Nonpharmacological Strategies to Improve Stability and Prevent Exacerbations of COPD

Exacerbations of chronic obstructive pulmonary disease (ECOPD) are the main cause of hospitalization, mortality, and progressive worsening in health-related quality of life (HRQL). Each ECOPD speeds functional decline, making these individuals increasingly susceptible to further infections. Therefore, we need strategies to prevent ECOPD and maintain disease stability as long as possible. In addition to medications, lifestyle interventions aimed at promoting vaccinations and avoiding smoking, minimizing exposure to environmental pollutants, encouraging physical activity, addressing obesity and malnutrition, along with empowering individuals through disease awareness and self-management, may improve stability and HRQL and reduce ECOPD rate. Although long-term oxygen therapy is known to enhance survival, its broader utility in curtailing healthcare utilization requires further clarification. Home noninvasive ventilation (NIV) and the more recently introduced high-flow nasal cannula may reduce the need for hospitalization and mortality in individuals with stable chronic hypercapnia. Long-term NIV should be initiated after ECOPD is successfully treated and set to reduce hypercapnia. Telemedicine programs may be potentially useful, but their effectiveness and safety in real life have to be confirmed.