Self-Care of People with Chronic Obstructive Pulmonary Disease: A Meta-Synthesis

  • Marco Clari
  • Maria Matarese
  • Dhurata Ivziku
  • Maria Grazia De Marinis
Systematic Review



Self-care in people with chronic obstructive pulmonary disease (COPD) can improve health-related quality of life, reduce hospital admissions and decrease dyspnoea.


This review aimed to systematically identify, evaluate and synthesise the qualitative literature on the self-care behaviours and strategies used by people with COPD.


The Joanna Briggs Institute (JBI) meta-aggregative method was followed. An electronic search of six relevant databases was conducted. The search was limited to articles published from January 1996 to January 2016. Reference lists of all identified articles were searched to find additional literature. Two independent reviewers analysed the studies against the inclusion criteria, extracted the data and assessed the methodological quality of the 14 identified papers using the JBI qualitative assessment and review critical appraisal instrument. Findings were synthesised using a meta-aggregation process.


Four synthesised findings emerged from the aggregation of 114 findings: self-care is directed towards the prevention, control and management of the physical consequences of COPD; self-care focuses on the management of the psychological effects of COPD; self-care is aimed at reducing the impact of COPD on social life; and self-care is influenced by contact with healthcare services and requires the acquisition of knowledge and skills.


This meta-synthesis provides evidence on the self-care behaviours and strategies that people with COPD perform to prevent, control and manage the physical, psychological and social consequences of the disease. The findings of this meta-synthesis could help healthcare professionals to tailor self-care educational programmes to the experiences, preferences and priorities of people with COPD.


Chronic Obstructive Pulmonary Disease Healthcare Professional Dyspnoea Attack Joanna Briggs Institute Chronic Obstructive Pulmonary Disease Participant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author contributions

MC and MM were responsible for the conception and design of the study, the acquisition, analysis and interpretation of data, and drafted the manuscript. DI contributed to data acquisition and analysis. MGM critically reviewed the manuscript for important intellectual content. All the authors approved the final version of the manuscript.

Compliance with Ethical Standards


This study received no grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest

M. Clari, M. Matarese, D. Ivziku and M. G. De Marinis declare that they have no conflict of interest.

Supplementary material

40271_2017_218_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 28 kb)


