Summary
Purpose: Poor adherence to therapy and the failure of current smoking cessation programs demonstrate that the current management of COPD can be improved, and it is necessary to educate physicians about new approaches for taking care of patients. Parallel chart is a narrative medicine tool that improves the doctor–patient relationship by asking physicians to write about their patients’ lives, thereby encouraging reflective thoughts on care.
Patients and methods: Between October 2015 and March 2016, 50 Italian pulmonologists were involved in the collection of parallel charts of anonymous patients with COPD. The nar- ratives were analyzed according to the Grounded Theory methodology.
Results: In the 243 parallel charts collected, the patients (mean age 69 years, 68% men) are described as still active and as a resource for their families (71%). The doctor–patient relationship started as difficult in 50% of cases, and younger age and smoking were the main risk factors. The conversations turned positive in 78% of narratives, displaying deeper mutual knowledge, trust for the clinicians’ ability to establish effective therapy (92%), support efforts to quit smoking (63%), or restore patients’ activities (78%).
Conclusion: All the physicians concurred that the adoption of innovative parallel charts was useful for improving clinical care and worthy of official inclusion in protocols for the manage- ment of COPD.

Relevance
Several studies have demonstrated the positive effects of a strong doctor–patient relationship and the benefits of good communication for patients’ compliance with treatment. Such communication can help physicians overcome harm- ful patient preconceptions, beliefs, and low disease literacy that underlie resistance to treatment. The effectiveness of treatment is also influenced by patients’ beliefs and choices regarding smoking. Literature shows that, despite con- temporary antismoking strategies, 80% of patients relapse after 1 year. The only effective solution to prevent relapse seems to be support through counseling. In conclusion, the current management of COPD can be improved and it is necessary to educate physicians about new ways to manage their patients.