FIG. 26:  The earlier study, by Rice et al,^[21] was carried out in five Veterans Affairs (VA) medical centers, which recruited patients at high risk for exacerbation from COPD.  The five centers listed in the Figure randomized patients to a self-management treatment group versus a usual background care group.  For the self-management group the patients were given a single 1–1.5 hour group education session conducted by a respiratory therapist case manager.  Patients were given an individualized written action plan for dealing with exacerbations and filled prescriptions; they were told to contact the case manager if they experienced any problems and there were also given the telephone number of the 24-h VA helpline to call whenever necessary.  So this was a very brief, simple self-management plan.