The five fundamentals of COPD care with examples of barriers to engagement and suggested actions
| Intervention | Examples of barriers to engagement with intervention | Examples of actions clinicians can take |
| Stop smoking | Housing-related stress Financial stress | Use motivational interviewing/MECC techniques Training in treating tobacco dependence Social prescribing referral |
| Vaccinate for influenza and pneumonia | Confusion around eligibility Language barriers Digital exclusion Vaccine hesitancy | Inclusion health approach to vaccination programmes (eg, CORE20Plus5) Motivational interviewing |
| Offer pulmonary rehabilitation if indicated | Limited understanding of diagnosis High symptom burden (eg, frightening breathlessness) Financial constraints preventing travel to sessions | Person-centred approach to care Curiosity about barriers preventing engagement |
| Develop a personalised self management plan | Limited health literacy and understanding of diagnosis Low level of relational continuity with health professionals | Management of breathlessness as a problem in its own right, using ‘Breathing Thinking Functioning’ model Screening for deprivation and other social determinants of health Access ARRS roles such as community connectors |
| Manage comorbidities | Complexity—living with and managing multiple comorbidities in the context of multiple social determinants (eg, deprivation, poor housing) | Conceptualising COPD as ‘syndemic’ in order to guide holistic interventions Social prescribing referral |
ARRS, additional roles reimbursement scheme; COPD, chronic obstructive pulmonary disease; MECC, make every contact count.