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Rescue packs post-discharge in chronic obstructive pulmonary disease (the RAPID study)

Background

People living with chronic obstructive pulmonary disease (COPD) – a common lung condition that affects over a million people in the UK – experience daily symptoms like breathlessness which can become severe enough to need hospital care. In a typical year, there are over 115,000 exacerbations needing hospital treatment in the UK.

Unfortunately, we know that once people get home from hospital, almost half of them will need to go back into hospital within the next 90 days (the ‘high-risk period’). Our study aims to improve this situation and reduce the number of people with COPD who end up back in hospital during the high-risk period.

When people go home from hospital, they are usually given basic information about how to look after their COPD. This is a called a self-management plan. Some are also given a set of medicines, including steroids and antibiotics, called a rescue pack, which they can take if their symptoms get worse again.  

People given a rescue pack aren’t always offered the right information about when and how to take their medicine, so rescue packs can be under-used, not used properly or over-used. Over-use of steroids can cause side effects like weight gain, loss of bone density, and thinning of the skin. Over-use of antibiotics can increase risk of bacteria becoming antibiotic resistant.

Under-use and improper use of rescue packs can lead to patients with COPD not getting the best treatment for their condition, and a higher risk that they will have to go back into hospital. We think that a standardised, better way of helping people to use a rescue pack is urgently needed, especially during the high-risk period following a hospital admission, when patients are at their most vulnerable. If we can show that the new, standardised approach is better, this simple package of care could be rolled out to the NHS. This would be very important in reducing re-admissions and improving the lives of those living with COPD – and could potentially save the NHS millions of pounds each year.

Approach

The study, which is led by King’s College London, involves a randomised controlled trial of the new standard approach to supporting people with COPD when they are given rescue packs (which includes giving them clear information about how and when to use them, and occasional reminders by telephone or text message after they have left hospital.)

Patients will be put into one of two groups at random when they leave hospital following an exacerbation. One group will receive the usual care, and the other will receive the new standard approach. By comparing the two groups, the team will be able to show whether the new approach is better for patients and for the NHS. Ninety days after they are discharged, we will compare the numbers of people being re-admitted in the two groups.

The team at THIS Institute will be working on two qualitative studies that form important parts of the wider study.

  • One study looks at what typically happens when patients are discharged after being hospitalised for COPD exacerbations in sites that are likely to join the trial. This study will investigate the usual discharge procedures in participating hospitals and how they vary, especially focusing on whether and how patients are given rescue packs. Knowing what usual discharge practices look like will help us understand the effect of the trial intervention.
  • The second study will involve interviewing patients who receive the new package of support for using rescue packs. It will look at what influences their attitudes towards rescue packs and how they use them, and whether they found the added support helpful.

This research programme will run until December 2027.

Additional co-investigators

  • Mona Bafadhel – King’s College London
  • John Hurst – University College London

Funding and ethics

This study is funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme. THIS Institute is leading the qualitative components of the study

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