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• BREATHE (Better Respiratory Education And Treatment Help Empower)
• The BREATHE 2 Study

BREATHE (Better Respiratory Education And Treatment Help Empower)

BREATHE (Better Respiratory Education And Treatment Help Empower) is an integrative multi-level study for improving patient-centered care delivery among patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the fourth-leading cause of death in the United States and a major cause of hospitalizations and emergency department visits.

When patients with COPD are about to be discharged from the hospital, they are often overwhelmed with instructions and paperwork. However, they may still go home without a clear understanding of how to manage their disease. About half of all COPD patients do not know how to properly use an inhaler. Simple household tasks, such as taking a shower or walking up the stairs, can trigger an episode of panicked breathlessness and frequent coughing that can send them back to the hospital.

Study Goals

With funding support from the Patient-Centered Outcomes Research Institute (PCORI), our team sought to develop and evaluate a patient and family-centered comprehensive program to support patients with COPD and their caregivers as they leave the hospital and increase their capacity to manage COPD at home.

Called BREATHE — Better Respiratory Education And Treatment Help Empower — the program goal is to improve the health-related quality of life among individuals hospitalized for COPD and reduce their future need to visit the hospital or emergency room.

We tested the BREATHE program in a randomized controlled trial that we conducted at Johns Hopkins Bayview Medical Center among 240 patients who were hospitalized due to COPD. A random half of the patients received the BREATHE program with their caregivers (if they had one), while the other half received usual care.

Study Intervention

Patients and caregivers participating in the BREATHE program met with a specialized nurse transition guide, referred to as a COPD nurse, starting during the hospital stay and for a three-month period postdischarge. Specially trained to support COPD patients and their caregivers, this nurse:

• Met with the patient (and caregiver, if available) as early as possible during the hospital stay to review their medical information and assess their needs and understanding of COPD.
• Communicated with the patient’s medical providers about their needs and barriers to care.
• Conducted follow-up home visits and phone calls.
• Was available by phone to answer patients’ and caregivers’ questions or concerns.
• Helped patients and caregivers develop a better understanding of COPD, the treatment plan and self-management skills, such as breathing exercises and recognizing early signs of COPD exacerbations (flare-ups).
• Contacted providers in the hospital and clinic as needed with any concerns or problems.
• Connected patients as needed with existing services such as programs for transportation, smoking cessation, mental health and substance abuse, as well as peer support groups/hotlines.
• Patients and their caregivers were also informed about and connected with existing services in areas such as transportation, smoking cessation, mental health and substance abuse, as well as peer support groups/hotlines.

The BREATHE study wrapped up in spring 2017, and we are preparing study results for publication.

Meet our Project Team

The BREATHE team is composed of a diverse project team of researchers, multidisciplinary health care professionals and leaders, community advocates and patients with COPD and their caregivers.

Meet our project team.

Journal Articles

H. Aboumatar, M. Naqibuddin, S. Chung, et al. Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients, in Contemporary Clinical Trials, Volume 62, 2017, pages 159-167, ISSN 1551-7144

News and Publications

• Mining Patients’ Wisdom for Safer Care, U.S. News & World Report, May 4, 2015
• “Johns Hopkins Awarded $2.1 Million to Improve Post-Hospital Care for Chronic Obstructive Pulmonary Disease”, Media release, Oct. 2, 2013

Videos

• Supporting Patients with COPD over the Long Term, PCORI, Nov. 2017

Principal Investigator: Hanan J. Aboumatar, M.D., M.P.H.

Funding Agency: PCORI

Project Dates: 11/1/13- 4/30/18

Learn more at PCORI.

The BREATHE 2 Study

Comparing the Effectiveness of Self-Management and Peer Support Communication Programs Among COPD Patients and Family Caregivers

Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalizations and death in the United States. People living with COPD often experience flare-ups of coughing, wheezing and shortness of breath, known as exacerbations, that lead them to come to the hospital. The disease also makes it difficult to carry out daily activities.

Studies have shown that helping patients better self-manage COPD can improve their quality of life and reduce hospital visits. However, it is unclear how to most effectively deliver this support. One promising approach involves peer support, in which people dealing with COPD get connected with each other to talk about how they handle similar problems and issues in managing their condition.

Funded by the Patient-Centered Outcomes Research Institute (PCORI), this study is evaluating the added benefits of receiving peer support. Participants in this study are invited to peer support get-togethers and are partnered with BREATHEPals, other people who have COPD (or care for someone with COPD) who have been able to successfully manage it.

Study Interventions

This is a randomized controlled trial in which we compare the effectiveness of two approaches to help people who have COPD and their caregivers better manage COPD.

• All participants receive support from a respiratory care practitioner, who discusses COPD self-management, reviews medication use and goes over BREATHE program education materials that were developed by physicians, researchers, COPD patients and their caregivers.
• A random half of participants are invited to take part in a peer support program. They are invited to eight get-togethers where they meet others who have COPD and discuss important topics on how to live with and cope with this condition. They also get matched with a BREATHEPal who meets with them at the get-togethers and holds one-on-one phone conversations with them as needed.

Called BREATHE 2, this study builds on BREATHE — Better Respiratory Education and Treatment Help Empower — a study in which COPD patients received BREATHE program education, resources and support from a specialized nurse transition guide, in the hospital and at home.

Study Outcomes

The primary study outcome is the change in the health-related quality of life of patient participants. We will also measure:

• Hospital and emergency room visits
• Patient-reported support, hope, and satisfaction
• Patient self-care behaviors, such as smoking cessation, participation in pulmonary rehabilitation and increased physical activity
• Caregiver stress, coping, and preparedness for caregiving

Meet our Project Team

The BREATHE team is composed of a diverse project team of researchers, multidisciplinary health care professionals and leaders, community advocates and patients with COPD and their caregivers.

Meet our project team.

Principal Investigator: Hanan J. Aboumatar, M.D., M.P.H.

Funding Agency: PCORI

Funding Support: $2.1 million

Project Dates: July 2016–July 2019

Learn more at PCORI.