Alqahtani JS, Aquilina J, Bafadhel M Research priorities for exacerbations of COPD. Lancet Respir Med. 2021; 9:(8)824-826

Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002; 48:(2)177-187

Baker E, Fatoye F. Patient perceived impact of nurse-led self-management interventions for COPD: a systematic review of qualitative research. Int J Nurs Stud. 2019; 91:22-34

Becker EA. Making COPD self-management education work. Respir Care. 2018; 63:(7)833-840

Boland M, Tsiachristas A, Kruis A, Chavannes N, Rutten-van Mölken M. Are disease management programs for COPD cost effective. Eur Respir J. 2012; 40:(56)

Bootland D, Coughlan E, Galloway R, Goubet S, McWhirter E. Critical appraisal from papers to patient: a practical guide.Boca Raton (FL): CRC Press; 2017

British Lung Foundation. Estimating the economic burden of respiratory illness in the UK. 2017. (accessed 18 August 2021)

British Thoracic Society. Quality improvement: COPD. 2018. (accessed 18 August 2021)

Bunker JM, Reddel HK, Dennis SM A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: study protocol. Implement Sci. 2012; 7

Burney P, Jithoo A, Bernet K Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty-a BOLD analysis. Thorax. 2014; 69:(5)465-473

Delivering better services for people with long-term conditions. 2013. (accessed 18 August 2021)

Currie GP. ABC of COPD, 3rd edn. : John Wiley & Sons; 2017

Devereux G. Definition, epidemiology and risk factors, 3rd edn. In: Currie GP. : John Wiley & Sons; 2017

Department of Health and Social Care. The NHS plan: a plan for investment, a plan for reform. 2000. (accessed 18 August 2021)

Department of Health and Social Care. Supporting people with long term conditions. An NHS and social care model to support local innovation and integration. 2005a. (accessed 18 August 2021)

Department of Health and Social Care. Supporting people with long term conditions: liberating the talent of nurses who care for people with long term conditions. 2005b. (accessed 18 August 2021)

Department of Health and Social Care. National Service Framework for long term conditions. 2005c. (accessed 18 August 2021)

Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002; 57:(10)847-852

Effing TW, Vercoulen JH, Bourbeau J Definition of a COPD self-management intervention: international expert group consensus. Eur Respir J. 2016; 48:(1)46-54

Evercare. Implementing the Evercare programme: interim report. 2004. (accessed 18 August 2021)

Global Initiative for Chronic Obstructive Lung Disease. 2021 global strategy for the diagnosis, management and prevention of COPD. 2021. (accessed 18 August 2021)

Guo YJ. Measurements of self-efficacy in patients with chronic kidney disease: a literature review. Nephrol Nurs J. 2017; 44:(2)159-176

Hosseinzadeh H, Shnaigat M. Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review. Aust J Prim Health. 2019; 25:(3)195-204

Hurst JR, Wedzicha JA. The biology of a chronic obstructive pulmonary disease exacerbation. Clin Chest Med. 2007; 28:(3)525-536

James Lind Alliance. COPD exacerbation top 10. (accessed 18 August 2021)

Jones R, Gruffydd-Jones K, Pinnock H Summary of the consultation on a strategy for services for chronic obstructive pulmonary disease (COPD) in England. Prim Care Respir J. 2010; 19:S1-S17

Kim V, Aaron SD. What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. Eur Respir J. 2018; 52:(5)

Landis SH, Muellerova H, Mannino DM Continuing to confront COPD International patient survey: COPD prevalence, and disease burden in 2012–2013. Int J Chron Obstruct Pulmon Dis. 2014; 9:597-611

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3:(11)

McHugh G, Chalmers K, Luker K. Caring for patients with COPD and their families in the community. Br J Community Nurs. 2007; 12:(5)219-222

Mitchell KE, Johnson-Warrington V, Apps LD A self-management programme for COPD: a randomised controlled trial. Eur Respir J. 2014; 44:(6)1538-1547

Murray CJ, Aravkin AY, Zheng P Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396:(10258)1223-1249

National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 2018. (accessed 18 August 2021)

Newham JJ, Presseau J, Heslop-Marshall K Features of self-management interventions for people with COPD associated with improved health-related quality of life and reduced emergency department visits: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2017; 12

Office for National Statistics. Causes of death. 2020. (accessed 18 August 2021)

Partridge MR, Dal Negro RW, Olivieri D. Understanding patients with asthma and COPD: insights from a European study. Prim Care Respir J. 2011; 20:(3)315-323

Philip J, Gold M, Brand C, Douglass J, Miller B, Sundararajan V. Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals. Intern Med J. 2012; 42:(7)816-822

Pinnock H, Kendall M, Murray SA Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study. BMJ. 2011; 342

Sapey E, Stockley RA. COPD exacerbations 2: aetiology. Thorax. 2006; 61:(3)250-258

Trappenburg JC, Schaap D, Monninkhof EM How do COPD patients respond to exacerbations?. BMC Pulmon Med. 2011; 11:(1)

World Health Organization. The top 10 causes of death. 2020. (accessed 18 August 2021)

COPD, exacerbation and self-management: a literature review

02 February 2022
12 min read
Volume 33 · Issue 2


The incidence of COPD is rising in the UK. Paula Boyer looks at the evidence for the self-management of COPD and how this can help manage exacerbations

Chronic obstructive pulmonary disease (COPD) is being increasingly diagnosed in the UK, and is expected to continue to rise due to an ageing population with multiple co-morbidities and exposure to risk factors, such as cigarette smoke, noxious gases and air pollutants. The prevalence of this disease is high in areas of socioeconomic deprivation and among highly industrial areas. The use of self-management plans in COPD is recommended by the National Institute for Health and Care Excellence (NICE), to enable patients with this disease to be competent and confident in taking part in managing their own health condition and recognising signs and symptoms of an exacerbation. The aim of this article is to discuss self-management of COPD and the clinical guidance surrounding exacerbation of disease.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world (World Health Organization (WHO), 2020), accounting for 6% of total deaths, followed by lower respiratory tract infections, which are the fourth leading cause of death and are associated with the highest communicable disease mortality rate in the world. Approximately 3 million people in the UK have been diagnosed with COPD (British Thoracic Society, (BTS) (2018)), although over 1 million people have yet to be diagnosed. The Global Initiative for Lung Disease (GOLD) (2021) has implied that this figure is also set to rise in the coming decades due to risk factor exposure and population ageing. The WHO (2020) estimated that 65 million people have moderate to severe COPD worldwide.

COPD is defined as a preventable, treatable disease of the airways that causes persistent respiratory symptoms and airflow obstruction and an abnormal inflammatory response to noxious gases and particles (GOLD, 2021). Boland et al (2012) expanded this definition, adding that it is a life-limiting illness that may cause a significant burden for patients and carers, with an increasing cost to the NHS. The British Lung Foundation (2017) estimated that COPD costs the NHS £1.9 billion each year.

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