Effectiveness of the 'living well with COPD' intervention on coping, smoking behavior and exacerbations in patients from Swiss primary care: A non-randomized controlled study

Background/Aim: Pivotal objectives of self-management programs are behavior change, coping and better health related quality of life (HRQL). The effects of the “Living well with COPD” (LWWCOPD) self-management program and usual care on coping, HRQL, smoking cessation and exacerbation frequency at 24 months were compared in COPD patients from primary care. Method: Prospective non-randomized controlled study with COPD patients who participated in the “LWWCOPD” program adapted to primary care in Switzerland. COPD patients from the primary care-based COPD Cohort ICE COLD ERIC(http://www.ClinicalTrials.govNCT00706602) served as control. The primary outcome was coping measured by the mastery domain of the Chronic Respiratory Questionnaire (CRQ). We performed multivariate regression analyses where we accounted for the lack of randomization with propensity scores. Results: 71 patients were in the self- management and 385 in the usual care cohort. Patients with the self-management program had significantly higher mastery scores (0.71(95% CI 0.28-1.13)), significantly less moderate to severe exacerbations (incidence rate ratio 0.68(95% CI 0.48-0.97)) and significantly more patients quit smoking (odds ratio 0.26 (95% CI 0.07-0.95). There was an effect on fatigue (0.75(95% CI 0.28-1.22)) whereas the effect just did not reach statistical significance for dyspnea (0.50, 95% CI -0.03-1.03) and emotional function (0.40, 95% CI -0.03-0.82, all CRQ). Conclusion: The LWWCOPD intervention in a primary care setting showed long-term benefits on coping, exacerbations and smoking cessation behavior.