BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent accident and emergency (A+E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture. AIMS: To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status. METHODS: Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups. RESULTS: After 12 months, total A+E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A+E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05 to 3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F[2,198] = 5.612, p = 0.004), depression (F[1.8,176.1] = 10.697, p <= 0.001) and dyspnoea (F[2,198] = 18.170, p <= 0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to Great British Pounds 30 k or Great British Pounds 270 per participant. CONCLUSION: The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care.

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