***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVE To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in individuals recently diagnosed with chronic obstructive pulmonary disease ( COPD ) . METHODS A r and omized control trial was undertaken during which an experimental group received 2h of education delivered by a certified COPD educator and a control group received usual care . The Bristol COPD Knowledge Question naire ( BCKQ ) was self-administered at the time of r and omization and approximately three months later . RESULTS Of the 93 individuals that completed the study , 50 ( forced expiratory volume in 1s [FEV(1)]=60.0+/-14.3 % predicted ; 22 males ) and 43 ( FEV(1)=58.2+/-14.4 % predicted ; 20 males ) participants were r and omized to the experimental and control groups , respectively . The BCKQ increased from 27.6+/-8.7 to 36.5+/-7.7 points ( p<0.001 ) in the experimental group , which was greater than any seen in the control group ( between-group difference 8.3 , 95 % confidence interval 5.5 - 11.2 points ) . CONCLUSION As little as 2h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge . PRACTICE IMPLICATION S A program of brief education delivered in the primary care setting , represents an important approach for many individuals with COPD who are unlikely to access pulmonary rehabilitation Background : Chronic obstructive pulmonary disease ( COPD ) is characterised by both an accelerated decline in lung function and periods of acute deterioration in symptoms termed exacerbations . The aim of this study was to investigate whether these are related . Methods : Over 4 years ,  peak expiratory flow ( PEF ) and symptoms were measured at home daily by 109 patients with COPD ( 81 men ; median ( IQR ) age 68.1 ( 63–74 ) years ; arterial oxygen tension ( Pao2 ) 9.00 ( 8.3–9.5 ) kPa , forced expiratory volume in 1 second ( FEV1 ) 1.00 ( 0.7–1.3 ) l , forced vital capacity ( FVC ) 2.51 ( 1.9–3.0 ) l ) ; of these , 32 ( 29 men ) recorded daily FEV1 . Exacerbations were identified from symptoms and the effect of frequent or infrequent exacerbations ( > or < 2.92 per year ) on lung function decline was examined using cross sectional , r and om effects models . Results : The 109 patients experienced 757 exacerbations . Patients with frequent exacerbations had a significantly faster decline in FEV1 and peak expiratory flow ( PEF ) of –40.1 ml/year ( n=16 ) and –2.9 l/min/year ( n=46 ) than infrequent exacerbators in whom FEV1 changed by –32.1 ml/year ( n=16 ) and PEF by –0.7 l/min/year ( n=63 ) . Frequent exacerbators also had a greater decline in FEV1 if allowance was made for smoking status . Patients with frequent exacerbations were more often admitted to hospital with longer length of stay . Frequent exacerbations were a consistent feature within a patient , with their number positively correlated ( between years 1 and 2 , 2 and 3 , 3 and 4 ) . Conclusions : These results suggest that the frequency of exacerbations contributes to long term decline in lung function of patients with moderate to severe COPD Exacerbations are an important cause of morbidity and mortality in COPD . We assessed treatment initiation and health care use at exacerbation in patients receiving a self-management education program including an action plan . COPD patients were r and omly assigned to  usual care or to a  comprehensive self-management program “ Living Well with COPD ” including a written action plan and case manager support , and were followed-up for 12 months . Patients in the usual care were managed by their respective practitioners . Patients in the self-management program received , as part of a written action plan , a prescription of antibiotics and prednisone for self-initiation in case of aggravation of 2 or more symptoms ( dyspnea , sputum volume , sputum purulence ) for at least 24 hours , and they had the support of a case-manager for reinforcement and monthly telephone follow-ups . At 12 months , 166 patients presented with at least one exacerbation . Exacerbations ( 606 ) were confirmed by aggravation of at least one symptom ; 403 ( 67.6 % ) presented 2 or more . Antibiotics were used in 61.6 % of exacerbations and prednisone in 47.9 % . In exacerbations presenting aggravation of 2 or more symptoms ,  antibiotics  and prednisone were used together more often in the action plan than in the usual care group ( 54.4 % vs. 34.8 % , p < 0.001 ) . In the action plan , compared to the usual care group , 17.2 % vs. 36.3 % exacerbations result ed in a hospitalization ( p < 0.001 ) . Self-management with the successful use of an action plan for acute exacerbation of COPD holds promise for reducing health care use Unreported chronic obstructive pulmonary disease ( COPD ) exacerbations are common , but their intermediate-to-long-term impacts on health-related quality of life ( HRQoL ) are unknown . The aim of the present study was to examine the impact of unreported exacerbations on HRQoL at 1 yr . A multicentric prospect i ve cohort study in 491 COPD patients was conducted in China . HRQoL was measured using the St George 's Respiratory Question naire ( SGRQ ) . Other measurements included sociodemographic , clinical , psychosocial and treatment profiles . Patients were monitored monthly for 12 months to document exacerbations ( at least one symptom worsening for ≥48 h ) . Patients were categorised into six groups : no exacerbation , one unreported exacerbation only , more than one unreported exacerbation only , one reported exacerbation only , more than one reported exacerbation only , and both unreported and reported exacerbations . Generalised estimating equations were used to estimate the adjusted associations between exacerbations and HRQoL change . A total of 466 unreported and 410 reported exacerbations were recorded . Compared with patients with no exacerbations , the change in SGRQ total score was similar amongst patients with one unreported exacerbation ( adjusted mean change 1.22 points ( 95 % CI -4.05–6.48 ) ) , but significantly worse among patients with more than one unreported exacerbation ( 4.61 ( 95 % CI 0.09–9.13 ) ) . Development and evaluation of self-management programmes emphasising early recognition of exacerbations and consequent action appear to be warranted BACKGROUND Chronic obstructive pulmonary disease ( COPD ) affects 14 to 20 million Americans and is associated with increased prevalence of affective disorders , contributing significantly to disability . This study compared cognitive behavioral therapy ( CBT ) group treatment for anxiety and depression