In a meta-analysis of 33 randomized controlled trials involving 12,288 patients with chronic obstructive pulmonary disease, investigators found that community-based management models could lead to better respiratory outcomes, increased exercise capacity, and fewer symptom exacerbations compared with usual care.
In the analysis, the investigators evaluated two models: community-based integrated management and telemedicine-based care. Both were assessed against hospital-centered care across several outcomes, including lung function, symptom severity, physical endurance, and frequency of acute exacerbations.
Participants in community-based programs showed better performance on the 6-minute walk test (6MWT), improving by 39.73 m over those receiving usual care (95% CI, 30.15–49.32; P < .01). Telemedicine-based interventions, however, did not yield a statistically significant improvement in 6MWT results (P = .10).
Lung function measures also improved. The FEV₁/FVC ratio increased by 6.17 percentage points (95% CI, 4.54–7.79; P < .01), and FEV₁% predicted rose by 4.91 points (95% CI, 3.96–5.85; P < .01) in the community-based groups compared with usual care.
Symptom control improved significantly. COPD Assessment Test scores decreased by 4.46 points (95% CI, −5.67 to −3.25; P < .01), and dyspnea symptoms, measured by the modified Medical Research Council (mMRC) scale, showed a mean reduction of 0.72 points (95% CI, −1.23 to −0.21; P = .01). Integrated management was more effective than telemedicine in reducing dyspnea severity (P = .01).
Telemedicine-based care was associated with a reduction in acute exacerbations. Across 3 studies with 283 participants, exacerbations decreased by an average of 0.56 events (95% CI, −0.79 to −0.32; P < .01).
However, neither intervention significantly improved patient-reported quality of life. Based on St George’s Respiratory Questionnaire scores, no meaningful difference was observed between intervention and control groups (mean difference, −1.98; 95% CI, −5.02 to 1.07; P = .20).
High heterogeneity was observed across the studies, particularly for 6MWT and COPD Assessment Test scores. Contributing factors included differences in patient demographics, study design, and the type and duration of interventions.
The findings suggested that both community-based integrated care and telemedicine may serve as effective strategies for managing chronic obstructive pulmonary disease symptoms and improving respiratory function. Further studies are needed to determine their long-term impact on quality of life.
The authors declared no competing interests.
Source: Frontiers in Medicine