  1. 1.
    Global Initiative For Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2016. Accessed 15 Oct 2016.
  2. 2.
    Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J Global Health. 2015;5(2):020415. doi: 10.7189/jogh.05-020415.CrossRefGoogle Scholar
  3. 3.
    World Health Organization. Global health estimates: projection of deaths by cause, age and sex, by world bank income group and WHO region. 2013. Accessed 15 Oct 2016.
  4. 4.
    Zwerink M, Brusse-Keizer M, van der Valk PD, Zielhuis GA, Monninkhof EM, van der Palen J, et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014(3):CD002990. doi: 10.1002/14651858.CD002990.pub3.
  5. 5.
    Riegel B, Jaarsma T, Stromberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194–204. doi: 10.1097/ANS.0b013e318261b1ba.CrossRefPubMedGoogle Scholar
  6. 6.
    Riegel B, Dickson VV, Faulkner KM. The situation-specific theory of heart failure self-care: revised and updated. J Cardiovasc Nurs. 2016;31(3):226–35. doi: 10.1097/JCN.0000000000000244.CrossRefPubMedGoogle Scholar
  7. 7.
    Effing TW, Bourbeau J, Vercoulen J, Apter AJ, Coultas D, Meek P, et al. Self-management programmes for COPD: moving forward. Chronic Respir Dis. 2012;9(1):27–35. doi: 10.1177/1479972311433574.CrossRefGoogle Scholar
  8. 8.
    Lomundal BK, Steinsbekk A. Five-year follow-up of a one-year self-management program for patients with COPD. Int J Chronic Obstr Pulm Dis. 2012;7:87–93. doi: 10.2147/COPD.S27352.CrossRefGoogle Scholar
  9. 9.
    Monninkhof E, van der Aa M, van der Valk P, van der Palen J, Zielhuis G, Koning K, et al. A qualitative evaluation of a comprehensive self-management programme for COPD patients: effectiveness from the patients’ perspective. Patient Educ Couns. 2004;55(2):177–84. doi: 10.1016/j.pec.2003.09.001.CrossRefPubMedGoogle Scholar
  10. 10.
    Sohanpal R, Steed L, Mars T, Taylor SJ. Understanding patient participation behaviour in studies of COPD support programmes such as pulmonary rehabilitation and self-management: a qualitative synthesis with application of theory. NPJ Primary Care Respir Med. 2015;25:15054. doi: 10.1038/npjpcrm.2015.54.CrossRefGoogle Scholar
  11. 11.
    Harrison SL, Janaudis-Ferreira T, Brooks D, Desveaux L, Goldstein RS. Self-management following an acute exacerbation of COPD: a systematic review. Chest. 2015;147(3):646–61. doi: 10.1378/chest.14-1658.CrossRefPubMedGoogle Scholar
  12. 12.
    Pinnock H, Steed L, Jordan R. Supported self-management for COPD: making progress, but there are still challenges. Eur Respir J. 2016;48(1):6–9. doi: 10.1183/13993003.00576-2016.CrossRefPubMedGoogle Scholar
  13. 13.
    Rycroft-Malone J, Burton CR. The synthesis of qualitative data. In: Richards DA, Hallberg IR, editors. Complex interventions in health: an overview of research methods. London: Routledge Taylor & Francis Group; 2015. p. 80–7.Google Scholar
  14. 14.
    Joanna Briggs Institute. Reviewers’ manual. 2014. Accessed 15 Oct 2016.
  15. 15.
    Hannes K, Lockwood C. Synthesizing qualitative research: choosing the right approach. Chichester: BMJ Books-Wiley-Blackwell; 2012.Google Scholar
  16. 16.
    Thomas LA. Effective dyspnea management strategies identified by elders with end-stage chronic obstructive pulmonary disease. Appl Nurs Res ANR. 2009;22(2):79–85. doi: 10.1016/j.apnr.2007.04.010.CrossRefPubMedGoogle Scholar
  17. 17.
    Stridsman C, Zingmark K, Lindberg A, Skar L. Creating a balance between breathing and viability: experiences of well-being when living with chronic obstructive pulmonary disease. Primary Health Care Res Dev. 2015;16(1):42–52. doi: 10.1017/S1463423614000048.CrossRefGoogle Scholar
  18. 18.
    Apps LD, Harrison SL, Williams JE, Hudson N, Steiner M, Morgan MD, et al. How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study. Int J Chronic Obstr Pulm Dis. 2014;9:257–63. doi: 10.2147/COPD.S52691.Google Scholar
  19. 19.
    Kauffman KS, Doede M, Diaz-Abad M, Scharf SM, Bell-Farrell W, Rogers VE, et al. Experience of insomnia, symptom attribution and treatment preferences in individuals with moderate to severe COPD: a qualitative study. Patient Prefer Adher. 2014;8:1699–704. doi: 10.2147/PPA.S71666.Google Scholar
  20. 20.
    Williams V, Hardinge M, Ryan S, Farmer A. Patients’ experience of identifying and managing exacerbations in COPD: a qualitative study. NPJ Primary Care Respir Med. 2014;24:14062. doi: 10.1038/npjpcrm.2014.62.CrossRefGoogle Scholar
