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Social Cognitive Theory underpinned the intervention,26 and included education, monitoring, and assessment of progress, and taught skills with the aim of increasing self efficacy.2728 We incorporated best evidence for the promotion of physical activity (tailored, ongoing support, duration six months, use of pedometer).29303132 The intervention components are detailed in web appendix 1.

The first telephone coaching session at one week after randomisation aimed to last 35-60 minutes (determined by the number of issues requiring discussion, such as current smoking), followed by a 15-20 minute telephone session at weeks 3, 7, and 11 with written supportive materials tailored to the patient after each telephone call (eg, summary of goals agreed, physical activity diary, contact details for local services, information leaflet showing correct inhaler use technique).

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Sixty per cent of primary care patients with COPD report exacerbations of their disease,10 which are associated with more rapid decline in lung function.14 Interventions that aim to reduce the severity of exacerbations include prompting early recognition of symptoms and rapid use of antibiotics or corticosteroids, or both, either through seeking a primary care appointment or use of a self treatment rescue drug pack.A sample of telephone consultations were recorded with the patients consent and reviewed by one researcher to determine compliance with the content of the intervention.Patients who had given informed consent and completed all the baseline measures were individually randomised in a 1:1 ratio to the telephone health coaching or usual care group stratified by centre.92% of patients were followed-up at six months and 89% at 12 months.There was no difference in SGRQ-C total score at 12 months (mean difference −1.3, 95% confidence interval −3.6 to 0.9, P=0.23).

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