Effects of a structured, nurse-led follow-up program on clinical outcomes in chronic obstructive pulmonary disease patients: A randomized controlled trial
Abstract
Background & Aim: Post-discharge follow-up is essential to prevent exacerbation in patients with COPD. This study examined the impact of a 3-month nurse-led follow-up program on early symptom worsening and severe post-discharge outcomes.
Methods & Materials: A single-center, parallel-group randomized clinical trial was conducted among 88 hospitalized COPD patients in Gonabad, Iran, in 2022. The intervention group received a structured nurse-led follow-up program for three months, including planned education, telephone-based symptom monitoring, and zone-based triage with referral when needed. The control group received usual post-discharge care without scheduled follow-up. Primary outcomes were the Modified Borg Dyspnea Scale and the COPD Assessment Test at baseline and three months. Secondary outcomes included unplanned emergency department visits, readmissions, and post-discharge physical complications. Data analysis was performed in SPSS 21.0 using the Chi-square test, Fisher’s exact test, ANCOVA, and paired t-test.
Results: Modified Borg Dyspnea Scale and COPD Assessment Test scores decreased in the intervention group from 3.31 (SD=2.32) to 2.71 (SD=2.84) and 14.91 (SD=10.91) to 12.65 (SD=11.04), respectively, while they increased in control group from 4.08 (SD=2.56) to 4.43 (SD=2.72) and 16.27 (SD=11.22) to 18.36 (SD=11.70) (adjusted p=0.002 for both outcomes. Clinically meaningful improvement was more frequent in the intervention group for both Modified Borg Dyspnea Scale (p=0.013) and CAT (p=0.007). Physical complications were lower in the intervention group (25.6% vs 48.9%; p=0.024), but emergency department visits and readmissions did not differ significantly.
Conclusion: A structured nurse-led follow-up program improved symptoms and reduced complications among patients with COPD. Its integration into transitional care is recommended to enhance recovery after hospitalization.
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14. Almassi Ghaleh E, Jamshidi Farsani S, Ariamloo P, Mehrnoosh N, Rassouli M, Ebadi A. Patient education and follow-up units in Iran: A quality improvement project. Nursing Practice Today. 2024;12(1):6-11.
15. Kamei T, Yamamoto Y, Kajii F, Nakayama Y, Kawakami C. Systematic review and meta-analysis of studies involving telehome monitoring-based telenursing for patients with chronic obstructive pulmonary disease. Japan Journal of Nursing Science. 2013;10(2):180-92. DOI: 10.1111/j.1742-7924.2012.00228.x.
16. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2022 Report). Available from: https://goldcopd.org/wp-content/uploads/2021/12/GOLD-REPORT-2022-v1.1-22Nov2021_WMV.pdf. [Last accessed on 2022 Jun 22].
17. Hasanpour Dehkordi A, Heidari-Beni F, Reiszadeh I, Hosseini M, Khajeh Ali F. Effect of Self-Management Program on Health Status and Dyspnea in Patients with Chronic Obstructive Pulmonary Disease. Tanaffos. 2022;21(1):96-103. PMID: 36258915.
18. Borg G. Perceived exertion as an indicator of somatic stress. Scandinavian Journal of Rehabilitation Medicine. 1970; 2(2):92-98. PMID: 5523831.
19. Williams N. The Borg Rating of Perceived Exertion (RPE) scale. Occupational Medicine. 2017;67(5):404-5. DOI: 10.1093/occmed/kqx063.
20. Mathioudakis AG, Abroug F, Agusti A, Ananth S, Bakke P, Bartziokas K, et al. ERS statement: A core outcome set for clinical trials evaluating the management of COPD exacerbations. European Respiratory Journal. 2022;59(5). DOI: 10.1183/13993003.02006-2021.
21. Ries AL. Minimally clinically important difference for the UCSD Shortness of Breath Questionnaire, Borg Scale, and Visual Analog Scale. COPD. 2005;2(1):105-10. DOI: 10.1081/copd-200050655.
22. Dehghan H, Parvari R, Haghi A, Rajabivardanjan H. (2013) Validity and Reliability of the Persian Version of Borg RPE in Two 10-0 and 20-6 Scales. Journal of Health System Research. 2013;9(8):851-858.
23. Shariat A, Cleland JA, Danaee M, Alizadeh R, Sangelaji B, Kargarfard M, et al. Borg CR-10 scale as a new approach to monitoring office exercise training. Work. 2018;60(4):549-54. DOI: 10.3233/wor-182762.
24. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. European Respiratory Journal. 2009;34(3):648-54. DOI: 10.1183/09031936.00102509.
25. Thomashow B, Stiegler M, Criner GJ, Dransfield MT, Halpin DMG, Han MK, et al. Higher COPD Assessment Test Score Associated With Greater Exacerbations Risk: A Post Hoc Analysis of the IMPACT Trial. Journal of Chronic Obstructive Pulmonary Disease. 2022;9(1):68-79. DOI: 10.15326/jcopdf.2021.0259.
