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Semin Respir Crit Care Med
DOI: 10.1055/a-2779-5052
Review Article

Nonpharmacological Strategies to Improve Stability and Prevent Exacerbations of COPD

Authors

  • Michele Vitacca

    1   Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy

  • Nicolino Ambrosino

    2   Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy

Funding Information This work was supported by the “Ricerca Corrente” Funding scheme of the Ministry of Health, Italy.
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Abstract

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.

Keywords

dyspnea - exacerbation - long-term oxygen therapy - noninvasive ventilation - quality of life - survival

Contributors' Statement

M.V.: conceptualization, visualization, writing—original draft, writing—review and editing; N.A.: writing—original draft, writing—review and editing.




Publication History

Received: 24 June 2025

Accepted: 27 December 2025

Article published online:
05 March 2026

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