Table 1.

Characteristics of trials included in the review

Study	Intervention group	Control group	Duration	Description of intervention
Cockcroft 198717 UK	n=42, 69% men, mean age 69.2 years (range 46-84), mean (SD) FEV1 0.78 I (0.31)	n=33, 67% men, mean age 70.5 years (range 51-84), mean (SD) FEV1 0.88 I (0.43)	9 months	Intervention: respiratory health worker visiting patients at home. Discharge planning component: not specified, not all patients recruited after acute admission. Home visits: patients visited once a month. Visits educative and supportive, tailored to individual needs. Intervention structured to published nursing model that entailed identifying problems in activities of daily living and setting goals to increase independence in these activities. Patients encouraged to recognise signs of deterioration and to take appropriate action, including contacting doctor. Nurses did not contact doctors except in cases of emergency (happened only once). Out of hours cover: not specified. Procedure for clinical deterioration: not specified. Clinical support to nurses: from consultant chest specialist and consultant physiotherapist who were independent of study. Additional services and health carers involved in intervention: not specified
Bergner 198818 USA	n=99, 64% men*	2 comparison groups: office care (n=100, 67% men), standard home care (n=102, 78% men)*	12 months	Intervention: specialised respiratory home care programme delivered by trained respiratory nurses. Discharge planning component: not specified, not all patients recruited after acute admission. Home visits: home care nurse visited within 24 hours of study entry and then as often as nurse considered necessary but at least once a month during study year. Nurses provided acute and continuing care—no other details given. Out of hours cover: not specified. Procedure for clinical deterioration: not specified. Clinical support to nurses: nurses worked with primary physician, care and medications provided only with physician approval. Additional services and health carers involved in intervention: not specified
Littlejohns 199119 UK	n=73, 67% men, mean (SD) age 62.9 (7.6) years, mean (SD) FEV1 45.2% (22.4%) of predicted, mean (SD) FVC 70.0% (17.3%) of predicted, mean (SD) SaO2 at rest 95.6% (3.0%), on exercise 91.5% (4.6%)	n=79, 63% men, mean (SD) age 62.5 (7.6) years, mean (SD) FEV1 50.2% (23.0%) of predicted, mean (SD) FVC 73.2% (19.0%) of predicted, mean (SD) SaO2 at rest 96.1% (2.7%), on exercise 91.7% (4.3%)	12 months	Intervention: respiratory health worker. Discharge planning component: not applicable. Home visits: not specified. Intervention: patients received normal care at chest clinic plus respiratory health worker who provided health education directed at the patient and primary care team; monitoring of treatment compliance and optimisation of treatment by ensuring correct inhalation techniques and supervision of domiciliary oxygen etc; monitoring of spirometry results and symptoms to enable acute exacerbations and worsening heart failure to be detected and treated early; liaison between hospital based services (including domiciliary physiotherapy and social services) and GP. Out of hours cover: not specified. Procedure for deterioration: not specified. Clinical support to nurses: not specified Additional services and health carers involved in intervention: not specified
Smith 199920 Australia	n=48, 56% men, mean (SD) age 70.0 (1.2) years, mean (SD) FEV1 0.84 I (0.06)	n=48, 65% men, mean (SD) age 69.8 (1.2) years, mean (SD) FEV1 0.90 I (0.07)	12 months	Intervention: “respiratory home based nursing intervention” (HBNI). Discharge planning component: inpatients visited by HBNI nurse on ward, discharge planning with goals for discharge. Case conference with social worker, hospital medical officer, GP, and HBNI nurse if considered beneficial (outpatients and GP referrals evaluated at home, discussion with GP on patient's needs, involvement of domiciliary services facilitated, appliances provided, and need for O2 therapy assessed at home). Home visits: inpatients seen by HBNI nurse within week of discharge. All referrals followed up by 2-4 weekly visits, spirometry and oximetry performed at each visit, and results communicated to GP. Ongoing education including use of inhaler medication, medication compliance, and fitness advice (as required fitness advice including: upper and lower limb training, “intimacy advice,” and coping strategies for dyspnoea). Education and counselling around smoking cessation, referral to GP for nicotine replacement. Nurse also aimed to identify exacerbations early. Out of hours cover: not specified. Procedure for clinical deterioration: not specified. Clinical support to nurses: not specified. Additional services and health carers involved in intervention: not specified
Farrero 200021 Spain	n=60†, mean (SD) age 68 (7) years, mean (SD) FVC 40% (11%) predicted, mean (SD) FEV1 28% (8%) predicted, mean (SD) PaO2 51 (6) mm Hg, mean (SD) PaCo2 54 (7) mmHg	n=62†, mean (SD) age 69 (8) years, mean (SD), FVC 38% (11%) of predicted, mean (SD) FEV1 27% (9%) predicted, mean (SD) PaO2 50 (7) mm Hg, mean (SD) PaCo2 56 (8) mm Hg	12 months	Intervention: hospital based home care programme. Discharge planning component: not applicable. Home visits: every three months by respiratory nurse. Visits included: questionnaire designed to detect changes in underlying respiratory symptoms; spirometry; pulse oximetry breathing room air and oxygen. Phone calls: monthly phone calls to patient by respiratory nurse. Out of hours cover: not stated. Procedure for clinical deterioration: patient could initiate attention depending on problem, resolved either by phone call, home visit, or visit to day hospital equipped to carry out chest radiography, arterial blood gases, and ECG and to provide intensive medical treatment if necessary. Clinical support to nurses: respiratory nurse supervised by respiratory physician. Additional services and health carers involved in intervention: not specified
