In this multicentre randomised controlled trial from the USA, the efficacy of a comprehensive care management programme (CCMP) in preventing hospitalisations for chronic obstructive pulmonary disease (COPD) was compared with usual care. This approach has shown favourable results in other chronic conditions but evidence is lacking in COPD. An unexpected increase in mortality resulted in the trial being terminated before enrolment was complete.

Patients with known COPD at risk of hospitalisations were randomised to receive either usual care or a CCMP. This constituted a series of educational sessions, personalised action-plans and prescriptions to target exacerbations and regular telephone contact with case managers. The primary end-point was time-to-first hospitalisation due to COPD.

As the trial was performed within the Veteran's Affairs health service, a data and safety monitoring committee was required. As a result, at the 2-year mark, with 467 patients enrolled out of a target of 960, a...