181 6 Cochrane review on integrated disease management for COPD as an out-patient or rescue clinic for patients with exacerbations of their disease”. The fact that most of the participants enrolled in the study lacked access to a primary care provider could explain the observation that the e ect was non-signi cant. 3.13. Number of patients experiencing at least one exacerbation Seven studies reported on the number of patients experiencing at least one exacerbation during follow-up. The de nition of exacerbation di ered slightly between studies. Trappenburg 2011 and Bourbeau 2003 de ned an exacerbation as an increase in symptoms with deterioration of dyspnoea or purulent sputum. Lenferink 2019 used a similar de nition (clear negative change in two symptoms classi ed as major symptoms (dyspnoea, sputum purulence, sputum volume) or in one major and one minor symptom (coughing, wheezing, fever) from baseline, for 2 or more consecutive days). Vasilopoulou 2017, Kruis 2014, and Sridhar 2008 de ned exacerbation as an “unscheduled need for healthcare, or need for steroid tablets, or antibiotics for worsening of their COPD”. Vasilopoulou 2017 and Kruis 2014 de ned exacerbation based on a visit to the general practitioner or the respiratory physician in combination with a prescription of antibiotics and/or prednisolone; Kruis 2014, Vasilopoulou 2017, and Kessler 2018 made a distinction between moderate and severe exacerbations. If provided, we included the results for severe exacerbations. Pooling of all studies reporting on the number of participants experiencing at least one exacerbation during follow-up showed no statistically signi cant di erence between groups (OR 0.96, 95% CI 0.65 to 1.42). Pooling based on follow- up periods showed consistent non-signi cant results for medium-term e ects (OR 0.72, 95% CI 0.90 to 1.27; I² = 47%) and long-term e ects (OR 1.53, 95% CI 0.90 to 2.60; I² = 0%; Analysis 1.25). Trappenburg 2011, which reported results at 6 months’ follow-up, indicated that although exacerbation rates did not di er between groups, exacerbations within the IDM group were perceived as substantially milder by patients. Sridhar 2008 , reporting on the number of participants experiencing at least one exacerbation at 24 months’ follow-up (long-term), stated that patients in the intervention group were more likely to have exacerbations treated with oral steroids alone or oral steroids and antibiotics than patients in the control group. The initiator of treatment in the control group was statistically more likely to be the patient rather than the GP, and this could explain the absence of an e ect. 3.14. Patients using at least one course of oral steroids We pooled data from four studies including 433 participants reporting on the number of patients using at least one course of oral steroids during follow-up (12 months) (Farrero 2001; Littlejohns 1991; Rea 2004; Sanchez-Nieto 2016). Pooling showed homogeneity between studies and no di erences between groups (OR 1.05, 95% CI 0.66 to 1.64; I² = 27%; Analysis 1.26). 3.15. Patients using at least one course of antibiotics Three studies with 321 participants reported on the number of patients using at least
RkJQdWJsaXNoZXIy MTk4NDMw