慢性阻塞性肺疾病目前在全世界許多國家，是主要引起殘障與死亡的慢性疾病之一；隨著人口老化與環境污染的增加，世界衛生組織預測到2030年，慢性阻塞性肺疾病將成爲世界第三大死因。根據文獻查證與臨床經驗顯示，醫療人員須滿足患者居家自我管理需求，包含：生理、心理、環境與社會服務等。本文除説明慢性阻塞性肺疾病患者自我管理，日常生活疾病自我管理需求，並強調醫療照護人員之角色，包含照護提供者、教育者、諮詢者、協調者與管理者，期望可以滿足患者需要，使居家照護服務更加完善。

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. The World Health Organization projects that, by 2030, COPD will be the third leading cause of death worldwide. These increases are in response to a longer life expectancy, coupled with an increasing number of individuals who smoke. According to literature review and past experiences, the patients with COPD may have the needs of disease self-management, such as physical, psychological, environmental, and social service. Thus, authors describe the contents of chronic disease self-management and the needs of self-management and healthcare professionals’ role on home care for patients with COPD. We except that healthcare professionals can meet the self-management needs and can contribute to the development of an evidence-based program for patients with COPD in the coming future.