cessation (21% v 8%, P<0.004) and lower cumulative death rates from all causes (1% v 3%, P<0.009) in the intervention community than in the control community during the four year followup. Improvements in knowledge of COPD and smoking hazards, outdoor air quality, environmental tobacco smoke, and working conditions were also achieved (all P<0.05). The difference in cumulative incidence rate of COPD (both around 4%) and cumulative death rate from COPD (2% v 11%) did not reach significance between the two communities. Conclusions A community based integrated intervention can have a significant impact on the prevention and management of COPD, mainly reflected in the annual rate of decline in FEV 1 .

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

“…[17][18][19][20] A few studies on the respiratory and systemic manifestations of COPD showed that the FEV 1 , expressed as the percentage of predicted values, did not change significantly in subjects with COPD, 21,22 which is consistent with our findings. Our results show that the decrease in FEV 1 in subjects with stage I and II COPD in the health management group was less pronounced than that in the control group.…”

To What Causes Do People Attribute Their Chronic Breathlessness? A Population Survey

“…[27][28][29] Significantly, a recent report of a community-based complex intervention (smoking cessation, pulmonary rehabilitation, optimization of medication, education) administered to smokers, whether with documented COPD or not, demonstrated reduction in the decline of pulmonary function tests, increased smoking cessation, and decline in hospital admission and deaths in the intervention group. 30 The reduction in pulmonary function test decline was sustained over the 4 year follow up.…”

The Association between BMI and COPD: The Results of Two Population-based Studies in Guangzhou, China

“…Th e questionnaires used in the two studies have been published elsewhere (6,7) and include questions about demographic variables, respiratory symptoms/disease history, co-morbidities, health care utilization, activity limitation, nutritional status, smoking and other potential risk factors for COPD. Body weight was measured in light clothing to the nearest 0.1 kg with a calibrated balance beam scale; height without shoes on was measured to the nearest 0.5 cm using a vertical ruler; and BMI (kg/m 2 ) was computed as the ratio of body weight (kg) to height squared (m 2 ).…”

“…M u y tio ( of poor progn low g owever, OPD MI and C rt study i 567 cts the lungs ystemic consey a low body mass quared (m 2 ) ratio, as dyspnea, and exercise ndicator of poor prognosis also suggested that low body o date, however, there have been onship between COPD and BMI. n between BMI and COPD through a nt cohort study in Guangzhou Th e detailed study protocols have been described in previous publications (6,7). Ethical approval of the study protocols was obtained from the Medical Ethics Committee of the Guangzhou Institute of Respiratory Diseases, and informed consent was obtained from all participants.…”