1 Delivery of pulmonary rehabilitation after hospitalisation for AECOPD reduces the odds of readmission for AECOPD by over 70%

(Figure 6; for a more detailed forest plot, see Figure 7 on the eAddenda). Pulmonary rehabilitation, which must include whole body exercise training, may provide opportunity to reverse the deleterious effects of the AECOPD on skeletal muscle function and physical activity. The non-exercise components of pulmonary rehabilitation may also assist in preventing future exacerbations by providing opportunities to optimise nutritional status; address psychosocial issues such as anxiety and depression, which are linked to exacerbation risk;70 encourage recognition and early treatment of exacerbations; and enhance self-management skills. Physiotherapists will need to identify and address individual barriers to attendance selleck screening library to ensure program uptake and completion. People with COPD often live with ill health for many years and must engage in complex health-related behaviours to ensure that their disease is optimally managed. Self-management interventions aim to encourage healthy behaviours and improve self-management skills, including prevention and early treatment of exacerbations. A meta-analysis including 1749 participants with COPD from nine studies showed that self-management interventions decreased the risk of respiratory-related hospitalisation by

over 40% (OR 0.57, 95% CI 0.43 to 0.75).71 Olopatadine However, a recent large trial of self-management for COPD was stopped early due to increased mortality in the intervention www.selleckchem.com/products/gsk-j4-hcl.html group,72 which has raised concerns regarding the risks of strategies that require patients to make independent choices regarding identification and treatment of AECOPD. However, when the body of evidence for self-management programs is considered in its entirety, including this trial,72 the meta-analysis shows no excess mortality risk.73 Nevertheless, this trial provides a reminder that behavioural interventions may have a powerful impact on outcomes, and that adequate support should be provided

to ensure that patients can successfully undertake the required behaviours. An action plan is an individualised, documented plan for responding to increased respiratory symptoms. Action plans may involve early commencement of pharmacotherapy and seeking medical care. There is no evidence that use of an action plan alone can decrease exacerbation rate or reduce healthcare utilisation, although it may increase the initiation of antibiotic and corticosteroid treatment at symptom onset.74 Action plans accompanied by the support of a case manager may reduce symptoms and accelerate symptom recovery after AECOPD.75 It is likely that more intensive support is required for the potential benefits of action plans to be fully realised, such as that provided in comprehensive self-management programs.