Self-Management in Pulmonary Rehabilitation

  • Jean BourbeauEmail author
  • Waleed Alsowayan
  • Joshua Wald


Pulmonary rehabilitation programmes have long recognized that, while exercise training is vitally important for patients with lung disease, equally important is the opportunity provided by a rehabilitation programme to deliver education to patients with chronic respiratory disease and help them to develop the skills and confidence they need to adopt a healthier lifestyle [1]. Patient education whether individually or in groups has always been an important component of pulmonary rehabilitation. The content and delivery of this education has gradually evolved from a traditional, didactic approach to one informed by an understanding of human psychology, which promotes adaptive behaviour change through the inclusion of collaborative self-management [2, 3].


  1. 1.
    Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Molken MP, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF. Rehabilitation AETFoP: an official american thoracic society/european respiratory society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188:e13–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Bourbeau J, Lavoie KL, Sedeno M. Comprehensive self-management strategies. Semin Respir Crit Care Med. 2015;36:630–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, Coultas D, Meek P, van der Valk P, Bischoff EW, Bucknall C, Dewan NA, Early F, Fan V, Frith P, Janssen DJ, Mitchell K, Morgan M, Nici L, Patel I, Walters H, Rice KL, Singh S, Zuwallack R, Benzo R, Goldstein R, Partridge MR, van der Palen J. Definition of a copd self-management intervention: international expert group consensus. Eur Respir J. 2016;48:46–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Colak Y, Afzal S, Nordestgaard BG, Vestbo J, Lange P. Prognosis of asymptomatic and symptomatic, undiagnosed copd in the general population in denmark: a prospective cohort study. Lancet Respir Med. 2017; 5(5):426–34.Google Scholar
  5. 5.
    Janson C, Marks G, Buist S, Gnatiuc L, Gislason T, McBurnie MA, Nielsen R, Studnicka M, Toelle B, Benediktsdottir B, Burney P. The impact of copd on health status: findings from the bold study. Eur Respir J. 2013;42:1472–83.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Huijsmans RJ, de Haan A, ten Hacken NN, Straver RV, van't Hul AJ. The clinical utility of the gold classification of copd disease severity in pulmonary rehabilitation. Respir Med. 2008;102:162–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Effing TW, Bourbeau J, Vercoulen J, Apter AJ, Coultas D, Meek P, Valk P, Partridge MR, Palen J. Self-management programmes for copd: moving forward. Chron Respir Dis. 2012;9:27–35.CrossRefPubMedGoogle Scholar
  8. 8.
    Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med. 1995;122:823–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Soicher JE, Mayo NE, Gauvin L, Hanley JA, Bernard S, Maltais F, Bourbeau J. Trajectories of endurance activity following pulmonary rehabilitation in copd patients. Eur Respir J. 2012;39:272–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Alison JA, McKeough ZJ, Johnston K, McNamara RJ, Spencer LM, Jenkins SC, Hill CJ, McDonald VM, Frith P, Cafarella P, Brooke M, Cameron-Tucker HL, Candy S, Cecins N, Chan AS, Dale MT, Dowman LM, Granger C, Halloran S, Jung P, Lee AL, Leung R, Matulick T, Osadnik C, Roberts M, Walsh J, Wootton S, Holland AE, Lung Foundation A, the Thoracic Society of A. New Z: Australian and new zealand pulmonary rehabilitation guidelines. Respirology. 2017;22:800–19.CrossRefPubMedGoogle Scholar
  11. 11.
    Bolton CE, Bevan-Smith EF, Blakey JD, Crowe P, Elkin SL, Garrod R, Greening NJ, Heslop K, Hull JH, Man WD, Morgan MD, Proud D, Roberts CM, Sewell L, Singh SJ, Walker PP, Walmsley S, British Thoracic Society Pulmonary Rehabilitation Guideline Development G, British Thoracic Society Standards of Care C. British thoracic society guideline on pulmonary rehabilitation in adults. Thorax. 2013;68(Suppl 2):ii1–30.CrossRefPubMedGoogle Scholar
  12. 12.
