He noted that because the study was predominantly in white males, it's difficult to extrapolate these findings to other populations.

Dr. Thomas Aldrich, a pulmonologist at Montefiore Medical Center in New York City, said, "It's really hard to imagine how this program could be so toxic, and it's hard to explain why it happened."

Aldrich said similar self-management programs like this have had good results in people with asthma. But, it's possible that there's an inherent difference in people with COPD, he noted. "Most people with COPD smoked, despite repeated health care warnings, so they've already demonstrated that they're not necessarily strongly influenced by health care advice, and maybe that's part of the problem," Aldrich said.

Dr. Len Horovitz, an internist and pulmonologist at Lenox Hill Hospital in New York City, agreed that patient differences may have played a role in this study's surprising findings. But he believes that an individual's threshold for reporting symptoms may be what's at play here.

"The threshold at which a patient will report symptoms, even when coached, is going to be quite variable. A patient might feel that their symptoms aren't much worse, although a lung function test would tell us they are. There's a lot of fear and denial for patients. And, it's hard for a doctor to know ahead of time how stoic a patient is," Horovitz said.

And, the problem with COPD is that symptoms can get worse very quickly.

"When in doubt, report your symptoms to your doctor. Because COPD is chronic, you learn to live with a lot of the symptoms," Horovitz said.

Whiteson agreed: "Come to me -- let me interpret what the symptoms mean. People with COPD can get very sick very quickly. We don't want you to wait even a day," he said.

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