D: Develop support network and self-management plan

In the early stages of disease, patients with COPD will often ignore mild symptoms. As the disease progresses, impairment and disability increase. As a health state, severe COPD has the third-highest perceived "severity" rating, on a par with paraplegia and first-stage AIDS.² Depression, anxiety, panic disorder, and social isolation add to the burden of disease as complications and comorbidities accumulate. Patients with COPD often have neuropsychological deficits suggestive of cerebral dysfunction. The deficits are with verbal and visual short-term memory, simple motor skills, visuomotor speed and abstract thought processing.

People with chronic conditions are usually cared for by partners or family members. In populations where the patient's chronic disease is non-respiratory, there is evidence that the psychological health status of carers and patients is linked. In one small population of patients with COPD, levels of loneliness, social isolation and depression were similar among carers and their patients, though more evidence is required.

The quality of care received from family carers is linked with the health of those carers, so that poor carer health status has been found to be associated with high rates of health service use, including hospitalisation, in patients with COPD.

It is not surprising that significant psychological and physical consequences occur in carers of patients with chronic diseases. One of the most effective means of improving the patient's functional and psychological state and reducing carer strain is pulmonary rehabilitation.