Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis

Nini H. Jonkman, Heleen Westland, Jaap C.A. Trappenburg, Rolf H.H. Groenwold, Erik W.M.A. Bischoff, Jean Bourbeau, Christine E. Bucknall, David Coultas, Tanja W. Effing, Michael J. Epton, Frode Gallefoss, Judith Garcia-Aymerich, Suzanne M. Lloyd, Evelyn M. Monninkhof, Huong Q. Nguyen, Job van der Palen, Kathryn L. Rice, Maria Sedeno, Stephanie J.C. Taylor, Thierry TroostersNicholas A. Zwar, Arno W. Hoes, Marieke J. Schuurmans

Research output: Contribution to journalReview articlepeer-review

47 Citations (Scopus)
17 Downloads (Pure)


Background: Self-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most. Methods: Randomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models. Results: Fourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes. Conclusion: Self-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.

Original languageEnglish
Pages (from-to)2063-2074
Number of pages12
JournalInternational Journal of COPD
Issue number1
Publication statusPublished - 31 Aug 2016
Externally publishedYes

Bibliographical note

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.


  • Chronic obstructive pulmonary disease
  • Individual patient data meta-analysis
  • Self-management
  • Subgroup analysis


Dive into the research topics of 'Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis'. Together they form a unique fingerprint.

Cite this