Chronic Obstructive Pulmonary Disease Self-Management in Three Low- and Middle-Income Countries A Pilot Randomized Trial

Pollard S.L.; Siddharthan T.; Hossen S.; Rykiel N.A.; Flores-Flores O.; Alupo P.; Quaderi S.; Ascencio I.; Barber J.A.; Chandyo R.; Das S.K.; Gianella G.; Kirenga B.; Grunstra K.; Miranda J.J.; Mohan S.; Ricciardi F.; Sharma A.K.; Shrestha L.; Soares M.O.; Wosu A.C.; Hurst J.R.; Checkley W. · American Journal of Respiratory and Critical Care Medicine (2023) · DOI: 10.1164/rccm.202303-0505oc

Resumen

Objectives: Chronic obstructive pulmonary disease (COPD) disproportionately affects low- and middle-income countries. Health systems are ill prepared to manage the increase in COPD cases. Methods: We performed a pilot effectiveness-implementation randomized field trial of a community health worker (CHW)supported, 1-year self-management intervention in individuals with COPD grades B–D. The study took place in low-resource settings of Nepal, Peru, and Uganda. The primary outcome was the St. George’s Respiratory Questionnaire (SGRQ) score at 1 year. We evaluated differences in moderate to severe exacerbations, all-cause hospitalizations, and the EuroQol score (EQ-5D-3 L) at 12 months. Measurements and Main Results: We randomly assigned 239 participants (119 control arm, 120 intervention arm) with grades B–D COPD to a multicomponent, CHW-supported intervention or standard of care and COPD education. Twenty-five participants (21%) died or were lost to follow-up in the control arm compared with 11 (9%) in the intervention arm. At 12 months, there was no difference in mean total SGRQ score between the intervention and control arms (34.7 vs. 34.0 points; adjusted mean difference, 1.0; 95% confidence interval, 24.2, 6.1; P = 0.71). The intervention arm had a higher proportion of hospitalizations than the control arm (10% vs. 5.2%; adjusted odds ratio, 2.2; 95% confidence interval, 0.8, 7.5; P = 0.15) at 12 months. Conclusions: A CHW-based intervention to support self-management of acute exacerbations of COPD in three resource-poor settings did not result in differences in SGRQ scores at 1 year. Fidelity was high, and intervention engagement was moderate. Although these results cannot differentiate between a failed intervention or implementation, they nonetheless suggest that we need to revisit our strategy. Clinical trial registered with www.clinicaltrials.gov (NCT03359915). Copyright

Instituciones: Universidad Peruana Cayetano Heredia; Universidad Científica del Sur; Universidad de San Martín de Porres