While common ingredients include tobacco cessation, flu shots, giving patients basic information about COPD and teaching breathing, coughing techniques, lifestyle modifications as well as energy conservation for day-to-day activities, the DMCB thinks the secret sauce of COPD disease management is the "Action Plan." It's mentioned as an option in the Global Initiative for Chronic Obstructive Lung Disease or "GOLD" guidelines (113 pages can be downloaded here , you'll find it mentioned as "B" evidence on page 71). An Action Plan typically consists of a ready-to-go and "shoot-first-and-ask-questions-later" patient initiated package of antibiotics and glucocorticosteroids that are started if there is a sudden cold, infection, cough, shortness of breath or other disease exacerbation. Both of the studies mentioned above included this in the intervention group.
Disease management: check.
Action plan: check.
Which is why this news is so counterintuitive (hat tip to KevinMD ). According to this article, the VA's Bronchitis and Emphysema Advice and Training to Reduce Hospitalization "BREATH" COPD disease management trial, which was started in 2006, was halted early in 2009 because of higher all cause mortality rates in the intervention group.
The DMCB went to the clinicaltrials.gov website to find out more. BREATH was a two phase study. The first part was a twelve month "feasibility" study performed at six VA sites that targeted a recruitment of 180 patients, followed by a second phase expansion at 8 other sites targeting the recruitment of an additional 780 patients. In reading the protocol, the DMCB thinks the intervention group received the standard mix of disease management services, including the education, telephonic follow-up and an Action Plan.
The trial was stopped in 2009. According to news reports, a manuscript in the works and should be published in the coming months. Until the paper gets published, the DMCB can only speculate about the cause of the increased death rate in the disease management intervention arm of BREATH. If it had to guess, however, it would wonder if the Action Plan play some sort of role - perhaps the antibiotics led to microbial resistance or the steroids hampered immunity.
(late post - Google formating wouldn't work)