191 6 Cochrane review on integrated disease management for COPD ndings (Zwerink 2014 number of courses of steroids OR 4.42; Lenferink 2017 OR 4.38). This might have to do with the nature of the action plans incorporated into selfmanagement programmes, which stimulate patients to start a course of prednisolone in case of increased symptoms. Education A Cochrane systematic review from 2016 assessed the e ectiveness of action plans with brief patient education for exacerbations in COPD (Howcroft 2016). Review authors showed that the intervention reduced the combined rate of hospitalisations and ED visits (rate ratio 0.59, 95% CI 0.44 to 0.79) and led to small but signi cant improvement in quality of life (SGRQ MD -2.8. 95% CI -4.8 to -0.8). One recent systematic review explored the e ects of health coaching for people with COPD (Long 2019). According to the de nition used in this review, health coaching programmes aim to improve self-management and healthy behaviour by teaching and motivating patients to achieve personalised goals. Long 2019 showed that health coaching had a signi cantly positive e ect on the SGRQ (MD -0.69). These review authors also found a signi cant reduction in COPD-related hospital admissions (OR 0.45). In contrast to both of these reviews, our subgroup analysis on studies with education as the main component did not nd signi cant di erences in SGRQ (MD 0.15) nor in respiratory-related hospital admissions (OR 0.83). This might be related to the content of the education, suggesting that action plans need to be an integral part of any educational component in IDM to be of bene t for patient outcomes. Additionally, as shown by Long 2019, education has a larger bene cial e ect when it is personalised and includes motivational techniques and goal-setting. It is hard to draw conclusions on our subgroup analysis of the dominant component and the ndings of earlier reviews because of the limited number of studies per dominant component and considerable variation among studies in terms of intervention duration. However, our ndings suggest that to improve exercise capacity, IDM programmes with an exercise focus or with use of telemonitoring components are best suited. IDM programmes using telemonitoring can provide large bene t with regard to respiratory-related admissions by monitoring the patient’s symptoms, providing tailored and individualised self-management support (i.e. delivery of coping skills), and managing unexpected patient hospitalisations. For quality of life, most reviews on di erent components show improvement. Overall, this suggests that a multi-component approach, such as that used in IDM programmes, should result in optimal bene t for multiple important outcomes. Finally, when compared to pharmaceutical treatments such as long-acting betaagonist (LABA)/long-acting muscarinic antagonist (LAMA) treatment or use of phosphodiesterase-4 inhibitors, our ndings from the SGRQ showed improvement of comparable magnitude. Our review showed that IDM resulted in improvement of 3.89 points on the SGRQ compared to 4.08 points for LABA/LAMA treatment (Maqsood 2019), as well as 1.06 points for phosphodiesterase-4 inhibitors (Janjua 2020). Although the con dence interval for IDM was wider (95% CI -6.16 to -1.63) compared to the con dence interval for LABA/LAMA treatment (95% CI -4.80 to -3.36), our results
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