with COPD education for COPD patients with moderate-to-severe anxiety and /or depressive symptoms . METHOD A r and omized controlled trial ( RCT ) was conducted between 11 July 2002 and 30 April 2005 at the Michael E. DeBakey VA Medical Center , Houston , TX . Participants were 238 patients treated for COPD the year before , with forced expiratory value in 1 second (FEV)1/forced vital capacity (FVC)<70 % and FEV1<70 % predicted , and symptoms of moderate anxiety and /or moderate depression , who were being treated by a primary care provider or pulmonologist . Participants attended eight sessions of CBT or COPD education . Assessment s were at baseline , at 4 and 8 weeks , and 4 , 8 and 12 months . Primary outcomes were disease-specific and generic quality of life ( QoL ) [ Chronic Respiratory Question naire ( CRQ ) and Medical Outcomes Survey Short Form-36 ( SF-36 ) respectively ] . Secondary outcomes were anxiety [ Beck Anxiety Inventory ( BAI ) ] , depressive symptoms [ Beck Depression Inventory-II ( BDI-II ) ] , 6-minute walk distance ( 6MWD ) and use of health services . RESULTS Both treatments significantly improved QoL , anxiety and depression ( p<0.005 ) over 8 weeks ; the rate of change did not differ between groups . Improvements were maintained with no significant change during follow-up . Ratios of post- to pretreatment use of health services were equal to 1 for both groups . CONCLUSIONS CBT group treatment and COPD education can achieve sustainable improvements in QoL for COPD patients experiencing moderate-to-severe symptoms of depression or anxiety Aims : The main objective of this study was to investigate whether a comprehensive self-management programme , including self-treatment guidelines for exacerbations and a fitness programme , is an efficient treatment option for chronic obstructive pulmonary disease ( COPD ) patients . Method : We r and omly allocated 248 COPD patients to either self-management  ( 127 ) or usual care ( 121 ) . Data on preference-based utilities ( EuroQol-5D ) , health-related quality of life ( HRQoL ) , health-care re source use and productivity losses associated with exacerbations were prospect ively collected . Quality -adjusted life years ( QALYs ) were calculated . The economic analysis took the societal perspective and the observation period was one year . Results : As we observed that the groups were equally effective in terms of QALYs and HRQoL ( SGRQ ) , we described a cost minimization analysis only . The self-management programme-specific costs amounted to 6642 per patient . In the base-case cost analysis , the incremental cost difference amounted to 838 per patient per year in favour of usual care . When only direct medical costs were included , the incremental annual cost of self-managementrelative to usual care was 179 per person per year . If time costs for the fitness programme were set to zero , the costs for self-management diminished to 542 . Sensitivity analysis showed that these results were robust to changes in the underlying assumptions . Conclusion : We conclude that the COPE self-management programme is not an efficient treatment option for moderate to severe COPD patients who rate their HRQoL relatively high . The programme was twice as expensive as usual care and had no measurable beneficial effects on QALYs or Objective To determine the feasibility and efficacy of a six-month , cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease ( COPD ) following pulmonary rehabilitation . Methods Participants who completed a two-week run-in were r and omly assigned to either MOBILE-Coached  ( n = 9 ) or MOBILE-Self-Monitored  ( n = 8) . All participants met with a nurse to develop an individualized exercise plan , were issued a pedometer and exercise booklet , and instructed to continue to log their daily exercise and symptoms . MOBILE-Coached also received weekly reinforcement text messages on their cell phones ; reports of worsening symptoms were automatically flagged for follow-up . Usability and satisfaction were assessed . Participants completed incremental cycle and six minute walk ( 6MW ) tests , wore an activity monitor for 14 days , and reported their health-related quality of life ( HRQL ) at baseline , three , and six months . Results The sample had a mean age of 68 ±11 and forced expiratory volume in one second 18 % predicted . Participants reported that logging their exercise and symptoms ( FEV1 ) of 40 ± was easy and that keeping track of their exercise helped them remain active . There were no differences between groups over time in maximal workload , 6MW distance , or HRQL ( p > 0.05 ) ; however , MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months ( p = 0.04 ) . Conclusions We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring . The latter finding needs to be interpreted with caution since this was a purely exploratory study . Trial registration Clinical Trials.gov ( NCT00373932 ) PURPOSE Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy . Limitations of most studies , however , include use of multiple outcome measures without pre design ated primary outcomes and lack of r and omized follow-up beyond 6 months . We conducted a 1-year r and omized controlled trial of Homing in on Health ( HIOH ) , a Chronic Disease Self-Management Program variant , addressing these limitations . METHODS We r and omized out patients ( N = 415 ) aged 40 years and older and who had 1 or more of 6 common chronic illnesses , plus functional impairment , to HIOH delivered in homes or by telephone for 6 weeks or to usual care . Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey‘s physical component ( PCS-36 ) and mental component ( MCS-36 ) summary scores . Secondary outcomes included the EuroQol EQ-5D and visual analog scale ( EQ VAS ) , hospitalizations , and health care expenditures . RESULTS Compared with usual care , HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks ( effect size 
    Output:
    
Subgroup analyses depending on the use of an exercise programme as part of the intervention revealed no statistically significant differences between studies with and without exercise programmes in our primary outcomes of HRQoL and respiratory-related hospital admissions .
Self management interventions in patients with COPD are associated with improved health-related quality of life as measured by the SGRQ , a reduction in respiratory-related hospital admissions , and improvement in dyspnoea as measured by the (m)MRC .
No statistically significant differences were found in other outcome parameters .