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Experts were asked to re-rate the statements without consensus. After round 1, experts received an overview of the results and were asked to complete the second online survey within 3 weeks.

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The aim of the first survey was to assess the relevance and feasibility of the predetermined self-management behaviors for each phase of the conceptual model and gain insight into the degree of consensus between experts. Self-management behaviors included in our final list were mostly in line with other studies.

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Surprisingly, avoiding viral or bacterial stimuli was considered to be important by our expert panel while convincing evidence is still lacking. Bold type indicates the returning self-management behaviors in which tanja bruins slot statement 1 was rated.

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Recently, increased attention has been paid on determining intervention strategies that are effective in targeting the relevant mechanisms of change using behavior change techniques.

To prevent missing additional input, a comment box was available to introduce new behaviors.

One expert of the panel was involved in this study by providing expert opinion on the process of the Delphi study TWE. Delphi round 2 Table 3 shows the results of round 2 in which statements regarding 16 self-management behaviors were re-rated and the added self-management behavior was rated for the first time.

Furthermore, it is important to determine which behaviors are feasible to influence. Two inclusion criteria were later added: Based on 2 Delphi rounds, consensus tanja bruins slot the expert panel was reached on a set of 17 self-management behaviors that were perceived both relevant and feasible to target and influence.

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Evidence regarding breathing techniques is also contradictory as one review showed that pursed lip breathing is effective to improve dyspnea, 38 while 2 other reviews found no evidence that breathing exercises improve lung function or relieve symptoms.

Final list of self-management behaviors Based on 2 Delphi rounds, the expert panel reached consensus on a set of 17 self-management behaviors that were both relevant and feasible to reduce exacerbation impact Table 4. Literature review Second, a scoping literature review was performed to identify potential self-management behaviors aiming to reduce exacerbation impact in each phase of the conceptual model.

Whereas, according tanja bruins slot the experts, increasing SABA and performing breathing techniques were not expected to contribute to the reduction of exacerbation impact, experts considered this important for symptom relief.

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Same descriptive statistics and inclusion and exclusion criteria Table 1 were used in this round. As self-management requires behavior change in COPD patients, it is important to identify effective intervention components aiming at behavior change.

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COPD, self-management, exacerbation, Delphi study, self-care, Delphi technique and behavior Introduction Chronic obstructive pulmonary disease COPD is a major problem for health care worldwide and the fourth leading cause of mortality. Development of a conceptual model At first, a scoping literature review was performed to specify different symptom fluctuation phases during the course of COPD and identify aims for each phase regarding reduction of exacerbation impact.

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The survey was pilot-tested by 5 experts in the field.

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