Primary prevention
Avoidance of tobacco exposure (both active and passive measures) and toxic fumes are of invaluable importance in primary prevention of COPD. All smokers should be offered interventions aimed at smoking cessation, including pharmacotherapy and counseling. Although smoking cessation may be associated with minor short-term adverse effects such as weight gain and constipation, its long-term benefits are unquestionable.[53]
The use of electronic nicotine delivery systems (ENDS), including e-cigarette and vaping products, as tobacco cessation aids is controversial. Based on available evidence and lack of knowledge about long-term effects on respiratory health, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines concluded that it is not possible to recommend ENDS for smoking cessation.[1] ENDS has been linked to severe pulmonary illness (e-cigarette or vaping product use-associated lung injury [EVALI]).[1][40][54][55][56] ENDS can contain and emit numerous potentially toxic substances (e.g., nicotine derivatives, polycyclic aromatic hydrocarbons, heavy metals, aldehydes).[40][55][56] The US Preventive Services Task Force (USPSTF) and the 2020 Surgeon General's report note insufficient evidence to evaluate the balance of benefits and risks of e-cigarettes for smoking cessation, and advise that clinicians should direct smokers to Food and Drug Administration (FDA)-approved smoking cessation medicines instead.[57][58] See Smoking cessation (Management approach).
For disease due to occupational exposures, primary prevention is achieved by elimination or reduction of exposures in the workplace. Public health measures such as congestion charging, high occupancy vehicle lanes, and promoting walking or cycling can be implemented to reduce harm from air pollution.[59]
Emerging evidence from observational studies conducted during the COVID-19 pandemic suggests that taking shielding measures during winter months (e.g., wearing face masks, reducing social contact, and regular handwashing) may have potential to reduce the risk of exacerbations in people with COPD.[1]
A professor of healthcare communication provides an overview of motivational interviewing.
Demonstration, with a professor of healthcare communication, of conducting a motivational interview with a patient about smoking cessation (part 1 of 2).
Demonstration, with a professor of healthcare communication, of conducting a motivational interview with a patient about smoking cessation (part 2 of 2).
Secondary prevention
Depending on local guidelines, patients should be vaccinated against influenza virus, Streptococcus pneumoniae, pertussis (whooping cough), varicella-zoster virus (shingles), respiratory syncytial virus, and coronavirus disease 2019 (COVID-19).[1][179]
Smoking cessation should be encouraged in all patients, in addition to guidance on avoiding exposure to occupational or environmental tobacco smoke and other irritants.[1][2] Smoking cessation significantly reduces the rate of progression of COPD and risk of malignancies. It also reduces the risk of coronary and cerebrovascular diseases. See Smoking cessation.
Vitamin D reduces the rate of moderate/severe exacerbations in patients with levels <25 nanomols/L.[267][268] Levels should be checked in patients who are hospitalized with an exacerbation of COPD, and supplementation should be given if levels are <25 nanomols/L.[1]
Shielding measures (e.g., mask wearing, minimizing social contact, and frequent hand washing) could be considered during winter months, alongside established COPD management, to help prevent exacerbations of COPD.[1]
Use of calcium supplementation and other medication may be necessary to prevent or treat osteoporosis in some patients, especially older women on long-term corticosteroid therapy. Bone density scans are done to evaluate progression of this condition.
Physical activity is recommended for all patients with COPD.[1]
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