Table 1 Multi-component strategy for self-directed management of chronic obstructive pulmonary disease (COPD) exacerbations

COPD education (control and intervention arms)

Basic COPD-specific education on (1) risk factors (e.g. household air pollution and tobacco), (2) symptoms and disease progression and (3) how to avoid exacerbations and maintain general lung health (exposure reduction, exercise, sleep and nutrition) using modified versions of standardised educational tools (e.g. ‘flip charts’) administered by trained CHWs

Facilitated self-management Action Plan

2-page Action Plans which colour-code states of respiratory health into green, yellow and red zones. (1) The green zone describes the patient’s baseline respiratory symptoms and actions emphasise daily healthy behaviour and harm reduction strategies, (2) The yellow zone denotes worsening dyspnoea and signifies an exacerbation warranting use of inhaled bronchodilators and orally administered corticosteroids. If there is a change in sputum quantity or colour the addition of antibiotics to corticosteroids is suggested, (3) The red zone pertains to profound dyspnoea or associated symptoms including chest pain, fevers, haemoptysis or change in mentation and urgent medical advice is recommended. Action plans will be facilitated by contact with assigned community health workers

Monthly visitation by CHWs

CHWs will reinforce concepts from the initial COPD education and the Action Plan during monthly visits. CHWs will assess the individual’s ability to recognise symptoms and take appropriate action as indicated by the Action Plan and will be trained to provide feedback and reinforcement accordingly. CHWs will provide additional rescue packs to participants as needed