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Impact of self-management interventions initiated during hospitalization on inhaler adherence and functional outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 22 July 2026
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Chronic obstructive pulmonary disease (COPD) remains a leading global health burden, with acute exacerbations accelerating functional decline and impairing quality of life. Reduced inhaler adherence is a well-recognized contributor to exacerbations and poorer outcomes in COPD. While self-management interventions are well established in stable COPD, their initiation during acute exacerbations has been inadequately explored. This randomized controlled trial, conducted in a South Indian tertiary hospital between July 2024 and May 2025, evaluated the effectiveness of a structured self-management program initiated during hospitalization for acute exacerbation of COPD. The intervention included individualized counseling, family engagement, structured telephonic follow-ups (weekly for 3 months, then monthly for 3 months), and scheduled outpatient reviews, while controls received standard care. Primary outcomes were inhaler adherence assessed by the Test of Adherence to Inhalers, health-related quality of life (HRQoL) measured with the St. George’s Respiratory Questionnaire (SGRQ), and functional capacity assessed by the six-minute walk test. At six months, good inhaler adherence was observed in 66.7% of the intervention group compared to 10% of controls (p<0.001). The mean between-group difference in six-minute walk distance at six months was 92.8 meters [95% confidence interval (CI): 58.1 to 127.6; p<0.001], favoring the intervention group. HRQoL also improved significantly, with a mean between-group difference in SGRQ score of -38.2 (95% CI: -46.7 to -29.8; p<0.001). These findings indicate that initiating structured self-management during hospitalization for acute exacerbation of COPD results in significant improvements in inhaler adherence, functional capacity, and quality of life. Integrating self-management into acute care pathways may therefore optimize patient-centered outcomes in this high-risk population.
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Ethics Approval
The institutional Ethics Committee (JIP/D(R)/ IECIS-5/O724/102) for the Interventional Studies and Research Monitoring Committee (JIP/ CON/NRMC/M.Sc./2023/MSN/5) approved the study. The procedures followed were in accordance with the institution's ethical standards. The trial was prospectively registered with the Clinical Trials Registry of India (CTRI/2024/09/073).How to Cite
“Impact of Self-Management Interventions Initiated During Hospitalization on Inhaler Adherence and Functional Outcomes in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial”. 2026. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2026.3695.
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