Heavy exposure to noxious gases and particles may cause chronic obstructive pulmonary disease (COPD). This condition is characterized by airway lesions that lead to chronic respiratory symptoms and permanent airflow limitation. COPD is currently the fourth leading cause of mortality globally and places a significant burden upon the healthcare system. Optimal management of patients with COPD should include smoking cessation counselling, the recommendation for pulmonary rehabilitation, and adequate drug prescription. All of the interventions are aimed at controlling COPD symptoms, avoiding exacerbations, and preserving life quality. Physicians should continue their formation, staying up to date with new diagnostic algorithms and changes in treatment.

This review investigated whether existing educational interventions for health professionals in the primary care setting are effective in conveying the optimal method for diagnosis and treatment of COPD.

This review is important for

Healthcare professionals working in primary care settings who are primarily responsible for people with COPD, general practitioners, researchers, and policymakers.

Outcomes of this review

This is a Cochrane Systematic Review (CSR) published in 2022. The primary outcomes analyzed were the amount of COPD diagnoses confirmed with spirometry, the percentage of patients introduced to pulmonary rehabilitation programs, and the percentage of patients with COPD prescribed medications according to guidelines. The CSR included 38 studies published and/or registered up to May 2021, with 4,936 healthcare professionals and 71,085 patients. The main results were inconclusive to determine the effectiveness of educational interventions for physicians to actually make diagnoses of COPD through spirometry. They were inconclusive to assess the participation in pulmonary rehabilitation programs or assessing the recommendation and the prescription of guideline-recommended drugs. On the other hand, those interventions probably improve influenza vaccination rates and patient satisfaction with care in COPD patients.

These results must be interpreted with caution because (i) the interventions’ designs varied along with (ii) the reporting of outcomes, thus making the studies heterogenous. As a result, meta-analysis was not possible for the main outcomes. The studies were deemed at (iii) high risk of bias across multiple domains, especially for performance bias, and for the nature of intervention itself for blinding bias. (iv) Furthermore, the overall evidence was low- or very low-quality for most of the outcomes.

Author’s conclusion of the review

The authors were uncertain whether educational interventions improved COPD diagnosis through spirometry, patients taking part in pulmonary rehabilitation programs, and medication prescription.

However, educational interventions may improve influenza vaccination rates and patient satisfaction with care.

Future recommendations

The authors recommended that additional randomized controlled trials (RCTs) or three-arm RCTs are needed, particularly to find out (a) the effectiveness of educational interventions; (b) which type of interventions and in what combination are the most effective in complex environments, and (c) to minimize performance bias. (d) It is necessary to report outcomes uniformly; therefore, the development of a gold standard is advisable. Furthermore, future studies should aim to (e) involve health-professional groups that are inadequately represented in the current literature; and/or (f) analyze other subgroups of patients. 

Robin Kuruvila Sentinella