***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Pulmonary rehabilitation ( PR ) is an effective intervention for the management of people with chronic obstructive pulmonary disease ( COPD ) . However , available re sources are often limited , and many patients bear with poor availability of programmes . Sustaining PR benefits and regular exercise over the long term is difficult without any exercise maintenance strategy . In contrast to traditional centre-based PR programmes , telerehabilitation may promote more effective integration of exercise routines into daily life over the longer term and broaden its applicability and availability . A few studies showed promising results for telerehabilitation , but mostly with short-term interventions . The aim of this study is to compare long-term telerehabilitation with unsupervised exercise training at home and with st and ard care . Methods / Design An international multicentre r and omised controlled trial conducted across sites in three countries will recruit 120 patients with COPD . Participants will be r and omly assigned to telerehabilitation , treadmill and control , and followed up for 2 years . The telerehabilitation intervention consists of individualised exercise training at home on a treadmill , telemonitoring by a physiotherapist via videoconferencing using a tablet computer , and self-management via a customised website . Patients in the  treadmill  arm are provided with a treadmill only to perform unsupervised exercise training at home . Patients in the control arm are offered st and ard care . The primary outcome is the combined number of hospitalisations and emergency department presentations . Secondary outcomes include changes in health status , quality of life , anxiety and depression , self-efficacy , subjective impression of change , physical performance , level of physical activity , and personal experiences in telerehabilitation . Discussion This trial will provide evidence on whether long-term telerehabilitation represents a cost-effective strategy for the follow-up of patients with COPD . The delivery of telerehabilitation services will also broaden the availability of PR and maintenance strategies , especially to those living in remote areas and with no access to centre-based exercise programmes . Trial registration Clinical Trials.gov : NCT02258646 In international and national guidelines patient education is recommended as an integral part of an effective management for both , asthma and COPD , respectively . The evaluation of numerous structured education programs for adult asthmatics revealed an increase of quality of life of the educated patients , reduced morbidity with less asthmatic attacks , a decrease of emergency visits , sick leave days and hospitalizations due to asthma . On the basis of cost/benefit analysis cost effectiveness could be demonstrated for education programs for asthmatics . On the basis of education programs in COPD including self-management , in a r and omized controlled study an improvement of the patient 's ability to react to exacerbations could be shown , thus reducing the morbidity by the disease . Further controlled studies of the effects of patient education on morbidity , mortality and cost effectiveness are necessary to establish the role of structured education programs in the treatment of COPD with sufficient validity PURPOSE To examine whether maintenance training ( MT ) for 1 year improved the long-term effects of a 7-week chronic obstructive pulmonary disease ( COPD ) rehabilitation program . METHODS After a 7-week outpatient rehabilitation program , 96 patients with COPD were r and omized to either an MT group ( n = 55 ) or a control group ( n = 41 ) . Both groups were requested to continue unsupervised training at home . The MT group received weekly supervised training the first 6 months , supervised training every second week the next 6 months , and finally no supervised training the last 6 months of the 18-month study period . Primary effect parameters were Endurance Shuttle Walk Test ( ESWT ) time and health status ( St. George 's Respiratory Question naire , SGRQ ) . Secondary effect parameters were adherence to supervised training , dropout rates , and hospitalization . RESULTS Compared with the control group , the MT group had significantly better ESWT times at 3 and 6 months ( + 43.9 seconds ; P= .03 , and + 75.1 seconds ; P= .02 ) and insignificantly higher ESWT time at 12 months ( + 66.6 seconds ; P= .40 ) . SGRQ total score declined gradually after the 7-week program with no difference between the 2 groups , and after 18 months , the score was 1.7 units ( 95 % confidence interval : −0.7 to 4.1 ) worse than at r and omization . There was no difference between the 2 groups regarding dropout rates or hospitalization . DISCUSSION Weekly MT for 12 months improved walking time but had no influence on health-related quality of life or hospital admissions , compared with unsupervised daily training at home . The effect of the MT was closely related to adherence to the program OBJECTIVE To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in individuals recently diagnosed with chronic obstructive pulmonary disease ( COPD ) . METHODS A r and omized control trial was undertaken during which an experimental group received 2h of education delivered by a certified COPD educator and a control group received usual care . The Bristol COPD Knowledge Question naire ( BCKQ ) was self-administered at the time of r and omization and approximately three months later . RESULTS Of the 93 individuals that completed the study , 50 ( forced expiratory volume in 1s [FEV(1)]=60.0+/-14.3 % predicted ; 22 males ) and 43 ( FEV(1)=58.2+/-14.4 % predicted ; 20 males ) participants were r and omized to the experimental and control groups , respectively . The BCKQ increased from 27.6+/-8.7 to 36.5+/-7.7 points ( p<0.001 ) in the experimental group , which was greater than any seen in the control group ( between-group difference 8.3 , 95 % confidence interval 5.5 - 11.2 points ) . CONCLUSION As little as 2h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge . PRACTICE IMPLICATION S A program of brief education delivered in the primary care setting , represents an important approach for many individuals with COPD who are unlikely to access pulmonary rehabilitation BACKGROUND Treatment of COPD requires multiple pharmacological and non-pharmacological intervention strategies . One target is physical inactivity because it leads to disability and contributes to poor physical and mental health . Unfortunately , less than 1 % of eligible patients have access to gold-st and ard pulmonary rehabilitation . METHODS A single-site parallel group r and omized trial was design ed to determine if a self-management lifestyle physical activity intervention would improve physical functioning and dyspnea . During the first six weeks after enrollment patients receive COPD self-management education delivered by a health coach using a workbook and weekly telephone calls . Patients are then r and omized to usual care or the physical activity intervention . The 20 week physical activity intervention is delivered by the health coach using a workbook supported by alternating one-on-one telephone counseling and computer assisted telephone calls . Theoretical foundations include social cognitive theory and the transtheoretical model . RESULTS Primary outcomes include change in Chronic Respiratory Question naire ( CRQ ) dyspnea domain and 6-minute walk distance measured at 6- , 12- , and 18-months after r and omization . Secondary outcomes include other CRQ domains ( fatigue , emotion , and mastery ) , SF-12 , and health care utilization . Other measures include process outcomes and clinical characteristics . CONCLUSIONS This theory driven self-management lifestyle physical activity intervention is design ed to reach patients unable to complete center-based pulmonary rehabilitation . Results will advance knowledge and methods for dissemination of a potentially cost-effective program for patients with COPD Introduction Recent research shows that advance care planning ( ACP ) for patients with chronic obstructive pulmonary disease ( COPD ) is uncommon and poorly carried out . The aim of the present study was to explore whether and to what extent structured ACP by a trained nurse , in collaboration with the chest physician , can improve outcomes in Dutch patients with COPD and their family . Methods and analysis A multicentre cluster r and omised controlled trial in patients with COPD who are recently discharged after an exacerbation has been design ed . Patients will be recruited from three Dutch hospitals and will be assigned to an intervention or control group , depending on the r and omisation of their chest physician . Patients will be assessed at baseline and after 6 and 12 months . The intervention group will receive a structured ACP session by a trained nurse . The primary outcomes are quality of communication about end-of-life care , symptoms of anxiety and depression , quality of end-of-life care and quality of dying . Secondary outcomes include concordance between patient 's preferences for end-of-life care and received end-of-life care , and psychological distress in bereaved family members of deceased patients . Intervention and control groups will be compared using univariate analyses and clustered regression analysis . Ethics and dissemination Ethical approval was received from the Medical Ethical Committee of the Catharina Hospital Eindhoven , the Netherl and s ( NL42437.060.12 ) . The current project provides recommendations for guidelines on palliative care in COPD and supports implementation of ACP in the regular clinical care . Clinical trial registration number NTR3940 Background Chronic obstructive pulmonary disease ( COPD ) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients , families and society . Pulmonary rehabilitation ( PR ) is a multidisciplinary program that integrates components of exercise training , education , nutritional support , psychological support and self-care , result ing in an improvement in dyspnea , fatigue and quality of life . Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD , PR is generally underutilized and strategies for increasing access to PR are needed . Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation . In the present study , patients with mild , moderate and severe COPD su bmi tted to either an outpatient or at-home PR program for 12 weeks were analyzed . Methods Patients who fulfilled the inclusion criteria were r and omized into three distinct groups : an  outpatient group who performed all activities at the clinic  , a home-based group who performed the activities at home and a control group . PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks . Results There was a significant difference in the distance covered on the six-minute walk test ( p < 0.05 ) and BODE index ( p < 0.001 ) in the outpatient and at-home groups after participating in the rehabilitation program compared to baseline . Conclusion A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD .RiassuntoRazionaleLa broncopneumopatia cronica ostruttiva ( BPCO ) è una causa frequente di morbilità e mortalità che colpisce un’ampia quota di popolazione sia nel mondo industrializzato che nei Paesi in via di sviluppo e rappresenta un peso economico di rilievo per pazienti , familiari e collettività . La riabilitazione respiratoria ( PR ) è un programma multidisciplinare che inegra componenti di riallenamento all’esercizio fisico , educazionale , supporto nutrizionale , supporto psicologico ed autoaiuto , che porta ad un miglioramento della dispnea , della affaticabilità e della qualità della vita . Nonostante la provata efficacia e le forti raccom and azioni delle società scientifiche al suo impiego routinario nel trattamento della BPCO , la PR è generalmente sottoutilizzata e si rendono perciò necessarie strategie per aumentarne l’utilizzo . La PR effettuata a domicilio ed auto-monitorata dal paziente stesso è un’alternativa alla classica riabilitazione ambulatoriale . In questo studio sono stati valuati pazienti con BPCO di grado lieve , moderato e grave sottoposti a un programma di PR ambulatoriale o domiciliare . MetodiI pazienti eligibili allo studio sono stati r and omizzati in tre gruppi : un gruppo ambulatoriale che effettuava tutte le attività in ospedale , un gruppo domiciliare che effettuava il programma a domicilio ed un gruppo di controllo . Il programma di PR consisteva in una combinazione di esercizi aerobici e di rafforzamento della muscolatura degli arti superiori e inferiori per 3 volte la settimana per 12 settimane . RisultatiSia nel gruppo che ha partecipato al PR ambulatoriale che in quello domiciliare si sono rilevate differenze significative rispetto alle misure di base nella distanza coperta con il test del cammino di 6 minuti ( p < 0.05 ) che nell’indice BODE ( p < 0.001 ) . Conclusion iUn programma di riabilitazione respiratoria automonitorato eseguito a domicilio ha efficacia sovrapponibile ad un programma ambulatoriale e può perciò essere considerato una valida alternativa nella gestione del paziente con BPCO Background Dyspnea ( SOB ) , dyspnea-related anxiety ( DA ) , and exercise performance have been shown to improve after  exercise training in patients with Chronic Obstructive Pulmonary Disease ( COPD ) . However , there are no published descriptions of the changes in dyspnea intensity or dyspnea-related anxiety during or across the exercise training sessions . Objectives To describe and compare the differences in the patterns of change in SOB , DA , and exercise performance during 12 exercise training sessions with and without nurse coaching . Methods Forty-five dyspnea-limited patients with COPD were r and omly 
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The number of behavioural change techniques clusters integrated in the self-management intervention , the duration of the intervention and adaptation of maintenance medication as part of the action plan did not affect HRQoL. Subgroup analyses did not detect any potential variables to explain differences in respiratory-related hospital admissions among studies .
Self-management interventions that include a COPD exacerbation action plan are associated with improvements in HRQoL , as measured with the SGRQ , and lower probability of respiratory-related hospital admissions .
No excess all-cause mortality risk was observed , but exploratory analysis showed a small , but significantly higher respiratory-related mortality rate for self-management compared to usual care .
Although we were unable to evaluate this strategy in this review , it can be expected to further increase the safety of self-management interventions .