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Study objectives: First, to determine the relationships among chronic sputum expectoration (CSE), exacerbations, airflow obstruction, and emphysema in patients with [α.sub.1]-antitrypsin deficiency ([α.sub.1]-ATD) [PiZ]. Second, to use multivariate analysis to [...]

ObjectiveTo evaluate the effectiveness of telephone health coaching delivered by a nurse to support self management in a primary care population with mild symptoms of chronic obstructive pulmonary disease (COPD).DesignMulticentre randomised controlled trial.Setting71 general practices in four areas of England.Participants577 patients with Medical Research Council dyspnoea scale scores of 1 or 2, recruited from primary care COPD registers with spirometry confirmed diagnosis. Patients were randomised to telephone health coaching (n=289) or usual care (n=288).InterventionsTelephone health coaching intervention delivered by nurses, underpinned by Social Cognitive Theory. The coaching promoted accessing smoking cessation services, increasing physical activity, medication management, and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). The nurses received two days of training. The usual care group received a leaflet about COPD.Main outcome measuresThe primary outcome was health related quality of life at 12 months using the short version of the St George’s Respiratory Questionnaire (SGRQ-C).ResultsThe intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of patients received all four calls. 92% of patients were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference −1.3, 95% confidence interval −3.6 to 0.9, P=0.23). Compared with patients in the usual care group, at six months follow-up, the intervention group reported greater physical activity, more had received a care plan (44% v30%), rescue packs of antibiotics (37% v29%), and inhaler use technique check (68% v55%).ConclusionsA new telephone health coaching intervention to promote behaviour change in primary care patients with mild symptoms of dyspnoea did lead to changes in self management activities, but did not improve health related quality of life.Trial registrationCurrent controlled trials ISRCTN 06710391

BackgroundExisting studies suggest that patients with COPD would like to know more about end-of-life issues such as prognosis, advance directives, intubation/mechanical ventilation and what dying might be like. Most want to be involved in end-of-life decision making but feel that doctors should initiate such discussions. Knowing when to discuss these issues can be difficult as the length of time between diagnosis and pre-terminal events varies widely in this group.Aims and objectivesThe aim of this study was to explore COPD patients' understanding, experience, views and information needs regarding end-of-life issues using qualitative methods.MethodsThe study was carried out within a respiratory department of an acute NHS trust in the West Midlands. Patients from four groups were interviewed using a semi-structured interview schedule. 1. New referrals to a COPD clinic. 2. Patients undergoing pulmonary rehabilitation. 3. Patients on long term oxygen therapy. 4. Patients who have required one or more episode of ventilation. Transcribed data were analysed using thematic analysis.ResultsTwelve patients were interviewed. Three major themes were identified: “living with COPD”, “facing death”, and “planning for the end of life”. Patients knew very little about end-of-life issues and advance care planning. Patients were not keen to discuss these issues until they had reached the stage of having already been ventilated. When discussions did occur they were initiated by doctors.ConclusionsPatients with COPD are reluctant to discuss end-of-life issues at a time when such discussions could be most helpful. Further research is required in order to determine how, in practice, information and discussions about end-of-life issues can be successfully introduced at an earlier stage whilst still being acceptable to patients.