These recommendations are based on expert opinion and evidence reviewed in the National Institute for Health and Clinical Excellence (NICE) clinical guideline Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update) [National Clinical Guideline Centre, 2010].

• NICE identified a Cochrane systematic review (three RCTs, 367 participants) which showed that people with self-management plans had better recognition of an exacerbation and reacted appropriately. Unfortunately, this behaviour did not result in any benefit in healthcare utilization, symptoms, quality of life, functional capacity, mental health, or mortality. The studies included were small and of poor quality.
• Two subsequent randomized controlled trials identified by CKS (298 participants) also confirmed these findings, and added that there was no difference in exacerbation rates [McGeoch et al, 2006; Wood-Baker et al, 2006].
• Despite the lack of evidence, experts believe that self-management plans are useful in the management of chronic obstructive pulmonary disease.
• The recommendation that a person with a supply of medications at home should contact a primary healthcare professional if they start treatment is based on feedback from CKS expert reviewers. They suggest that a review should be done in any case:
• To ensure that the patient understood what they are doing.
• To ensure that medications are taken appropriately.
• To record the exacerbation.
• To review the time antecedent to the exacerbation to see if any other preventative factor might have been helpful.
• To re plenish home stocks of oral steroids/antibiotics.