{"doi":"10.1164/rccm.202303-0505oc","title":"Chronic Obstructive Pulmonary Disease Self-Management in Three Low- and Middle-Income Countries: A Pilot Randomized Trial","abstract":"Abstract Objectives Chronic obstructive pulmonary disease (COPD) disproportionately affects low- and middle-income countries. Health systems are ill prepared to manage the increase in COPD cases. Methods We performed a pilot effectiveness-implementation randomized field trial of a community health worker (CHW)-supported, 1-year self-management intervention in individuals with COPD grades B–D. The study took place in low-resource settings of Nepal, Peru, and Uganda. The primary outcome was the St. George’s Respiratory Questionnaire (SGRQ) score at 1 year. We evaluated differences in moderate to severe exacerbations, all-cause hospitalizations, and the EuroQol score (EQ-5D-3 L) at 12 months. Measurements and Main Results We randomly assigned 239 participants (119 control arm, 120 intervention arm) with grades B–D COPD to a multicomponent, CHW-supported intervention or standard of care and COPD education. Twenty-five participants (21%) died or were lost to follow-up in the control arm compared with 11 (9%) in the intervention arm. At 12 months, there was no difference in mean total SGRQ score between the intervention and control arms (34.7 vs. 34.0 points; adjusted mean difference, 1.0; 95% confidence interval, −4.2, 6.1; P = 0.71). The intervention arm had a higher proportion of hospitalizations than the control arm (10% vs. 5.2%; adjusted odds ratio, 2.2; 95% confidence interval, 0.8, 7.5; P = 0.15) at 12 months. Conclusions A CHW-based intervention to support self-management of acute exacerbations of COPD in three resource-poor settings did not result in differences in SGRQ scores at 1 year. Fidelity was high, and intervention engagement was moderate. Although these results cannot differentiate between a failed intervention or implementation, they nonetheless suggest that we need to revisit our strategy. Clinical trial registered with www.clinicaltrials.gov (NCT03359915).","journal":"American Journal of Respiratory and Critical Care Medicine","year":2023,"id":348405,"datarank":0.5312209266344476,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.1584849291662475,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.1584849291662475,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":9,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9588,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03359915"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":364002,"name":"Trishul Siddharthan","orcid":"0000-0001-9914-1839","position":1,"is_corresponding":false},{"id":364005,"name":"Shakir Hossen","orcid":"0000-0002-4881-5052","position":2,"is_corresponding":false},{"id":454857,"name":"Natalie A. Rykiel","orcid":"0009-0003-9204-9054","position":3,"is_corresponding":false},{"id":304803,"name":"Oscar Flores-Flores","orcid":"0000-0002-9780-937X","position":4,"is_corresponding":false},{"id":304804,"name":"Patricia Alupo","orcid":"0000-0001-8946-0940","position":5,"is_corresponding":false},{"id":364008,"name":"Shumonta Quaderi","orcid":"0000-0001-5714-7685","position":6,"is_corresponding":false},{"id":1091073,"name":"I.S.I. Ascencio","orcid":null,"position":7,"is_corresponding":false},{"id":764291,"name":"Julie Barber","orcid":"0000-0001-5762-762X","position":8,"is_corresponding":false},{"id":777422,"name":"Ram K. Chandyo","orcid":"0000-0003-2352-4424","position":9,"is_corresponding":false},{"id":1059599,"name":"Santa Kumar Das","orcid":"0000-0002-6832-439X","position":10,"is_corresponding":false},{"id":304805,"name":"Gonzalo Gianella","orcid":"0000-0002-9880-7747","position":11,"is_corresponding":false},{"id":364009,"name":"Bruce Kirenga","orcid":"0000-0002-2023-2840","position":12,"is_corresponding":false},{"id":1091074,"name":"Kelli Grunstra","orcid":null,"position":13,"is_corresponding":false},{"id":38941,"name":"J. Jaime Miranda","orcid":"0000-0002-4738-5468","position":14,"is_corresponding":false},{"id":1034824,"name":"Sakshi Mohan","orcid":"0000-0002-1268-1769","position":15,"is_corresponding":false},{"id":1034825,"name":"Federico Ricciardi","orcid":"0000-0002-4473-7691","position":16,"is_corresponding":false},{"id":816924,"name":"Arun Sharma","orcid":"0000-0002-3524-748X","position":17,"is_corresponding":false},{"id":1090651,"name":"Laxman Shrestha","orcid":"0000-0002-9991-3074","position":18,"is_corresponding":false},{"id":404006,"name":"Marta Soares","orcid":"0000-0003-1579-8513","position":19,"is_corresponding":false},{"id":364003,"name":"Adaeze C. Wosu","orcid":"0000-0003-2216-1211","position":20,"is_corresponding":false},{"id":304800,"name":"John R. Hurst","orcid":"0000-0002-7246-6040","position":21,"is_corresponding":false},{"id":268905,"name":"William Checkley","orcid":"0000-0003-1106-8812","position":22,"is_corresponding":false},{"id":364004,"name":"Suzanne L. Pollard","orcid":"0000-0001-9019-5259","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T01:12:06.040073Z","pmid":"37698443","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}