  21. 21.
    Brandt CL. Study of older adults’ use of self-regulation for COPD self-management informs an evidence-based patient teaching plan. Rehabil Nurs Off J Assoc Rehabil Nurses. 2013;38(1):11–23. doi: 10.1002/rnj.56.Google Scholar
  22. 22.
    Cooney A, Mee L, Casey D, Murphy K, Kirwan C, Burke E, et al. Life with chronic obstructive pulmonary disease: striving for ‘controlled co-existence’. J Clin Nurs. 2013;22(7–8):986–95. doi: 10.1111/j.1365-2702.2012.04285.x.CrossRefPubMedGoogle Scholar
  23. 23.
    Sossai K, Gray M, Tanner B. Living with chronic obstructive pulmonary disease: experiences in northern regional Australia. Int J Ther Rehabil. 2011;18(11):631–42.CrossRefGoogle Scholar
  24. 24.
    Avsar G, Kasikci M. Living with chronic obstructive pulmonary disease: a qualitative study. Aust J Adv Nurs. 2010;28(2):46–52.Google Scholar
  25. 25.
    Chen KH, Chen ML, Lee S, Cho HY, Weng LC. Self-management behaviours for patients with chronic obstructive pulmonary disease: a qualitative study. J Adv Nurs. 2008;64(6):595–604. doi: 10.1111/j.1365-2648.2008.04821.x.CrossRefPubMedGoogle Scholar
  26. 26.
    Karnevisto M, Kaistila T, Paavilainen E. Severe chronic obstructive pulmonary disease in a family’s everyday life in Finland: perceptions of people with chronic obstructive pulmonary disease and their spouses. Nurs Health Sci. 2007;9(1):40–7.CrossRefGoogle Scholar
  27. 27.
    Fraser DD, Kee CC, Minick P. Living with chronic obstructive pulmonary disease: insiders’ perspectives. J Adv Nurs. 2006;55(5):550–8. doi: 10.1111/j.1365-2648.2006.03946.x.CrossRefPubMedGoogle Scholar
  28. 28.
    Cicutto L, Brooks D, Henderson K. Self-care issues from the perspective of individuals with chronic obstructive pulmonary disease. Patient Educ Couns. 2004;55(2):168–76. doi: 10.1016/j.pec.2003.08.012.CrossRefPubMedGoogle Scholar
  29. 29.
    Jeng C, Tsao LI, Ho CH, Chang PC. Experiences of daily activities within two weeks after hospital discharge among Taiwanese elderly patients with chronic obstructive pulmonary disease. J Nurs Res JNR. 2002;10(3):168–76.CrossRefPubMedGoogle Scholar
  30. 30.
    Nield M. Dyspnea self-management in African Americans with chronic lung disease. Heart Lung J Crit Care. 2000;29(1):50–5.CrossRefGoogle Scholar
  31. 31.
    Patton M. Qualitative evaluation and research methods. 3rd ed. Newbury Park, CA: Sage publications; 2002.  Google Scholar
  32. 32.
    Kaptein AA, Fischer MJ, Scharloo M. Self-management in patients with COPD: theoretical context, content, outcomes, and integration into clinical care. Int J Chronic Obstr Pulm Dis. 2014;9:907–17. doi: 10.2147/COPD.S49622.CrossRefGoogle Scholar
  33. 33.
    Braido F, Baiardini I, Menoni S, Bagnasco AM, Balbi F, Bocchibianchi S, et al. Disability in COPD and its relationship to clinical and patient-reported outcomes. Curr Med Res Opin. 2011;27(5):981–6. doi: 10.1185/03007995.2011.563285.CrossRefPubMedGoogle Scholar
  34. 34.
    Jorgensen LB, Dahl R, Pedersen PU, Lomborg K. Evaluation of a multi-modal grounded theory approach to explore patients’ daily coping with breathlessness due to chronic obstructive pulmonary disease. J Res Nurs. 2013;18(5):423–40.CrossRefGoogle Scholar
  35. 35.
    Pooler C. Living with chronic lower pulmonary disease: disruptions of the embodied phenomenological self. Global Qual Nurs Res. 2014;1:1–11.Google Scholar
  36. 36.
    Christenbery TL. Dyspnea self-management strategies: use and effectiveness as reported by patients with chronic obstructive pulmonary disease. Heart Lung J Crit Care. 2005;34(6):406–14. doi: 10.1016/j.hrtlng.2005.07.005.CrossRefGoogle Scholar
  37. 37.
    Bucknall CE, Miller G, Lloyd SM, Cleland J, McCluskey S, Cotton M, et al. Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial. BMJ. 2012;344:e1060. doi: 10.1136/bmj.e1060.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015(2):CD003793. doi: 10.1002/14651858.CD003793.pub3.
  39. 39.
    Guo JB, Chen BL, Lu YM, Zhang WY, Zhu ZJ, Yang YJ, et al. Tai Chi for improving cardiopulmonary function and quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2016;30(8):750–64. doi: 10.1177/0269215515604903.CrossRefPubMedGoogle Scholar
  40. 40.
