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 counselling. Although smoking cessation may be associated with minor short-term adverse effects such as weight gain and constipation, its long-term benefits are unquestionable.  For disease due to occupational exposures, primary prevention is achieved by elimination or reduction of exposures in the workplace.
Vaccination against viral influenza and Streptococcus pneumoniae is strongly recommended in all patients with cardiopulmonary diseases, including COPD.
Use of calcium 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.
There are conflicting data with regards to prophylactic antibiotic therapies. Prophylactic antibiotics, such as macrolides, may be considered for reducing the risk of acute exacerbation.   While current guidelines do not yet advocate the use of prophylactic antibiotics, evidence from the MACRO study suggests that azithromycin reduces the risk of acute exacerbations in patients with COPD. However, when administered for 1 year, the most noted side effect was a decrement in hearing.  Evidence A Azithromycin therapy is believed to be most effective in preventing acute exacerbation with a great efficacy in older patients and milder Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. Little evidence of treatment benefit is seen in current smokers. 
Physical activity is recommended for all patients with COPD. 
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