non-pharmacological management

Last edited 02/2021 and last reviewed 02/2021

Non-pharmacological treatment is complementary to pharmacological treatment and should form part of the comprehensive management of COPD

After receiving a diagnosis of COPD a patient should be given further information about the condition. Physicians should emphasize the importance of a smoke free environment, prescribe vaccinations, empower adherence to prescribed medication, ensure proper inhaler technique, promote physical activity and refer patients (GOLD B-GOLD D) to pulmonary rehabilitation

Non-pharmacological management of COPD*

* Can include pharmacological treatment

Education, self-management, and pulmonary rehabilitation

• aim of self-management interventions is to motivate, engage and coach patients to positively adapt their health behavior(s) and develop skills to better manage their COPD on a day-to-day basis
• basis of enabling patients to become active partners in their ongoing care is to build knowledge and skills
• important to recognize that patient education alone does not itself change behavior or even motivate patients, and it has had no impact on improving exercise performance or lung function, but it can play a role in improving skills, ability to cope with illness, and health status
• rehabilitation is indicated in all patients with relevant symptoms and/or a high risk for exacerbation 
• physical activity is a strong predictor of mortality. Patients should be encouraged to increase the level of physical activity although we still don't know how to best ensure the likelihood of success

Vaccination

• influenza vaccination is recommended for all patients with COPD
• pneumococcal vaccinations PCV13 and PPSV23 are recommended for all patients >65 years of age, and in younger patients with significant comorbid conditions including chronic heart or lung disease.

Nutrition

• Nutritional supplementation should be considered in malnourished patients with COPD.

End of life and palliative care

• zll clinicians managing patients with COPD should be aware of the effectiveness of palliative approaches to symptom control and use these in their practice 
• end of life care should include discussions with patients and their families about their views on resuscitation, advance directives and place of death preferences.

Treatment of hypoxemia 

• in patients with severe resting hypoxemia long-term oxygen therapy is indicated 
• in patients with stable COPD and resting or exercise-induced moderate desaturation, long term oxygen treatment should not be routinely prescribed. However, individual patient factors may be considered when evaluating the patient's needs for supplemental oxygen
• resting oxygenation at sea level does not exclude the development of severe hypoxemia when travelling by air

Treatment of hypercapnia

• in patients with severe chronic hypercapnia and a history of hospitalisation for acute respiratory failure, long term noninvasive ventilation may be considered.

Interventional bronchoscopy and surgery

• in selected patients with heterogeneous or homogenous emphysema and significant hyperinflation refractory to optimized medical care, surgical or bronchoscopic modes of lung volume reduction (e.g., endobronchial one-way valves, lung coils or thermal ablation) may be considered.
• in selected patients with a large bulla, surgical bullectomy may be considered
• in selected patients with very severe COPD and without relevant contraindications, lung transplantation may be considered

Reference:

• Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2021 Report)