    O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk D, Balter M, Ford G, Gervais A, Goldstein R, Hodder R, Maltais F, Road J, Canadian Thoracic S. Canadian thoracic society recommendations for management of chronic obstructive pulmonary disease--2003. Can Respir J. 2003;10 Suppl A:11A–65A.CrossRefPubMedGoogle Scholar
  13. 13.
    O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk DD, Balter M, Ford G, Gervais A, Goldstein R, Hodder R, Kaplan A, Keenan S, Lacasse Y, Maltais F, Road J, Rocker G, Sin D, Sinuff T, Voduc N. Canadian thoracic society recommendations for management of chronic obstructive pulmonary disease—2007 update. Can Respir J. 2007;14 Suppl B:5B–32B.CrossRefPubMedGoogle Scholar
  14. 14.
    Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, Lopez Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: gold executive summary. Eur Respir J. 2017;49Google Scholar
  15. 15.
    Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469–75.CrossRefPubMedGoogle Scholar
  16. 16.
    Bourbeau J, Nault D, Dang-Tan T. Self-management and behaviour modification in copd. Patient Educ Couns. 2004;52:271–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Zwerink M, Brusse-Keizer M, van der Valk PD, Zielhuis GA, Monninkhof EM, van der Palen J, Frith PA. Effing T: self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014:CD002990.Google Scholar
  18. 18.
    Agle DP, Baum GL, Chester EH, Wendt M. Multidiscipline treatment of chronic pulmonary insufficiency. 1. Psychologic aspects of rehabilitation. Psychosom Med. 1973;35:41–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Cockcroft A, Bagnall P, Heslop A, Andersson N, Heaton R, Batstone J, Allen J, Spencer P, Guz A. Controlled trial of respiratory health worker visiting patients with chronic respiratory disability. Br Med J. 1987;294:225–8.CrossRefGoogle Scholar
  20. 20.
    Howland J, Nelson EC, Barlow PB, McHugo G, Meier FA, Brent P, Laser-Wolston N, Parker HW. Chronic obstructive airway disease. Impact of health education. Chest. 1986;90:233–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaptein AA, Fischer MJ, Scharloo M. Self-management in patients with copd: theoretical context, content, outcomes, and integration into clinical care. Int J Chron Obstruct Pulmon Dis. 2014;9:907–17.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Monninkhof E, van der Valk P, van der Palen J, van Herwaarden C, Partridge MR, Zielhuis G. Self-management education for patients with chronic obstructive pulmonary disease: a systematic review. Thorax. 2003;58:394–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.CrossRefPubMedGoogle Scholar
  24. 24.
    Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupre A, Begin R, Renzi P, Nault D, Borycki E, Schwartzman K, Singh R, Collet JP. Chronic Obstructive Pulmonary Disease axis of the Respiratory Network Fonds de la Recherche en Sante du Q: Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003;163:585–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Gadoury MA, Schwartzman K, Rouleau M, Maltais F, Julien M, Beaupre A, Renzi P, Begin R, Nault D, Bourbeau J, Chronic Obstructive Pulmonary Disease axis of the Respiratory Health Network, FdlresdQ. Self-management reduces both short- and long-term hospitalisation in COPD. Eur Respir J. 2005;26:853–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Bourbeau J, Collet JP, Schwartzman K, Ducruet T, Nault D, Bradley C. Economic benefits of self-management education in COPD. Chest. 2006;130:1704–11.CrossRefPubMedGoogle Scholar
  27. 27.
