Toward a standardized framework for chronic obstructive pulmonary disease self-care: An umbrella review.

BACKGROUND

Chronic obstructive pulmonary disease is the fourth leading cause of death worldwide, causing 3.5 million deaths in 2021, approximately 5% of global deaths. Its burden remains high because no disease-modifying therapy can halt progression. Current treatments mainly alleviate symptoms and reduce exacerbations. Self-care is therefore fundamental to long-term management, improving symptom control, exacerbations, and quality of life. However, chronic obstructive pulmonary disease self-care is defined and operationalized inconsistently across studies and programs, with widely varying components. Grounded in the tripartite structure of maintenance, monitoring, and management, a consolidated synthesis is needed to clarify core components, assess alignment with international guidance, and identify evidence gaps to support standardized practice and comparable research.

OBJECTIVES

To (1) identify the core components of chronic obstructive pulmonary disease self-care; (2) map these components to international chronic obstructive pulmonary disease guidelines to determine areas of consensus and gaps; and (3) construct a standardized chronic obstructive pulmonary disease self-care framework for clinical practice and research.

DESIGN

An umbrella review with a two-stage synthesis method, first extracting core components from international guidelines and then supplementing evidence gaps using systematic reviews.

METHODS

We searched eight electronic databases (including PubMed, Web of Science, Scopus, Embase, and the Cochrane Library) from inception to April 20, 2026, for eligible reviews addressing chronic obstructive pulmonary disease self-care components. Two reviewers independently screened records, appraised methodological quality, and extracted data. Using a best-fit framework approach, guideline-derived self-care recommendations were organized within the maintenance, monitoring, and management structure and supplemented with evidence from systematic reviews to address gaps.

RESULTS

From 8660 records identified, 14 reviews met the inclusion criteria. Ten core components of chronic obstructive pulmonary disease self-care were synthesized: (i) lifestyle modification; (ii) psychological coping and social support engagement; (iii) preventive vaccination uptake; (iv) adherence to medication and inhaler technique; (v) management of acute exacerbations; (vi) active participation in scheduled follow-up; (vii) acquisition and application of health literacy; (viii) daily monitoring and tracking of symptoms; (ix) proactive consultation for unplanned healthcare issues; and (x) self-directed access to health information and resources. Most components, particularly (i) to (vii), were broadly consistent with international chronic obstructive pulmonary disease guideline recommendations, indicating consensus on key self-care maintenance and management. In contrast, monitoring and patient-initiated engagement components, including (viii) to (x), were emerging components that are less explicitly represented in guidelines, highlighting gaps between formal recommendations and emerging practice.

CONCLUSION

This umbrella review established a comprehensive, evidence-based framework comprising ten core self-care components for chronic obstructive pulmonary disease, bridging the gap between guideline recommendations and real-world practice.

REGISTRATION: PROSPERO CRD42023464435, registered 14/5/2025.