The primary objective of this study is to determine if a sputum colour chart can aid patient self-management of COPD exacerbations, such that use of the chart is non-inferior to usual care with respect to hospital admissions. There are also a range of other secondary objectives as detailed in the secondary outcomes section. An integral pilot phase, economic evaluation and process evaluation are also included.
This study is a pragmatic, individually randomized trial, set in primary care, comparing usual care to the use of a sputum colour chart in patients at risk of hospital admission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), with the hypothesis that use of a colour chart will be non-inferior to usual care with respect to hospital admission rate after 12 months of follow-up, this being the primary outcome measure. Use of a chart might reduce antibiotic use, and thus might also change patterns of antibiotic resistance long term, such that these are important secondary outcomes. There is an internal pilot phase, a detailed process evaluation and a cost-effectiveness study. The trial protocol also includes three sub-studies: 1) using a daily electronic symptom diary capable of picking up symptom defined (but potentially unreported) AECOPD, since these are an important prognostic marker (section 3); 2) collecting sputum samples from patients to assess patterns of antibiotic resistance and 3) a qualitative study which will include staff (for example, healthcare staff delivering the intervention) and patients. This trial uses a sputum colour chart as part of a self-management intervention that enables patients with COPD to determine whether they have an exacerbation, and whether this requires antibiotic treatment. The 5 point sputum colour chart, adapted from Bronkotest® is being used.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
2,954
5-point Sputum Colour Chart plus best standard care
West Midlands Clinical Research Network
Birmingham, United Kingdom
RECRUITINGNumber of hospital admissions where the primary reason for admission is AECOPD
A binary outcome assessing incidence of at least one AECOPD over 12 months after randomisation where patients needed hospitalisation (defined by hospital discharge letter/coding).
Time frame: 12 months post randomisation
Number of self-reported AECOPD every 3 months
Self-reported AECOPD (including those for which admission is required) obtained by telephone calls
Time frame: 3, 6, 9 and 12 months post randomisation
Number of Self-reported antibiotic and steroid prescriptions for AECOPD
Self-reported number of hospitalisations due to AECOPD obtained by telephone calls
Time frame: 3, 6, 9 and 12 months post randomisation
Number of all cause hospital admissions
All cause hospital admission taken from Hospital Episode Statistics (HES) and/or participant self-report
Time frame: 12 months post randomisation
Number of readmissions to hospital for AECOPD at 30 and 90 days
Readmissions to hospital for AECOPD at 30 and 90 days taken from HES and/or participant self-report
Time frame: 12 months post randomisation
Number of Bed days due to AECOPD
Total in hospital bed days due to AECOPD taken from HES and/or participant self-report
Time frame: 12 months post randomisation
Number of participant deaths from all causes
All-cause mortality taken from HES and/or medical records
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: 12 months post randomisation
Number of unscheduled GP visits for AECOPD
Self-reported unscheduled GP visits for AECOPD
Time frame: 12 months post randomisation
Number of prescriptions for 2nd courses of antibiotics within 14 days of self-reported event (defined as treatment failure)
Self-reported prescriptions for 2nd courses of antibiotics within 14 days of self-reported
Time frame: 12 months post randomisation
Number of prescriptions for oral anti-fungals
Self-reported prescriptions for oral anti-fungals (e.g. for oral thrush)
Time frame: 12 months post randomisation
Quality of life by COPD assessment test
Quality of life measured using the COPD assessment test (CAT) at 3 monthly intervals
Time frame: 3, 6, 9 and 12 months post randomisation
Quality of life measured using the EuroQoL-5Dimension-5Level questionnaire
Measured at 3 monthly intervals. The EQ-5D-5L generates a score from 5 to 25 (5 being 'no problem' on all of the 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression), the total score will be used for the economic evaluation only
Time frame: 3, 6, 9 and 12 months post randomisation
Antibiotic resistance
identification of antibiotic resistant pathogens within sputum culture
Time frame: at baseline, all AECOPD and 12 months post randomisation
Healthcare resource utilisation
determined from participant self-report on bespoke questionnaire (in development)
Time frame: 3, 6 and 9 and 12 months post randomisation