Evaluating the impact of self-management interventions on COPD outcomes in low- and middle-income countries in Asia: a systematic review

Background: Chronic Obstructive Pulmonary Disease (COPD) presents a significant health and economic challenge in low- and middle-income countries (LMICs) in Asia, where healthcare resources are often limited. Self-management programs (SMPs) offer a potential solution by empowering patients to manage their condition and reduce healthcare costs. However, there needs to be more consolidated evidence on the effectiveness of these programs in LMICs, and their success may depend on specific contextual factors. 

Methods: This systematic review analyzed studies on COPD self-management interventions in Asian LMICs, focusing on outcomes such as health-related quality of life (HRQoL), exacerbation rates, healthcare utilization, and out-of-pocket (OOP) costs. Two databases- PubMed and Scopus were systematically searched following PRISMA guidelines, and data were extracted and analyzed to identify the effectiveness of these programs and the challenges encountered during implementation. 

Results: The findings indicate that self-management programs in LMICs can improve HRQoL, reduce exacerbation rates, and lower OOP costs in specific contexts. However, the effectiveness of these programs is influenced by local healthcare infrastructure, digital and health literacy, and economic barriers. Digital interventions tended to be more beneficial in urban areas with better infrastructure, while programs led by community health workers were more effective in rural settings. 

Conclusion: Self-management interventions show promise for managing COPD in resource-limited settings, but context-specific adaptations are essential. Flexible program designs tailored to local conditions and strengthened collaborations among healthcare providers and policymakers are crucial for sustainable implementation and scaling.