    Luo X, Zhang J, Castelberg R, Wu T, Yu P, He C, et al. The effects of traditional Chinese exercise in patients with chronic obstructive pulmonary disease: a meta-analysis. PLoS One. 2016;11(9):e0161564. doi: 10.1371/journal.pone.0161564.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Parke HL, Epiphaniou E, Pearce G, Taylor SJ, Sheikh A, Griffiths CJ, et al. Self-management support interventions for stroke survivors: a systematic meta-review. PLoS One. 2015;10(7):e0131448. doi: 10.1371/journal.pone.0131448.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Garcia-Aymerich J, Pitta F. Promoting regular physical activity in pulmonary rehabilitation. Clin Chest Med. 2014;35(2):363–8. doi: 10.1016/j.ccm.2014.02.011.CrossRefPubMedGoogle Scholar
  43. 43.
    Tonnesen P. Smoking cessation and COPD. Eur Respir Rev Off J Eur Respir Soc. 2013;22(127):37–43. doi: 10.1183/09059180.00007212.CrossRefGoogle Scholar
  44. 44.
    Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.Google Scholar
  45. 45.
    Moskowitz JT, Hult JR, Bussolari C, Acree M. What works in coping with HIV? A meta-analysis with implications for coping with serious illness. Psychol Bull. 2009;135(1):121–41. doi: 10.1037/a0014210.CrossRefPubMedGoogle Scholar
  46. 46.
    Duangdao KM, Roesch SC. Coping with diabetes in adulthood: a meta-analysis. J Behav Med. 2008;31(4):291–300. doi: 10.1007/s10865-008-9155-6.CrossRefPubMedGoogle Scholar
  47. 47.
    Penley JA, Tomaka J, Wiebe JS. The association of coping to physical and psychological health outcomes: a meta-analytic review. J Behav Med. 2002;25(6):551–603.CrossRefPubMedGoogle Scholar
  48. 48.
    Nes LS, Segerstrom SC. Dispositional optimism and coping: a meta-analytic review. Pers Soc Psychol Rev Off J Soc Pers Soc Psychol Inc. 2006;10(3):235–51. doi: 10.1207/s15327957pspr1003_3.CrossRefGoogle Scholar
  49. 49.
    Ersek M, Turner JA, Kemp CA. Use of the chronic pain coping inventory to assess older adults’ pain coping strategies. J Pain Off J Am Pain Soc. 2006;7(11):833–42. doi: 10.1016/j.jpain.2006.04.002.CrossRefGoogle Scholar
  50. 50.
    Kendall M, Buckingham S, Ferguson S, MacNee W, Sheikh A, White P et al. Exploring the concept of need in people with very severe chronic obstructive pulmonary disease: a qualitative study. BMJ Support Palliat Care. 2015. doi: 10.1136/bmjspcare-2015-000904.
  51. 51.
    Bourbeau J, Lavoie KL, Sedeno M. Comprehensive self-management strategies. Semin Respir Crit Care Med. 2015;36(4):630–8. doi: 10.1055/s-0035-1556059.CrossRefPubMedGoogle Scholar
  52. 52.
    Jordan RE, Majothi S, Heneghan NR, Blissett DB, Riley RD, Sitch AJ, et al. Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis. Health Technol Assess. 2015;19(36):1–516. doi: 10.3310/hta19360.CrossRefGoogle Scholar
  53. 53.
    Rijken M, Jones M, Heijmans M, Dixon A. Supporting self-management. In: Nolte E, McKee M, editors. Caring for people with chronic conditions: a health system perspective. Berkshire: Open University Press; 2008. p. 116–42.Google Scholar
  54. 54.
    Jonkman NH, Westland H, Trappenburg JC, Groenwold RH, Bischoff EW, Bourbeau J, et al. Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis. Eur Respir J. 2016;48(1):55–68. doi: 10.1183/13993003.01860-2015.CrossRefPubMedGoogle Scholar
  55. 55.
    Jun J, Kovner CT, Witkoski Stimpfel A. Barriers and facilitators of nurses’ use of clinical practice guidelines: an integrative review. Int J Nurs Stud. 2016;60:54–68. doi: 10.1016/j.ijnurstu.2016.03.006.CrossRefPubMedGoogle Scholar
  56. 56.
    Riegel B, Vaughan Dickson V, Goldberg LR, Deatrick JA. Factors associated with the development of expertise in heart failure self-care. Nurs Res. 2007;56(4):235–43. doi: 10.1097/01.NNR.0000280615.75447.f7.CrossRefPubMedGoogle Scholar
  57. 57.
    Tseng J, Halperin L, Ritholz MD, Hsu WC. Perceptions and management of psychosocial factors affecting type 2 diabetes mellitus in Chinese Americans. J Diabetes Complicat. 2013;27(4):383–90. doi: 10.1016/j.jdiacomp.2013.01.001.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Marco Clari
    • 1
  • Maria Matarese
    • 2
  • Dhurata Ivziku
    • 1
  • Maria Grazia De Marinis
    • 2
  1. 1.Department of Biomedicine and PreventionUniversity of Rome ‘Tor Vergata’RomeItaly
  2. 2.Unit of Nursing Science, Faculty of MedicineCampus Bio-Medico University of RomeRomeItaly

Personalised recommendations