Patient discussions

All patients should be well educated about the disease course and symptoms of exacerbation or decompensation. Their expectation of the disease, treatment, and prognosis should be realistic. It is important to remember that no medicine has been shown to modify the long-term decline in lung function, and the primary goal of pharmacotherapy is to control symptoms and prevent complications.

Regular medical follow-up is necessary to optimize the treatment. If there is any worsening of symptoms, immediate medical attention is required.

Self-management interventions

Action plans for acute exacerbations of COPD are associated with improvements in health-related quality of life and fewer admissions to the hospital for respiratory problems.[146]

Self-management plans should include personalized advice on:[1]

  • Breathlessness and stress management techniques

  • Energy conservation

  • Avoiding aggravating factors

  • How to monitor symptoms

  • How to manage worsening symptoms

  • Contact information to use in the event of an exacerbation

Studies have found a beneficial effect of cognitive behavioral therapy (CBT) on outcomes including symptoms of depression and anxiety, quality of life, and frequency of emergency department visits.[150][151][152]

Patients should be encouraged to:[153][154]

  • Quit active or passive smoking

  • Avoid environmental exposure to toxic fumes

  • Stay as healthy and active as possible

  • Subscribe to health coaching (where available)

See Smoking cessation (Patient discussions).

Motivational interviewing overview
Motivational interviewing overview

A professor of healthcare communication provides an overview of motivational interviewing.

Motivational interviewing: smoking cessation part 1
Motivational interviewing: smoking cessation part 1

Demonstration, with a professor of healthcare communication, of conducting a motivational interview with a patient about smoking cessation (part 1 of 2).

Motivational interviewing: smoking cessation part 2
Motivational interviewing: smoking cessation part 2

Demonstration, with a professor of healthcare communication, of conducting a motivational interview with a patient about smoking cessation (part 2 of 2).

Recommend physical activity

Systematic reviews and meta-analyses report that:​[164][170][171][172][173][271]

  • Exercise training on its own can improve physical activity in COPD; greater improvements can be made with the addition of physical activity counseling

  • Combined aerobic exercise and strength training is more effective than aerobic exercise alone in increasing leg muscle strength

  • Exercise capacity and pulmonary function can be improved with yoga, Qigong, Tai Chi, and other home-based breathing exercises.

​One Cochrane review concluded that there is limited evidence for improvement in physical activity with physical activity counseling, exercise training, and pharmacologic management of COPD.[169] [ Cochrane Clinical Answers logo ] Interventions included in the review assessed in the review had primarily been assessed in single studies. The optimal timing, components, duration, and models for improving physical activity remain unclear.

Consider inhaler device technique

Ask patients to bring their inhalers to clinic to facilitate a review of inhaler use.[1][158][159][160][161]

  • Demonstrate inhaler use and review technique at subsequent appointments; using a placebo device may be most effective for teaching inhaler technique to adults ages ≥65 years,

  • Pharmacist-led interventions and lay health coaching can improve inhaler technique and adherence.

  • Preferred inhaler device attributes (e.g., small size, rapid onset of symptom relief) have been reported in patient preference studies.[162][163]

The majority of patients make at least one error in using their inhaler, and incorrect inhaler use is associated with worse disease control.[155][156]​ Poor technique is more likely when patients are using multiple devices or have never received inhaler technique training.[157]

Metered dose inhaler
Metered dose inhaler

A principal pharmacist shows a patient how to use a metered dose inhaler and discusses ways of improving inhaler technique.

Metered dose inhaler plus spacer
Metered dose inhaler plus spacer

A principal pharmacist shows a patient how to use a metered dose inhaler plus a spacer and discusses ways of improving inhaler technique.

Dry powder inhalers
Dry powder inhalers

A principal pharmacist shows a patient how to use dry powder devices and discusses ways of improving inhaler technique.

Soft mist inhaler
Soft mist inhaler

A principal pharmacist shows a patient how to use a soft mist inhaler and discusses ways of improving inhaler technique.

Dietary advice and oral supplements

Have been found to improve body weight, quality of life, respiratory muscle strength and 6-minute walk distance.[174][175]​

Nutritional support has not been consistently found to improve lung function.[175]

Preparing for air travel

Optimize the patient's condition prior to air travel and assess their need for inflight oxygen. Advise patients to:​[206]

  • Inquire about venous thromboembolism prophylaxis, especially before long flights

  • Carry all medications and spacer devices in their hand luggage

  • Have any emergency medications immediately accessible during the flight

  • Consider increased oxygen flow during air travel (if receiving continuous oxygen therapy)

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