D3. Self-management

Patients who take appropriate responsibility for their own management may have improved outcomes (Effing et al., 2007) [evidence level III-1]

A distinction can be made between 'self management' and 'self-management support'. ‘Self-management’ is a normal part of daily living, and involves the actions individuals take for themselves and their families to stay healthy and to care for minor, acute and long-term conditions. ‘Self management support’ is the facility that healthcare and social-care services provide to enable individuals to take better care of themselves. The onus in recent times has been on delivering training for self-management skills to individuals through a range of interventions. (Osborne et al., 2008)

Patients with chronic illness who participate in self-manage­ment have better outcomes, including reduced healthcare costs, than those who do not. (Lorig et al., 1999) This study included some people with COPD. In COPD, behavioural education alone is effective, although less effective than integrated pulmo­nary rehabilitation programs that include an exercise com­ponent. (Ries et al., 1995)

The concept of written action plans for patients with COPD is derived from their success in asthma management indicating doses and medications to take for maintenance therapy and for exacerbations. Instructions for crises are often also included. A systematic review by Turnock et al (Turnock et al., 2005) found that the use of action plans results in an increased ability to recognise and react appropriately to an exacerbation by individuals. However, there was no evidence these behavioural changes alter health-care utilisation.