January 2012 Study Shows Community-based Programmes Effective in Helping People to Manage their Chronic Obstructive Pulmonary Diseas

A new study from NUI Galway has shown a significant improvement in managing breathing difficulties among people suffering from COPD, or chronic obstructive pulmonary disease. The Health Research Board (HRB) - funded study trialled a community-based approached, through nurses, GP practices and physiotherapists, to help sufferers better manage their condition.

COPD is a progressive disease that makes it hard to breathe. The disease can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness, and other symptoms. While cigarette smoking is the leading cause of COPD, long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, may also contribute to COPD.

The PRINCE (Pulmonary Rehabilitation in Nurse-led Community Environment) study was funded by the HRB, and consisted of a two-armed randomised cluster trial. In one arm (intervention group), persons with COPD received a structured education pulmonary rehabilitation programme, while the other arm (control group) received usual care.

The study is one of the largest pulmonary rehabilitation trials conducted in primary care.

The pulmonary rehabilitation programme was specifically designed by the study team for clients living in the community with COPD. The programme was delivered in GP practices or venues close by and facilitated by practice nurses and physiotherapists who were trained by the PRINCE study team to facilitate the programme. The content of the programme included medication management, breathing techniques and exercise training. It was delivered two hours per week over eight weeks. The study found that people who attended the programme were significantly better able to manage their breathing difficulties than those who did not attend.

Principal study investigators Professor Kathy Murphy and Dr Dympna Casey, from the School of Nursing at NUI Galway, are excited by the study findings. Professor Murphy commented: “We both feel strongly that healthcare research must make a real difference to patients’ lives and we are delighted that the findings of our large trial does just that. Our study found that a community based pulmonary rehabilitation programme facilitated by trained physiotherapists and practice nurses who had no prior COPD expertise, is feasible, safe, and effective. Not only that, but it makes a real difference to patients with moderate to severe COPD by improving their dyspnoea and physical functioning.”

Dr Casey added: “A key strength of this study is that by involving the practitioners who work within primary care and training them to facilitate delivery of the pulmonary rehabilitation programmes, we have helped to strengthen and build capacity within the Irish primary health care setting to manage COPD more effectively. Our work shows that it’s possible to expand the scope of pulmonary rehabilitation practice in Ireland from hospital-based to community-based programmes.”

The comprehensive findings of the PRINCE Study were presented at a Respiratory Symposium sponsored by Pfizer and co-ordinated by the PRINCE research team, which was held in NUI Galway on 21 January 2012. The symposium, which focuses on respiratory management, was chaired by Dr Andrew Murphy Professor of General Practice, NUI Galway, and member of the PRINCE research team. The symposium also included a number of key note speakers including Dr Joe Clarke, HSE Primary Care Clinical Lead, and Professor JJ. Gilmartin, Respiratory Consultant, GUH, Galway.

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