Egan 200222 Australia	n=33, 36% men, mean age 67.2 years, 19% had FEV1 <35% predicted	n=33, 60% men, mean age 67.8 years, 19% had FEV1 <35% predicted	Duration of intervention 6 weeks, follow-up for 3 months	Intervention: nursing based case management. Discharge planning component: case manager (CM) conducted case conference and arranged discharge planning. Intervention: after admission CM conducted comprehensive nursing assessment to identify physical, psychosocial, and resource needs, during admission CM coordinated patient's care using clinical path. CM provided education for patient and carer on managing disease, treatment, rehabilitation, and available community services, conducted case conference and arranged discharge planning. After discharge CM provided ongoing support and acted as referral point for community services for patient with follow-up care at 1 and 6 weeks after discharge. Home visits: not clear if CM visited patient at home. Phone calls: CM made phone calls to patient and caregiver on regular basis. Out of hours cover: not specified. Procedure for clinical deterioration: not specified. Clinical support to nurses: not specified. Additional services and health carers involved in intervention: not specified
Hermiz 200223 Australia	n=84, 49% men, mean age 67.1 years‡	n=93, 46% men, mean age 66.7 years‡	Duration of intervention 1 month, follow-up 3 months	Intervention: home based care by community nurse. Discharge planning component: none. Home visits: visit by community nurse one week and one month after discharge. First visit included detailed assessment of patient's health status and respiratory function; written and verbal education on disease and advice on smoking cessation; managing activities of daily living and energy conservation; exercise; understanding and use of drugs; health maintenance; and early recognition of signs that require medical intervention. Nurse also identified problems and, if indicated, referred patients to other services, such as home care. Care plan documenting problem areas, education provided, and referral to other services posted to patient's GP, and GP contacted by phone, if necessary. Second visit included: progress and need for further follow-up reviewed. Patients encouraged to refer to education booklet for guidance and to keep in contact with GP. Out of hours cover: not applicable. Procedure for clinical deterioration: not applicable. Clinical support for nurses: not specified. Additional services and health carers involved in intervention: not specified
Bourbeau 200324 Canada	n=96 (52% men), mean (SD) age 69.4 (6.5) years, mean (SD) FEV1 1 l (0.33), FEV1:FVC 45%	n=95 (59% men), mean (SD) age 69.6 (7.4) years, mean (SD) FEV1 0.98 l (0.31), FEV1:FVC 45%	12 months	Intervention: “disease specific self management programme” delivered by trained health professionals (most were nurses) acting as case managers. Discharge planning component: not applicable. Home visits: weekly for first 8 weeks, visits lasted one hour. Intervention included an educational programme covering: basic information about COPD, breathing and coughing techniques, energy conservation, relaxation exercises, inhaler technique, an individualised action plan for acute exacerbation, healthy lifestyles (smoking, nutrition, sexuality, sleep, and managing emotions), leisure activities and travelling, a simple home exercise programme, and education around long term oxygen therapy, if appropriate. After week 7 patients encouraged to follow (unsupervised) the home exercise programme at least 3 times a week for 30-45 mins. Phone calls: weekly for first 8 weeks then monthly, patients also able to phone case managers for advice and supervision of treatment. Out of hours cover: not specified. Procedure for clinical deterioration: patients had customised action plan for acute exacerbation, contact list, symptom monitoring list linked to appropriate therapeutic actions, and prescription for drugs. Clinical support for case managers: received supervision and collaboration from treating physician. Additional services and health carers involved in intervention: not specified
Monninkhof 200325 Netherlands	n=127 (85% men), mean (SD) age 65 (7) years, mean (SD) FEV1 1.7 l (0.56)	n=121 (84% men), mean (SD) age 65 (7) years, mean (SD) FEV1 1.76 l (0.54)	12 months	Intervention: comprehensive self management educational programme, delivered by respiratory nurse, and fitness course delivered by physiotherapists. Discharge planning component: not applicable. Intervention: five clinic based, 2 hour, group self management education sessions held at 1, 2, 3, 4, and 12 weeks. Educational programme included information about COPD; coping with breathlessness; plan for acute exacerbation; exercise; relaxation and energy conservation; nutrition; communication with their chest physician; and social relationships. Home visits: not specified. Phone calls: not specified. Out of hours cover: not specified. Procedure for clinical deterioration: patients had self treatment action plans for acute exacerbation based on symptom perception, including prescription for drugs or medication to keep at home. Clinical support to nurses: not specified. Additional services and health carers involved in intervention: one or two 1 hour small group fitness sessions a week led by physiotherapist for duration of follow-up. Beside physical goals fitness programme aimed at coping with COPD, social interactions, and behavioural change. Programme included strength training, breathing and cardiovascular exercises, individual goals and training log. Note: patient recruitment followed on from earlier RCT of fluticasone propionate (patients were re-randomised for this study)

FEV₁=forced expiratory volume in one second, FVC=forced vital capacity, SaO₂=arterial oxygen saturation, PaO₂=partial pressure of oxygen in arterial blood, GP=general practitioner, ECG=electrocardiography, COPD=chronic obstructive pulmonary disease.

^*Across study: mean age 65.1 years, mean FEV₁ 33.8% predicted.

^†All patients required and were receiving long term oxygen therapy.

^‡No data provided on severity of COPD at baseline.