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.

One Cochrane review found that self-management interventions that include an action plan for acute exacerbations of COPD are associated with improvements in health-related quality of life and fewer admissions to hospital for respiratory problems. An exploratory analysis found a small, but significantly higher, respiratory-related mortality rate for self-management compared to usual care, although no excess risk of all-cause mortality was seen.[71]

One randomised controlled trial found that a telephone health coaching intervention to promote behaviour change in patients with mild COPD in primary care led to improvements in self-management activities, but did not improve health-related quality of life.[72]

Patients should stay as healthy and active as possible. It is necessary to stop active or passive smoking and avoid environmental exposure to toxic fumes.

Regular medical follow-up is necessary to optimize the treatment. If there is any worsening of symptoms, immediate medical attention is required. Patients on continuous oxygen therapy may need increase in oxygen flow during air travel.

Physical activity is recommended for all patients with COPD and they should be encouraged to maintain it.[1] One systematic review and meta-analysis of randomised controlled trials found that exercise training on its own can improve physical activity in COPD, and greater improvements can be made with the addition of physical activity counseling.[90] Another systematic review and meta-analysis found that a combination of aerobic exercise and strength training was more effective than strength training or endurance training alone in increasing the 6-minute walking distance.[91]

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