Health status guided COPD Care (MARCH).

A study to explore the value of Health Status measument guided treatment of COPD in comparison to regular (NHG guideline) treatment.

We hypothesize that a treatment algorithm that is based on a simple validated measure of health status (CCQ) improves quality of life (as measured on a separate scale) and other classical COPD outcome measurement parameters such as exacerbation frequency and secondary parameters like patient satisfaction, and health care utilization compared to care based on current GOLD guidelines.

The baseline and last visit will be performed at at the general practitioner practices or nearby at physiotherapist practices.

1. Patient demographics:

A. Age, gender, marital status;

B. Educational level;

C. Employment status;

D. Postal code;

E. Smoking status, pack years;

F. Duration of COPD.
2. Co-morbidity, using the Charlson comorbidity index http://www.medalreg.com/qhc/medal/ch1/1_13/01-13-01-ver9.php3;

3. Previous participation in: Formal smoking cessation program, pulmonary rehabilitation, reactivation;

4. Medication use;

5. Lung function:

A. FEV1 , FEV1 % predicted;

B. FVC;

C. IC;

D. Reversibility.

6. Body Mass Index;

7. Weight;

8. Length;

9. Functional exercise capacity:

A. 6 minute walking distance test.

10. Patient reported outcomes:

A. St. George’s Respiratory Questionnaire (SGRQ);

B. CCQ;

C. Modified Medical Research Council (mMRC) dyspnoea scale;

D. EuroQol-5D;

E. Depression and anxiety Scale (HADS).



During each follow-up visit; both intervention group and FEV1-guided group. 3 times a year (excluding last visit):

1. CCQ;

2. Spirometry;

3. Pulmonary medication use;

4. Generic questionnaire about treatment offered and received;

5. Generic questionnaire about unscheduled visits to the GP or hospital because of pulmonary problems;

6. At visit 4 SGRQ, mMRC, EuroQOL-5d and HADS will be taken.



Health care professional:

1. Treatment offered to the patient will be recorded in the computer program;

2. Treating health care professional;

3. Characteristics of the patients’ treating health care professional (general practitioner or practice assistant): Years in practice.

Control treatment:

Standard COPD Treatment according the NHG guidelines.



Experimental treatment:

Standardized health status measurement by the CCQ followed by treatment advice given to the general practitioner generated by an algorithm based on the CCQ score. Depending on the general practitioner, the patient is informed by telephone or during a new consultation on the new therapy.

The GP is asked to indeed comply to the treatment advice.
After the consultation, the GP completes a questionnaire about the treatment decisions made.

The patient completes a general questionnaire about treatment(s) received since the last visit, including any hospital visits.

After the third patient visit the general practitioner receives the results of the third spirometry.