PICO question 1 addresses the following categories: (1) pneumococcal vaccinations; (2) influenza vaccinations; (3) smoking cessation programs; (4) pulmonary rehabilitation; (5) education, action plans, and case management; and (6) telemonitoring. These topics may be considered complex interventions30 in that they contain multiple interacting components and possess nonlinear causal pathways subject to a host of variables.31 Rigorous evaluation of complex interventions can be complicated by numerous factors, including the need to adapt interventions to local contexts and issues of feasibility and acceptability.32 Many of the nonpharmacologic trials have limitations with respect to such methodologic aspects as how the intervention was standardized and the details of the experimental treatment and comparator as they were implemented. Prevention of exacerbations often was not the primary outcome for many studies examining the efficacy and effectiveness of nonpharmacologic interventions, thus limiting our ability to make definitive recommendations. We recognize that some interventions may have beneficial outcomes relevant to overall health and quality of life but are insufficient to recommend their use to prevent exacerbations.