Dr Karen Marshall 
Everyone's Talking About
Empowering and engaging people with chronic diseases to manage their own health is vital.[1] Self-management interventions and coaching by healthcare professionals are recommended and are considered a major component of care for COPD patients.[2]
A self-management approach can result in raised self-confidence, better quality of life, improved clinical outcomes, and greater achievement of goals that are important to the person.[3] This article will cover the importance of self-management in chronic obstructive pulmonary disease (COPD) and the incredible ways digital is transforming respiratory care.
COPD and self-management
Self-management skills are important in patients with COPD, who are responsible for their own day-to-day care.[4]
Patients with COPD typically experience breathlessness, wheeze, chest tightness, fatigue, activity limitation, cough (with or without sputum production) and are affected by exacerbations.[2] These symptoms significantly influence a person’s health status and prognosis.[2] Once established COPD cannot be cured, but effective self-management strategies can lessen the burden of disease and improve quality of life.[5]
People with COPD also experience symptoms of depression and anxiety more frequently than the general population. It seems that both these conditions have an impact on prognosis, as physical activity is reduced, dyspnoea is worsened, the frequency of exacerbations increase and so does the use of health resources.[6]
Self-management interventions are important for people with COPD to: [7]
- acquire and practise the skills they need to carry out disease-specific medical regimens
- guide changes in health behaviour
- provide emotional support to empower people to control their disease.
Unfortunately, people with COPD report gaps in core knowledge, such as not receiving information about expectations after diagnosis, being told inaccurate information regarding prognosis and treatment options, and almost no education on self-management.[8] Patients state they wish they had learned self-management skills early on — for example, how to spot early signs of an exacerbation and what to do about it, and how to stay active and cope with episodes of anxiety and dyspnoea with techniques such as pursed-lip breathing.[8]
Transforming care through digital methods
During the pandemic, we have seen remarkable examples of the way digital methods have transformed the delivery of care. The need now is for the health and care sector to adopt digital tools, urgently and consistently, to address NHS England’s long-term health improvement goal.[9]
In the context of COPD and the NHS Long Term Plan, there is an aim to increase access to pulmonary rehabilitation. New models of providing rehabilitation to those with mild COPD, including digital tools, will be offered to provide support to a wider group of patients with rehabilitation and self-management support.[10]
One possible way to help patients with self-management is to use digital technology,[11]and BreathTec may be the answer.
The BreathTec programme
BreathTec is a digital, personalised, interactive, self-management programme developed by myself and my colleague Dr Graham Burns.
BreathTec was adapted from a highly effective, face-to-face cognitive behavioural therapy (CBT) intervention for COPD patients with symptoms of anxiety. The study found that the CBT intervention delivered by respiratory nurses was a clinically and cost-effective treatment for anxiety in patients with COPD, relative to self-help leaflets.[12] There are challenges to implementing face-to-face cognitive behavioural therapy-based programme, at the scale required, including the availability of trained therapists, especially with respiratory expertise.[12]
BreathTec was co-developed with patients and carers over several years to ensure it was relevant to their needs, easy and accessible to use, with helpful content to aid self-management. Patients work through five sessions (initial assessment, managing breathlessness, staying physically active, mental health, and final review), providing feedback after each session.
To understand the impact of BreathTec, the programme is being evaluated using anonymised data from patients, which uses results from several questionnaires and self-reporting tools. These results have been submitted for publication with the European Respiratory Society. In the meantime, a case study has been published exploring its impact in one trust setting. The case study, on an analysis of 36 patients, found that 67% had symptoms of anxiety at baseline, and for 42% of these patients their symptoms of anxiety had significantly improved on completion of BreathTec. More recent analysis of 42 patients found on average a 57% improvement in anxiety from baseline to post-intervention.[13]
Conclusion
Patients with COPD experience debilitating breathlessness, reduced physical activity, deconditioning, and symptoms of anxiety and depression.[2],[6]
BreathTec plays an important role in addressing these key issues. It is not a replacement for usual clinical care, but a much-needed digital resource to help patients with self-management of their condition.
Find out more about BreathTec here.
Any advice given and opinions expressed in this article are those of the author and do not reflect the view of Chiesi Limited (Chiesi). All content in this article is for informational and educational purposes only. Although Chiesi strives to always provide accurate information, it is not responsible for and does not verify for accuracy any of the information contained within.
[1] NHS England. Involving people in their own health and care: Statutory guidance for clinical commissioning groups and NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-involving-people-health-care-guidance.pdf
[2] Global Initiative for Chronic Obstructive Lung Disease. 2024 Gold Report. Available at: https://goldcopd.org/2024-gold-report/
[3] The Health Foundation. Supporting self-management. Available at: https://www.health.org.uk/sites/default/files/SupportingSelfManagement.pdf
[4] Effing TW, Vercoulen JH, Bourbeau J, et al. Definition of a COPD self-management intervention: International Expert Group consensus. Eur Respir J. 2016; 48(1): 46-54
[5] Cannon D, Buys N, Sriram KB, et al. The effects of chronic obstructive pulmonary disease self-management interventions on improvement of quality of life in COPD patients: A meta-analysis. Respir Med. 2016; 121: 81-90
[6] Martínez-Gestoso S, García-Sanz MT, Carreira JM, et al. Impact of anxiety and depression on the prognosis of copd exacerbations. BMC Pulm Med. 2022; 22(1): 169
[7] Schrijver J, Lenferink A, Brusse-Keizer M, et al. Self-management interventions for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2022; 1(1): CD002990
[8] Han MK, Martinez CH, Au DH, et al. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. Lancet Respir Med. 2016; 4(6): 473-526
[9] NHS England. Our strategy to digitise, connect and transform. Available at: https://transform.england.nhs.uk/digitise-connect-transform/our-strategy-to-digitise-connect-and-transform/
[10] NHS. Long Term Plan – Respiratory disease. Available at: https://www.longtermplan.nhs.uk/online-version/chapter-3-further-progress-on-care-quality-and-outcomes/better-care-for-major-health-conditions/respiratory-disease/
[11] Whitehead L, Seaton P. The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review. J Med Internet Res. 2016; 18(5): e97
[12] Heslop-Marshall K, Baker C, Carrick-Sen D, et al. Randomised controlled trial of cognitive behavioural therapy in COPD. ERJ Open Res. 2018; 4(4): 00094-2018
[13] Health Innovation South West. Case study – BreathTec. Available at: https://healthinnovationsouthwest.com/wp-content/uploads/publications/BreathTec-case-study-15.06.23.pdf
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