    Fan VS, Gaziano JM, Lew R, Bourbeau J, Adams SG, Leatherman S, Thwin SS, Huang GD, Robbins R, Sriram PS, Sharafkhaneh A, Mador MJ, Sarosi G, Panos RJ, Rastogi P, Wagner TH, Mazzuca SA, Shannon C, Colling C, Liang MH, Stoller JK, Fiore L, Niewoehner DE. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: a randomized, controlled trial. Ann Intern Med. 2012;156:673–83.CrossRefPubMedGoogle Scholar
  28. 28.
    Bischoff EW, Hamd DH, Sedeno M, Benedetti A, Schermer TR, Bernard S, Maltais F, Bourbeau J. Effects of written action plan adherence on copd exacerbation recovery. Thorax. 2011;66:26–31.CrossRefPubMedGoogle Scholar
  29. 29.
    Bucknall CE, Miller G, Lloyd SM, Cleland J, McCluskey S, Cotton M, Stevenson RD, Cotton P, McConnachie A. Glasgow supported self-management trial (gsust) for patients with moderate to severe copd: randomised controlled trial. BMJ. 2012;344:e1060.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Peytremann-Bridevaux I, Taffe P, Burnand B, Bridevaux PO, Puhan MA. Mortality of patients with copd participating in chronic disease management programmes: a happy end? Thorax. 2014;69:865–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Camp PG, Hernandez P, Bourbeau J, Kirkham A, Debigare R, Stickland MK, Goodridge D, Marciniuk DD, Road JD, Bhutani M, Dechman G. Pulmonary rehabilitation in canada: a report from the canadian thoracic society copd clinical assembly. Can Respir J. 2015;22:147–52.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    O'Neill B, Elborn J, MacMahon J, Bradley JM. Pulmonary rehabilitation and follow-on services: a northern ireland survey. Chron Respir Dis. 2008;5:149–54.CrossRefPubMedGoogle Scholar
  33. 33.
    Yohannes AM, Connolly MJ. Pulmonary rehabilitation programmes in the uk: A national representative survey. Clin Rehabil. 2004;18:444–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Blackstock FC, Webster KE, McDonald CF, Hill CJ. Comparable improvements achieved in chronic obstructive pulmonary disease through pulmonary rehabilitation with and without a structured educational intervention: a randomized controlled trial. Respirology. 2014;19:193–202.CrossRefPubMedGoogle Scholar
  35. 35.
    Norweg AM, Whiteson J, Malgady R, Mola A, Rey M. The effectiveness of different combinations of pulmonary rehabilitation program components: a randomized controlled trial. Chest. 2005;128:663–72.CrossRefPubMedGoogle Scholar
  36. 36.
    Cosgrove D, Macmahon J, Bourbeau J, Bradley JM, O'Neill B. Facilitating education in pulmonary rehabilitation using the living well with copd programme for pulmonary rehabilitation: a process evaluation. BMC Pulm Med. 2013;13:50.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Bourbeau J. The role of collaborative self-management in pulmonary rehabilitation. Semin Respir Crit Care Med. 2009;30:700–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Bourbeau J. Making pulmonary rehabilitation a success in copd. Swiss Med Wkly. 2010;140:w13067.PubMedGoogle Scholar
  39. 39.
    Bourbeau J, Lavoie KL, Sedeno M, De Sousa D, Erzen D, Hamilton A, Maltais F, Troosters T, Leidy N. Behaviour-change intervention in a multicentre, randomised, placebo-controlled copd study: methodological considerations and implementation. BMJ Open. 2016;6:e010109.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Bourbeau J, Casan P, Tognella S, Haidl P, Texereau JB, Kessler R. An international randomized study of a home-based self-management program for severe copd: the comet. Int J Chron Obstruct Pulmon Dis. 2016;11:1447–51.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Bourbeau J, Nault D. Self-management strategies in chronic obstructive pulmonary disease. Clin Chest Med. 2007;28:617–28. viiCrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Montreal Chest InstituteMcGill University Health CentreMontréalCanada
  2. 2.Center for Innovative Medicine (CIM)McGill University Health Centre (MUHC)MontrealCanada

Personalised recommendations