TY - JOUR
T1 - Community based integrated intervention for prevention and management of chronic obstructive pulmonary disease (COPD) in Guangdong, China
T2 - Cluster randomised controlled trial
AU - Zhou, Yumin
AU - Hu, Guoping
AU - Wang, Dali
AU - Wang, Shaoyi
AU - Wang, Yujun
AU - Liu, Zhigang
AU - Hu, Jinxin
AU - Shi, Zhe
AU - Peng, Gongyong
AU - Liu, Shengming
AU - Lu, Jiachun
AU - Zheng, Jingping
AU - Wang, Jian
AU - Zhong, Nanshan
AU - Ran, Pixin
PY - 2010/12/4
Y1 - 2010/12/4
N2 - Objective: To evaluate the effects of a community based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. Design: Cluster randomised controlled trial. Setting: Eight healthcare units in two communities. Participants: Of 1062 people aged 40-89, 872 (101 with COPD and 771 without COPD) who fulfilled the inclusion and exclusion criteria were allocated to the intervention or the usual care programmes. Intervention: Participants randomly assigned to integrated intervention (systematic health education, intensive and individualised intervention, treatment, and rehabilitation) or usual care. Main outcome measures: Annual rate of decline in forced expiratory rate in one second (FEV1) before use of bronchodilator. Results: Annual rate of decline in FEV1 was significantly lower in the intervention community than the control community, with an adjusted difference of 19 ml/year (95% confidence interval 3 to 36) and 0.9% (0.1% to 1.8%) of predicted values (all P<0.05), as well as a lower annual rate of decline in FEV1/FVC (forced vital capacity) ratio (adjusted difference 0.6% (0.1% to 1.2%) P=0.029). There were also higher rates of smoking cessation (21% v 8%, P<0.004) and lower cumulative death rates from all causes (1% v 3%, P<0.009) in the intervention community than in the control community during the four year follow-up. Improvements in knowledge of COPD and smoking hazards, outdoor air quality, environmental tobacco smoke, and working conditions were also achieved (all P<0.05). The difference in cumulative incidence rate of COPD (both around 4%) and cumulative death rate from COPD (2% v 11%) did not reach significance between the two communities. Conclusions: A community based integrated intervention can have a significant impact on the prevention and management of COPD, mainly reflected in the annual rate of decline in FEV1. Trial registration: Chinese Clinical Trials Registration (ChiCTR-TRC-00000532).
AB - Objective: To evaluate the effects of a community based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. Design: Cluster randomised controlled trial. Setting: Eight healthcare units in two communities. Participants: Of 1062 people aged 40-89, 872 (101 with COPD and 771 without COPD) who fulfilled the inclusion and exclusion criteria were allocated to the intervention or the usual care programmes. Intervention: Participants randomly assigned to integrated intervention (systematic health education, intensive and individualised intervention, treatment, and rehabilitation) or usual care. Main outcome measures: Annual rate of decline in forced expiratory rate in one second (FEV1) before use of bronchodilator. Results: Annual rate of decline in FEV1 was significantly lower in the intervention community than the control community, with an adjusted difference of 19 ml/year (95% confidence interval 3 to 36) and 0.9% (0.1% to 1.8%) of predicted values (all P<0.05), as well as a lower annual rate of decline in FEV1/FVC (forced vital capacity) ratio (adjusted difference 0.6% (0.1% to 1.2%) P=0.029). There were also higher rates of smoking cessation (21% v 8%, P<0.004) and lower cumulative death rates from all causes (1% v 3%, P<0.009) in the intervention community than in the control community during the four year follow-up. Improvements in knowledge of COPD and smoking hazards, outdoor air quality, environmental tobacco smoke, and working conditions were also achieved (all P<0.05). The difference in cumulative incidence rate of COPD (both around 4%) and cumulative death rate from COPD (2% v 11%) did not reach significance between the two communities. Conclusions: A community based integrated intervention can have a significant impact on the prevention and management of COPD, mainly reflected in the annual rate of decline in FEV1. Trial registration: Chinese Clinical Trials Registration (ChiCTR-TRC-00000532).
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U2 - 10.1136/bmj.c6387
DO - 10.1136/bmj.c6387
M3 - Article
C2 - 21123342
AN - SCOPUS:78649893510
SN - 0959-8146
VL - 341
SP - 1203
JO - BMJ (Online)
JF - BMJ (Online)
IS - 7784
M1 - c6387
ER -