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People getting comprehensive education had higher death risk,researchers found. By Serena Gordon HealthDay Reporter MONDAY, May 14 (HealthDay News) -- In a finding that seemscounterintuitive, a new study revealed that people with chronicobstructive pulmonary disease (COPD) were more likely to die afterreceiving comprehensive education and self-management tools. "The comprehensive care management program was associated withunanticipated excess mortality," wrote study authors Dr. VincentFan, of the Veterans Affairs Puget Sound Health Care System inSeattle, and colleagues. They added that this finding differedsignificantly from previous studies done on self-management inCOPD. And, the program used in the study also failed to decreaseCOPD-related hospitalizations. The results are published in the May 15 online issue of the Annals of Internal Medicine . COPD refers to either emphysema or chronic bronchitis. Theseprogressive lung diseases are usually caused by cigarette smoking,and make it harder and harder to breathe as they get worse. COPDcauses the production of mucus, which leads to coughing, shortnessof breath and wheezing, according to the U.S. National Heart, Lung,and Blood Institute. Symptoms can get worse very quickly,particularly after an infection, and these disease exacerbations(flare-ups) often result in the need to be hospitalized, accordingto background information in the journal. Findings from several previous studies suggested that educatingCOPD patients and helping them design emergency plans could helpreduce the number of hospitalizations. The current study included 426 people being treated for COPD at oneof 20 Veterans Affairs hospital-based outpatient clinics. The studyvolunteers were almost all male (about 97 percent), and about nineof 10 were white. About half were married, and most had graduatedfrom high school and attended some college or vocational school.Just under 30 percent were still smoking. The intervention group had 209 people, while the usual-care grouphad 217. The study intervention consisted of four individual 90-minuteweekly educational sessions. These sessions included an assessmentof that person's COPD, including their current medications and whattriggered exacerbations for them. Participants received a written,individualized action plan that included the steps they needed totake when their COPD flared up. They were taught how to recognizethe symptoms of a flare, and they were given daily COPD managementadvice. They were also given prescriptions for prednisone (asteroid anti-inflammatory medication) and an antibiotic. Case managers were available every day to answer any questions byphone. The study volunteers were instructed to call in if they hadto initiate treatment based on their written plan. Researchers alsocalled to check in on the volunteers every two months. The one-year incidence of COPD hospitalizations was 27 percent inthe intervention group and 24 percent in the usual-care group.Twenty-eight people died in the intervention group versus 10 peoplein the usual-care group -- a three times higher risk of death,according to the study. Due to safety concerns, the trial was stopped early. Theresearchers don't know why extra education and self-managementwould lead to an increased risk of death, however. "I'm not convinced that the intervention increased the risk ofdeath. It certainly was not expected, and other studies that havelooked at COPD and other diseases have found that people do wellwith these types of interventions," said Dr. Jonathan Whiteson,director of cardiopulmonary rehabilitation at NYU Langone MedicalCenter in New York City. "If you flip a coin, the odds are 50-50 that you'll get heads. But,if you flip the coin 20 times, you might only get heads a fewtimes. But, if you keep flipping the coin, it will eventually evenout. That could be what was going on here. If they hadn't stoppedthe study, it might have equaled out a little more," Whiteson said. He noted that because the study was predominantly in white males,it's difficult to extrapolate these findings to other populations. Dr. Thomas Aldrich, a pulmonologist at Montefiore Medical Center inNew York City, said, "It's really hard to imagine how this programcould be so toxic, and it's hard to explain why it happened." Aldrich said similar self-management programs like this have hadgood results in people with asthma. But, it's possible that there'san inherent difference in people with COPD, he noted. "Most peoplewith COPD smoked, despite repeated health care warnings, so they'vealready demonstrated that they're not necessarily stronglyinfluenced by health care advice, and maybe that's part of theproblem," Aldrich said. Dr. Len Horovitz, an internist and pulmonologist at Lenox HillHospital in New York City, agreed that patient differences may haveplayed a role in this study's surprising findings. But he believesthat an individual's threshold for reporting symptoms may be what'sat play here. "The threshold at which a patient will report symptoms, even whencoached, is going to be quite variable. A patient might feel thattheir symptoms aren't much worse, although a lung function testwould tell us they are. There's a lot of fear and denial forpatients. And, it's hard for a doctor to know ahead of time howstoic a patient is," Horovitz said. And, the problem with COPD is that symptoms can get worse veryquickly. "When in doubt, report your symptoms to your doctor. Because COPDis chronic, you learn to live with a lot of the symptoms," Horovitzsaid. Whiteson agreed: "Come to me -- let me interpret what the symptomsmean. People with COPD can get very sick very quickly. We don'twant you to wait even a day," he said. More information Learn more about chronic obstructive pulmonary disease from the U.S. National Heart, Lung, and Blood Institute . SOURCES: Jonathan Whiteson, M.D., director, cardiopulmonaryrehabilitation, NYU Langone Medical Center, New York City; LenHorovitz, M.D., internist and pulmonologist, Lenox Hill Hospital,New York City; Thomas Aldrich, M.D., pulmonologist, MontefioreMedical Center, and professor of medicine, Albert Einstein Collegeof Medicine, New York City; May 15, 2012, Annals of Internal Medicine , online Copyright © 2012 HealthDay . All rights reserved. We are high quality suppliers, our products such as China Suspended Working Platform , China Swing Staging for oversee buyer. To know more, please visits Window Cleaning Cradle.
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