Chronic obstructive pulmonary disease (COPD) is a prevalent condition causing progressive airflow obstruction and deterioration in health-related quality of life (HRQOL) and overall health status. This major community health problem is correlated with significant morbidity, mortality and costs to health care systems globally. Few data report the effectiveness of outreach home nursing intervention programs to help individuals self-manage COPD. This study reviewed the effectiveness of outreach nursing programs for improving lung function, exercise tolerance, HRQOL, mortality and hospitalization outcomes for COPD patients. Although nursing outreach COPD programs for COPD may improve HRQOL and related outcomes for those with mild to moderate disease, the impact of such programs on hospitalization rates has not been adequately examined.

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition causing progressive airflow obstruction and deterioration in health-related quality of life (HRQOL) and overall health status. This major community health problem is correlated with significant morbidity, mortality and costs to health care systems globally. Few data report the effectiveness of outreach home nursing intervention programs to help individuals self-manage COPD. Home COPD nursing including education about pulmonary disease and medications, and monitoring of lung function may result in optimal health status and reduce hospitalization. This systematic review evaluates the potential effectiveness of outreach nursing programs in improving lung function, exercise tolerance, HRQOL, mortality and hospitalization outcomes for COPD patients.

Method: A comprehensive database search was conducted to identify randomized controlled trials (RCTs) evaluating the effectiveness of home-based COPD nursing intervention programs featuring COPD education, and ongoing lung functioning assessment. Four trials were included and reviewed by two separate appraisers for methodological quality according to Cochrane Collaboration criteria. Three trials examined mortality after twelve months of care, and one looked at mortality at seven months. Data were abstracted and analyzed via standard research techniques.

Findings: Home nursing COPD did not significantly reduce overall mortality, but mortality for those with less severe COPD was improved. HRQOL was also improved for those with moderate disease only. No changes in exercise capacity and lung functioning were found across studies. No improvements in hospital admission rates were found in the one study that examined this outcome.

Conclusions: Nursing outreach COPD programs may improve HRQOL and related outcomes for COPD patients with mild to moderate disease. Those with severe COPD appear not to benefit from such programs. The impact of home COPD nursing programs on hospitalization rates among those with mild to moderate COPD has not been adequately examined.

Reference: Smith B, Appelton S, Adams R, Southcott A, Ruffin R. "Home care outreach nursing for chronic obstructive pulmonary disease". Cochrane Database of Systematic Reviews 2003; 1.

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