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Researchers developed a new COPD-ES questionnaire for healthcare professionals to improve the management of stable chronic obstructive pulmonary disease.

Patient-centered educational intervention can potentially improve self-management and clinical outcomes in chronic obstructive pulmonary disease (COPD), according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease.

“Current research on disease education for patients with COPD has shown varied and inconsistent results,” wrote Yi Yang and colleagues. “Consequently, it remains challenging for healthcare professionals to provide clear and concise recommendations regarding the form and content of COPD education programs. Therefore, this study aims to design and validate a COPD self-evaluation (COPD-ES) questionnaire and apply it in the disease education of patients with stable COPD.”

Education Versus Standard Care

The randomized controlled study enrolled 89 stable patients with COPD from October 2022 to June 2023. Participants were split into a control group (n=48), which received standard COPD management per GOLD 2022 guidelines, and an intervention group (n=41), which also completed the COPD-ES questionnaire monthly.

The COPD-ES questionnaire included 10 key items selected through expert evaluation. Patients in the intervention group received professional feedback on their responses, reinforcing self-management strategies. At 3 and 6 months, follow-up assessments measured changes in disease knowledge, medication use, smoking status, and clinical outcomes, including CAT scores, mMRC grading, and acute exacerbation rates.

Improved Adherence, Reduced Exacerbations

Results after 6 months showed significant improvements in the intervention group compared to the control:

• Smoking cessation: The smoking rate dropped from 60% to 22% in the intervention group while remaining unchanged in controls.
• Medication adherence: All patients in the intervention group reported proper medication use at 6 months, compared to only 12% at baseline.
• Symptom improvement: CAT scores in the intervention group decreased significantly (from 19.3 to 15.5, p < 0.007), indicating better disease control.
• Exacerbation reduction: 63% of intervention patients had no exacerbations, compared to 37% in the control group (P=0.009).

Additionally, patients in the intervention group showed improved GOLD group classification, reflecting better disease control and fewer high-risk patients.

“This study innovatively involves monthly scheduled contacts via telephone or other online communication tools initiated by researchers rather than prompted by patient complaints or symptoms. These regular interactions may subtly encourage patients to focus on improving daily self-management behaviors like avoiding cold exposure, harmful smoke, adhering to medications, and increasing exercise,” the researchers said.

“Patients are also motivated to actively seek COPD-related knowledge to prevent symptom worsening during these monthly contacts.”

Implications for Clinical Practice

The study suggests integrating a simple self-evaluation questionnaire into COPD management can significantly improve patient adherence and outcomes.

The researchers noted that the COPD-ES had good internal consistency and excellent content validity, making it comparable in quality to other tools such as the LMIC COPD-KQ, the COPD-Q, and the BCKQ.

“Additionally, the COPD-ES questionnaire utilizes various formats, including open-ended and yes/no questions. Open-ended questions offer flexibility for deeper patient reflection, potentially enhancing response authenticity by avoiding superficial answers. Yes/no questions are more easily accepted and facilitate simpler scoring,” the researchers explained.

The study was limited to a single center and included a relatively short follow-up. The study authors noted further research is needed to assess long-term benefits and broader applicability in diverse patient populations.

For physicians, incorporating structured patient education tools like the COPD-ES questionnaire could enhance disease management and reduce the burden of COPD exacerbations in clinical practice.

“Overall, the COPD-ES questionnaire developed in this study is scientifically robust, effective, and reliable,” Yang and colleagues concluded.