Abstract:

Objective To construct a hierarchical management model for chronic obstructive pulmonary disease (COPD) suitable for primary hospitals and to evaluate its effects on the risk of acute exacerbation, lung function, and quality of life in patients. Methods A total of 120 patients with stable COPD diagnosed in 3 primary hospitals between January 2023 and January 2025 were enrolled and assigned to a control group (routine management) and an intervention group (hierarchical management). After 12 months of follow-up, the annual number of acute exacerbations, pulmonary function indices, and COPD Assessment Test (CAT) scores were compared between the two groups. Results A total of 112 patients completed the follow-up, including 57 in the intervention group and 55 in the control group. After 12 months of intervention, the annual number of acute exacerbations was significantly lower in the intervention group than in the control group (2[1, 2] vs 2[2, 3], P=0.016). The percentage of predicted forced expiratory volume in the first second (FEV₁%) was significantly improved in the intervention group compared with the control group (64[63, 66]% vs 61[58, 63]%, P=0.001). The reduction in CAT score was also significantly greater in the intervention group than in the control group (9[8, 10] vs 12[9, 14], P=0.001).Conclusion Implementation of a hierarchical management model for COPD in primary hospitals can effectively improve clinical outcomes and has potential for broader application.

Key words: pulmonary disease, chronic obstructive, primary hospitals, hierarchical management, behavioral education, pulmonary function