Recipient organisationNIHR Leicester Biomedical Research Centre
NIHR supportRecorded as supported by this research centre
PeriodFeb 2025 — Dec 2027
In plain English
AI plain-English summary
Every year, 43% of patients hospitalised with a COPD exacerbation are readmitted within 90 days, and 12% die in that window. Despite national guidelines recommending that hospitals provide “rescue packs” of steroids and antibiotics on discharge, repeated audits show this has not reduced those grim numbers. The RAPID trial will test whether adding a structured self-management plan—rescue packs plus a written action plan and twice-weekly symptom checks by phone or text—can cut 90-day readmissions by 20%. The trial will randomise 1,400 patients across 30 NHS trusts. If it works, the intervention is cheap and could be rolled out immediately. The estimated cost saving to the NHS is roughly £350 million per year, but the real impact would be on patients: fewer terrifying returns to hospital and a lower chance of dying in the months after discharge. This is not fundamental science; it is a pragmatic test of whether a simple, low-tech change to discharge procedures can finally deliver the improvement that guidelines alone have failed to achieve.
View original technical description
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease affecting approximately 10% of the adult population globally. COPD is recognised to be an important area of focus, as part of one of the healthcare challenges defined by the Office of Life Sciences. Patients with COPD often experience exacerbations which are triggered episodes leading to disease worsening. Exacerbations are associated with increased morbidity and a risk of mortality. Severe exacerbations, where patients are hospitalised, are of particular concern to patients, carers and healthcare givers. The National Institute for Health and Care Excellence (NICE) recommends that hospital clinicians looking after patients with COPD should provide rescue packs (a course of prednisolone and antibiotics) and a basic management plan to patients on discharge. It is recognised that there is a high-risk 90-day period to patients with COPD following discharge from hospital, where there is a 43% risk of readmission and a 12% risk of mortality; however repeated national audit data has shown that, despite NICE recommendations this high risk of readmission and mortality has not changed. We will conduct a multicentre randomised clinical trial of 1400 patients in 30 acute NHS trusts. This will test the hypothesis that a self-supported rescue pack management plan consisting of rescue packs + written self-management plan + twice weekly telephone/text symptom alert assessments in the high-risk 90-day period is better than standard care in reducing 90-day readmission by 20%. If successful, this intervention would be rapidly implementable, improve patient clinical outcomes and have a cost saving of approximately £350 million per annum
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