Indeed, self-management interventions, underpinned by health psychology principles, have been seen as an alter-native to the conventional PR approach. Such programs are seen particularly as strategies for improving health behaviors, such as regular exercise, and integrating them into daily life. Chronic disease self-management is defined as a process that facilitates an individual’s confidence and capability to engage in health-promoting behaviors in order to deal with the impact of their condition on all aspects of their health – namely, a sense of self, physical, emotional, social, and medical domains so as to maximize function and quality of life. 17,18 Self-management education or training is recognized as needing to be interactive, to facilitate not only the acquisition of health behavior knowledge but its implementation, by fostering the self-management skills of collaborative goal-setting with associated action plans, problem solving, and decision-making. 13 However, with the exception of increased uptake of a symptom-based action plan to manage COPD exacerbations (ie, self-management of symptoms),19 and some decrease in hospitalization rates,20 the evidence for the efficacy of holistic COPD-specific self-management approaches, while popular and continuing to increase in practice, has been limited. 20–25