The key feature of self-management is to increase patients' involvement and control in their disease and improve their well being. Self-management is not intended to replace components of patient health care such as medication and pulmonary rehabilitation. We may be enthusiastic about recent results of self-management programs in chronic obstructive pulmonary disease (COPD) patients showing a reduction in hospital admissions. However, noted Bourbeau, being interested only in patients' hospital admissions is overly narrow. The pivotal objective of self-management programs is to change patients' behavior. The success should correspond to the goals of self-management (e.g., acquiring key self-management skills such as problem solving, decision making, early symptom recognition, and taking action) and self-health behaviors (maintaining comfortable breathing, implementing an action plan in the event of an exacerbation, and facilitating exercise maintenance). Pulmonary rehabilitation is increasingly becoming a realistic component of COPD patient management, but it should not stand as an isolated intervention. Pulmonary rehabilitation should be part of an integrated care process and include self-management support (i.e., aiming to achieve a shift from management by the health care provider to management by the patients themselves, which implies structural behavior change). Changing patient behavior and ensuring maintenance are complex processes and require time.

WHAT THE ARTICLE MAY MEAN TO YOU AS A HEALTH CARE PROFESSIONAL: Bourbeau succinctly summarized the importance of self-management in the management of chronic pulmonary diseases. Patients perform all the steps required to control their condition, but it is up to them to review their progress and refine their actions when required.

WHAT THE ARTICLE MAY MEAN TO YOU AS A PATIENT: The article points out not only your role in the management of a respiratory condition, but that of your health care provider. It provides suggestions on how you can optimize the use of self-management skills over time.

J Bourbeau. The Role of Collaborative Self-Management in Pulmonary Rehabilitation. Seminars in Respiratory & Critical Care Medicine, 2009;30:700-707.