TY - JOUR T1 - Self-management for COPD?: Why does it generate negative connotations? JF - British Journal of General Practice JO - Br J Gen Pract SP - e522 LP - e524 DO - 10.3399/bjgp14X681157 VL - 64 IS - 625 AU - Ratna Sohanpal AU - Eleni Epiphaniou AU - Stephanie Taylor Y1 - 2014/08/01 UR - http://bjgp.org/content/64/625/e522.abstract N2 - A recent NHS mandate,1 calls for supporting and empowering people with long-term conditions to help patients manage their condition and reduce hospital admissions. In chronic obstructive pulmonary disease (COPD) this may mean ensuring individuals are actively engaged in self-management, to complement pharmacological care and enhance outcomes. Delivery of pulmonary rehabilitation, that assists patient self-management and provision of self-management education and support to increase self-efficacy and help patients with COPD to better manage their condition, is widely recommended in health policy guidelines.2 There is good evidence that patients with COPD want to understand their condition and manage breathlessness and exacerbations.3The evidence for the benefit of self-management in COPD is patchy. A Cochrane review4 suggested that self-management education may reduce hospital admissions but because of heterogeneity among the included studies definite conclusions could not be drawn. The majority of the interventions in the included studies were non-theory-based self-management plans or structured self-management education programmes. Hence, one review recommendation was that future self-management programmes should be designed using behaviour change theory. Our recent pilot study5 of a COPD-specific self-management education programme based on the self-efficacy theory, a major component of the sociocognitive theory, showed that the intervention had the potential to be useful and cost effective. The findings supported the self-efficacy theory as the intervention-group participants adopted core self-management skills. These included as goal-setting and action planning, which enabled the practice of self-management behaviours through the process of performance mastery (practising skills through use of action plans) and modelling (emulating others) provided by the study peer leaders.In contrast, last year an editorial in the Lancet 6 questioned the usefulness and safety of self-management programmes in COPD altogether, and stated ‘The widespread implementation of … ER -