26. Jones PW, Price D, van der Molen T. Role of clinical questionnaires in optimizing everyday care of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease. 2011;6:289-96. DOI: 10.2147/COPD.S18181.
27. Azargon A, Gholami M, Farhadi A, Hadi Chegni M, Zendedel A. Evaluation of the Persian Transcript of the COPD Assessment Test in the Measurement of COPD Health Status in Iranian COPD Patients. Global Journal of Health Science. 2015;8(5). DOI: 10.5539/gjhs.v8n5p225.
28. Ordak M. Multiple comparisons and effect size: Statistical recommendations for authors planning to submit an article to Allergy. Allergy. 2023;78(5): 1145-47. DOI: 10.1111/all.15700.
29. Helvaci A, Gok Metin Z, Ozdemir L, Ergun P. The Effects of a Nurse-Led Education and Counseling Program on Dyspnea, Health Status, and Care Dependency in Patients With Chronic Obstructive Pulmonary Disease: A Feasibility Study. Home Health Care Management & Practice. 2019;31(4):249-56. DOI: 10.1177/1084822319850819.
30. Ergan B, Goktalay T, Ergun P, Yi̇lmaz D, Ocakli B, Gurgun A, et al. A multicenter randomized trial for the effectiveness of structured discharge and follow-up protocol on readmission rate in COPD patients receiving LTOT/NIV: one-year interim analysis. European Respiratory Journal. 2018; 52:OA5410. DOI: 10.1183/13993003.congress-2018.OA5410.
2. Adeloye D, Song P, Zhu Y, Campbell H, Sheikh A, Rudan I, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: A systematic review and modelling analysis. Lancet Respiratory Medicine. 2022;10(5):447-58. DOI: 10.1016/S2213-2600(21)00511-7.
3. Davoudi Dastanaei F, Jafarzadeh Esfahani A, Belyani S, Rezvani R. Prevalence and Severity of Chronic Pulmonary Disease and Its Lifestyle Determinants in the Persian Cohort Study Mashhad: A Cohort Study Protocol. Journal of Nutrition, Fasting & Health. 2025;13(1):1-7. DOI: 10.22038/JNFH.2024.78077.1503.
4. Lin Y, Walker A, Batta M, Ottilie-Kovelman S, Duchenko A, Brugger C, et al. Economic burden of chronic obstructive pulmonary disease and post-tuberculosis sequelae in low- and middle-income countries: A database compiled from a systematic review and meta-analysis. BMJ Public Health. 2024;2(1):e000441. doi: 10.1136/bmjph-2023-000441.
5. Nunez A, Miravitlles M. Preventing readmissions of COPD patients: more prospective studies are needed. European Respiratory Review. 2020;29(156). DOI: 10.1183/16000617.0097-2020.
6. Benetti A, Fiorelli EM, Grassi D, Montano N. A Proposed Checklist for Optimizing COPD Patient Discharge Processes in Italian Internal Medicine Wards. International Journal of Chronic Obstructive Pulmonary Disease. 2026;21:571480. DOI: 10.2147/COPD.S571480.
7. Aranburu-Imatz A, Lopez-Carrasco JC, Moreno-Luque A, Jimenez-Pastor JM, Valverde-Leon MDR, Rodriguez-Cortes FJ, et al. Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022;19(15). DOI: 10.3390/ijerph19159101.
8. Dou Y, Zhang L, Wang Y, Xu X, Wu B. Effectiveness of nursing care intervention on the management of patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomized controlled trials. Advances in Clinical and Experimental Medicine. 2025;34(5):693-708. DOI: 10.17219/acem/189880.
9. Kıymaç Sarı M, Şen Yılmaz M, Çevik Akyıl R. Nurse-led telehealth interventions in COPD patients. European Respiratory Journal. 2024; 64: Suppl. 68, PA4148.
10. Lavesen M, Ladelund S, Frederiksen AJ, Lindhardt BØ, Overgaard D. Nurse-initiated telephone follow-up on patients with chronic obstructive pulmonary disease improves patient empowerment, but cannot prevent readmissions. Danish Medical Journal. 2016;63(10):A5276. PMID: 27697128.
11. Berkhof FF, van den Berg JW, Uil SM, Kerstjens HA. Telemedicine, the effect of nurse-initiated telephone follow-up on health status and health-care utilization in COPD patients: A randomized trial. Respirology. 2015;20(2):279-85. DOI: 10.1111/resp.12437.
12. Aboumatar H, Naqibuddin M, Chung S, Chaudhry H, Kim SW, Saunders J, et al. Effect of a Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Hospitalized Patients With Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. JAMA. 2018;320(22):2335-43. DOI: 10.1001/jama.2018.17933.
13. Hägi-Pedersen M-B, Christensen HC, Bove DG, Wollesen S, Andersen MN, Hägi-Pedersen D. Optimizing care of patients with chronic obstructive pulmonary disease via remote patient monitoring and nurse support. Nordisk Sygeplejeforskning. 2025;15(3):1-16. DOI: 10.18261/nsf.15.3.6.
