The increase in phone communications in the context of an exacerbation has some clinical importance. This observation reinforces the previously emphasized need to put action plans in place in the setting of appropriate teaching and coaching.7 and 15 An increase in phone calls could have created new opportunities for patient empowerment. It has been demonstrated that in chronic disease management, patients need to be informed and guided in order to gain empowerement.16 and 17 Case managers provide the teaching necessary in COPD to allow empowerment and this study shows that it is a resource that severe COPD patients use to take proper action in the event of an exacerbation and to decrease emergency visits and hospital admissions.