14. Almassi Ghaleh E, Jamshidi Farsani S, Ariamloo P, Mehrnoosh N, Rassouli M, Ebadi A. Patient education and follow-up units in Iran: A quality improvement project. Nursing Practice Today. 2024;12(1):6-11.
15. Kamei T, Yamamoto Y, Kajii F, Nakayama Y, Kawakami C. Systematic review and meta-analysis of studies involving telehome monitoring-based telenursing for patients with chronic obstructive pulmonary disease. Japan Journal of Nursing Science. 2013;10(2):180-92. DOI: 10.1111/j.1742-7924.2012.00228.x.
16. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2022 Report). Available from: https://goldcopd.org/wp-content/uploads/2021/12/GOLD-REPORT-2022-v1.1-22Nov2021_WMV.pdf. [Last accessed on 2022 Jun 22].
17. Hasanpour Dehkordi A, Heidari-Beni F, Reiszadeh I, Hosseini M, Khajeh Ali F. Effect of Self-Management Program on Health Status and Dyspnea in Patients with Chronic Obstructive Pulmonary Disease. Tanaffos. 2022;21(1):96-103. PMID: 36258915.
18. Borg G. Perceived exertion as an indicator of somatic stress. Scandinavian Journal of Rehabilitation Medicine. 1970; 2(2):92-98. PMID: 5523831.
19. Williams N. The Borg Rating of Perceived Exertion (RPE) scale. Occupational Medicine. 2017;67(5):404-5. DOI: 10.1093/occmed/kqx063.
20. Mathioudakis AG, Abroug F, Agusti A, Ananth S, Bakke P, Bartziokas K, et al. ERS statement: A core outcome set for clinical trials evaluating the management of COPD exacerbations. European Respiratory Journal. 2022;59(5). DOI: 10.1183/13993003.02006-2021.
21. Ries AL. Minimally clinically important difference for the UCSD Shortness of Breath Questionnaire, Borg Scale, and Visual Analog Scale. COPD. 2005;2(1):105-10. DOI: 10.1081/copd-200050655.
22. Dehghan H, Parvari R, Haghi A, Rajabivardanjan H. (2013) Validity and Reliability of the Persian Version of Borg RPE in Two 10-0 and 20-6 Scales. Journal of Health System Research. 2013;9(8):851-858.
23. Shariat A, Cleland JA, Danaee M, Alizadeh R, Sangelaji B, Kargarfard M, et al. Borg CR-10 scale as a new approach to monitoring office exercise training. Work. 2018;60(4):549-54. DOI: 10.3233/wor-182762.
24. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. European Respiratory Journal. 2009;34(3):648-54. DOI: 10.1183/09031936.00102509.
25. Thomashow B, Stiegler M, Criner GJ, Dransfield MT, Halpin DMG, Han MK, et al. Higher COPD Assessment Test Score Associated With Greater Exacerbations Risk: A Post Hoc Analysis of the IMPACT Trial. Journal of Chronic Obstructive Pulmonary Disease. 2022;9(1):68-79. DOI: 10.15326/jcopdf.2021.0259.
26. Jones PW, Price D, van der Molen T. Role of clinical questionnaires in optimizing everyday care of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease. 2011;6:289-96. DOI: 10.2147/COPD.S18181.
27. Azargon A, Gholami M, Farhadi A, Hadi Chegni M, Zendedel A. Evaluation of the Persian Transcript of the COPD Assessment Test in the Measurement of COPD Health Status in Iranian COPD Patients. Global Journal of Health Science. 2015;8(5). DOI: 10.5539/gjhs.v8n5p225.
28. Ordak M. Multiple comparisons and effect size: Statistical recommendations for authors planning to submit an article to Allergy. Allergy. 2023;78(5): 1145-47. DOI: 10.1111/all.15700.
29. Helvaci A, Gok Metin Z, Ozdemir L, Ergun P. The Effects of a Nurse-Led Education and Counseling Program on Dyspnea, Health Status, and Care Dependency in Patients With Chronic Obstructive Pulmonary Disease: A Feasibility Study. Home Health Care Management & Practice. 2019;31(4):249-56. DOI: 10.1177/1084822319850819.
30. Ergan B, Goktalay T, Ergun P, Yi̇lmaz D, Ocakli B, Gurgun A, et al. A multicenter randomized trial for the effectiveness of structured discharge and follow-up protocol on readmission rate in COPD patients receiving LTOT/NIV: one-year interim analysis. European Respiratory Journal. 2018; 52:OA5410. DOI: 10.1183/13993003.congress-2018.OA5410.
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| pulmonary disease; chronic obstructive; nurses; disease management; patient readmission; randomized controlled trial | ||
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How to Cite
1.
Saberi Noghabi E, Mohammadzadeh F. Effects of a structured, nurse-led follow-up program on clinical outcomes in chronic obstructive pulmonary disease patients: A randomized controlled trial. Nurs. pract. today. 2026;:X-X.
